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43 Cards in this Set
- Front
- Back
What is durable medical equipment?
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Supplies used primarily in the patient's home and used for medical purposes |
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What do HCPCS Level ll codes allow?
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DMEPOS dealers to submit a claim for a product or service as soon as it is approved by the Food and Drug Administration (FDA), even though there is no code that describes the product or service. |
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When are HCPCS Level ll modifiers used?
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How long is the ACA grace period before an insurer can discontinue someone's coverage for failure to pay a monthly premium?
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Ninety days |
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What is the AMA?
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American Medical Association |
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What is the AMA responsible for?
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Annual updates; the two levels of HCPCS codes
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What does HCPCS do?
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Furnished health care providers and suppliers with a standardized language for reporting professional services, procedures, supplies, and equipment |
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What do the HCPCS Level l codes report?
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Procedures and services using the CPT manual
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What is the HCPCS National Panel responsible for?
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Making decisions about additions, revisions, and deletions to the permanent national alphanumeric codes |
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What are the HCPCS Level ll types of codes?
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Permanent national codes, Dental codes, Miscellaneous codes, temporary codes, and modifiers |
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What are the HCPCS Level ll codes maintained by? |
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What types of codes are the HCPCS Level ll codes considered when a DMEPOS dealer submits a claim for a product or service? |
Miscellaneous codes |
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What is Orthotics? |
The branch of medicines that deals with the design and fitting of orthopedic devices
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What happens to a HCPCS Level ll code when a permanent code is established by the HCPCS National Panel to replace a temporary code? |
The temporary code is deleted and cross-referenced to the new permanent codes |
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When does Medicare give HCPCS Level ll codes the highest priority? |
If the CPT code is general and the HCSPCS Level ll code is more specific |
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CPT and HCPCS Level ll codes |
Both are national codes published by the American Dental Association |
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Where are the HCPCS Level ll codes contained? |
HCPCS Level ll Standard Edition by the AMA |
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What organization published the coding manual for CDTs?
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The American Dental Association |
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What do G codes help identify?
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how do you identify HCPCS Level ll modifiers?
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They are either alphabetic (two letters) or alphanumeric (one letter followed by one number) |
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Which HCPCS Level ll codes are reported to the local MAC?
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Codes that begin with the letters D, G, M, P, or G
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Where should you code from and where do you verify your findings?
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Tabular section, then index
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What kind of codes are used to report DMEPOS?
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HCPCS Level ll codes (miscellaneous) |
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What was the previous name of the CMS?
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HCFA |
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What are NOC (not otherwise classified) codes labeled as?
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Miscellaneous codes |
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What is the Hospital Patient prospective payment system (OPPS)? |
Provides authority for CMS to implement a prospective payment system (PPS) under Medicare for hospital outpatient services (Section 4523 of the Balances Budget Act in 1997
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What does OPPS require?
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Hospitals and ambulatory surgery centers to report product-specified HCPCS Level ll C codes with CPT codes to obtain reimbursement for biological, devices, drugs and other items associated with implantable device technologies
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What is the Modifier-UE used for?
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"Used equipment" products
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Where are J codes found?
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The Table of Drugs (medications)
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What is found in the index?
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The location of services or procedures |
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What does MAC stand for?
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Medicare Administrative Contractor |
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What does the MAC do? |
Processes Medicare claims, enroll health care providers in the Medicare program and educated providers on Medicare billing requirements |
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What else does the MAC do (Section 1861)? |
Handles claims appeals and answer beneficiary and provider inquiries (Social Security Act defines the items and services for which Medicare may pay as well as the provider types recognized by the Medicare program |
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What is the Medicare Carriers Manual (MCM)?
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Guidelines established by Medicare about coverage for HCPCS Level ll service/ consult when descriptor of HCPCS Level ll code |
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What are the three characteristics of the HCPCS Level ll coding system?
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Ensuring uniform reporting of medical products or services, uses code descriptors to identify similar products or services rather than brand names, not a reimbursement methodology for making coverage or payment determinations |
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When assigning both a CPT and HCPCS code, which would a health care provider used for the administration of an injection and then medication?
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CPT, then HCPCS |
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How are claims that contain miscellaneous codes revised?
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Manually by the payer and must have a complete description of the product or service, pricing information for product or service, documentation to explain why the item or service is needed
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What do temporary codes do?
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Allow payers the flexibility to establish codes that are needed before the next January 1st update |
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What are transitional pass-through payments?
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Temporary additional payments made for certain innovative medical devices, drugs, and biological provided to Medicare beneficiaries |
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Where are H codes reported to?
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State Medicaid agencies that are mandated by state law to establish separate codes for identifying mental health services |
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What do most state Medicare programs use?
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What is IV chelation therapy?
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An experimental type of chemical endarterectomy which is used to treat arteriosclerosis |
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What does the NCCI policy manual state?
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HCPCS code Q0091 (screening pap smears) includes services necessary to procure and transport the specimen to the lab |