In what situation(s) should a provider NOT use a modifier?
- CPT already indicates 2-4 lesions
- CPT indicates multiple extremities
What are other names for Three-Day Payment Window?
ALL OF THE ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
What happens during the post-service stage?
Final coding, preparation and submission of claims, payment processing, balance billing
and resolution.
What are the below tasks part of?
- Educate patients
- Coordinate to avoid duplicate patient contacts
- Be consistent in key aspects of account resolution
- Follow best practices for communication
Best practices created by the Medical Debt Task Force
Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle
initiative?
Process Compliance
Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility
B. Health Plan Contracting
,What is "implied certification"?
When it is implied that a provider met all compliance standards before submitting a
claim
Which of the following are essential elements of an effective compliance program?
A. Established compliance standards and procedures.
B. Designation of a compliance officer employed within the Billing Department.
C. Oversight of personnel by high-level personnel.
D. Automatic dismissal of any employee excluded from participation in a federal
healthcare program.
E. Reasonable methods to achieve compliance with standards, including monitoring
systems and hotlines.
A. Established compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including monitoring
systems and hotlines.
When was Health Information Technology for Economic and Clinical Health (HITECH)
Act signed into law?
FEB 17, 2009
When did HITECH Act become effective?
2013
Annually, the OIG publishes a work plan of compliance issues and objectives that will
be focused on throughout the following year. Identify which option is NOT a work plan
task mentioned in this course.
A. Payments to Physicians for Co-Surgery Procedures
B. Denials and Appeals in Medicare Part D
C. Medicare Hospital Payments for Claims Involving the Acute- and Post-Acute-Care
,Transfer Policies
D. Standard Unique Employer Identifier
D. Standard Unique Employer Identifier
What Plan are the tasks below a part of?
- Medicare Payments Made Outside of the Hospice Benefit
- Denials and Appeals in Medicare Part C and Part D
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits
The 2020 OIG Work Plan
When was the Preservation of Access to Care for Medicare Beneficiaries and Pension
Relief Act signed into law?
JUNE 25 2010
What is the Medicare DRG Three-Day Payment Window?
All Diagnostic services provided to a Medicare patient by a hospital on the Date of the
patient's Inpatient admission or during the 3 calendar days (or in the case of a non-IPPS
hospital: 1 calendar day) immediately BEFORE the Date of Admission are REQUIRED
to be included on the bill for the IP stay (unless there is no Part A coverage)
Do Outpatient Non-Diagnostic Services qualify for separate payments if provided with
the Three-Day Payment Window?
No
What is modifier 59?
Used to identify CPTs OTHER THAN E&M services, NOT normally reported together,
but are appropriate under the circumstances.
Documentation must support a different session, different procedure or surgery,
different site or organ system, separate.
What is condition code 51?
, Code noted on the separate UB-04 OP claim, thus indicating the charge is unrelated to
the admission.
What kind of hospitals are the following:
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's hospitals for
examples
Non-IPPS hospitals
What are the 3 types of medical necessity screenings and noncoverage notifications
required in the Medicare program?
1. Advanced Beneficiary Notice of Noncoverage (ABN) for Part B services.
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
What is Medicare Part B ABN?
Used to explain to a Medicare patient that the ordered test or services probably WILL
NOT be covered by the Medicare b/c the DX info provided by the Dr. does NOT support
the need for these services.
****May also be used for voluntary notifications, in place of the Notice of Exclusion for
Medicare Benefits (NEMB).
What is the Two-Midnight Rule?
Hospital admissions spanning 2 midnights would be considered appropriate for payment
under the IPPS rule
What are some MSP claims that require additional review by the OIG to ensure
compliance?
- W/C
- Black Lung Program services
- Veterans Affairs (VA) services
- Federal grant programs
- Public Health Service programs (i.e Medicaid)
What are some cases where Medicare is the Secondary Payer?
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller GEEKA. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $14.79. You're not tied to anything after your purchase.
