Biology Forums - Study Force

HCPCS is the acronym for the:
 
  Healthcare Current Procedures Coding System.
 
  Health Coding for Procedures and Claim Sets.
 
  Healthcare Common Procedure Coding System.
 
  Healthcare Coding for Procedures and Claims Systems.

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(Q. 2) HCPCS was developed to achieve all of the following goals EXCEPT:
 
  coordinating government programs by uniform application of Centers for Medicare and Medicaid Services (CMS) policies.
 
  ensuring the validity of profiles and fee schedules through standardized coding.
 
  allowing providers and suppliers to communicate their services in a consistent manner.
 
  implementing standard fee structures for all providers across all plans.

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(Q. 3) The five-digit CPT codes used to report services and procedures performed by healthcare providers are also known as:
 
  Level I HCPCS.
 
  Level II HCPCS.
 
  Level III HCPCS.
 
  They are not considered HCPCS codes.

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(Q. 4) What are four benefits of a compliance plan?
 
  What will be an ideal response?

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(Q. 5) What is physician self-referral as regulated by the Stark Law?
 
  What will be an ideal response?

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(Q. 6) What types of listings can be found in the Medicine section of the CPT code book?
 
  What will be an ideal response?

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(Q. 7) What are the two parts of a radiology code?
 
  What will be an ideal response?

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(Q. 8) Explain the four applications of modifier -51.
 
  What will be an ideal response?

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(Q. 9) What is unbundling or fragmented billing?
 
  What will be an ideal response?

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(Q. 10) What is the purpose of cross-references in the CPT code book?
 
  What will be an ideal response?

1)  Answer: Healthcare Common Procedure Coding System.

2)  Answer: implementing standard fee structures for all providers across all plans.

3)  Answer: Level I HCPCS.

4)  Answer: Benefits are speeding and optimizing proper payment of claims, minimizing billing mistakes, reducing the chances that an audit will be conducted by the Centers for Medicare and Medicaid Services (CMS) or the Office of Inspector General (OIG), and avoiding conflicts with the self-referral and anti-kickback statutes.

5)  Answer: Physician self-referral is the practice of a physician referring a patient to a medical facility in which he or she has a financial interest.

6)  Answer: The Medicine section contains a variety of listings for reporting procedures and services provided by many different types of healthcare providers. In addition, services and procedures provided by nonphysician practitioners such as audiologists and physical, occupational, and speech therapists are found in this section.

7)  Answer: The radiology code may have two parts: the technical component and the professional component.

8)  Answer: Modifier -51 is used to identify:
Multiple medical procedures performed at the same session by the same provider.
Multiple, related operative procedures performed at the same session by the same provider.
Operative procedures performed in combination, at the same operative session, by the same provider.
A combination of medical and operative procedures performed at the same session by the same provider.

9)  Answer: Unbundling occurs when procedures are reported individually that should have been included under a bundled code. This practice will result in a claim denial and may also be considered fraud.

10)  Answer: Cross-references provide additional information and direct the coder to other entries that may apply to the procedure or service.

Thank you for helping me throughout this difficult semester