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4. OIG Issues Medicare & Medicaid General 100 Point 200 Points 300 Points 400 Points 500 Points 100 Point 200 Points 300 Points 400 Points 500 Points 300 Points 400 Points 500 Points E & MCoding

5. A two digit alpha/numeric codes used in conjunction with the CPT or HCPCS code that may increase or decrease reimbursement

6. What is a Modifier?

7. A statistical classification system that arranges diseases and injuries into groups according to established criteria

8. What is the International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM)?

9. The American Medical Association (AMA) publishes and maintains this coding system

10. What is Current Procedural Terminology or CPT?

11. An inpatient classification system based on: principal diagnosis, secondary diagnosis, surgical factors, age, sex, and discharge status

12. What is Diagnosis Related Groups or DRGs?

13. CMS contracts with the AMA to use CPT coding for the Medicare program using this expanded version

14. What is Healthcare Common Procedure Coding System or HCPCS?

15. Providers use a billing code that reflects a higher payment rate for a device or service provided than the actual device or service furnished to the patient

16. What is Upcoding?

17. Submitting bills by piecemeal or in fragmented fashion to maximize reimbursement

18. What is Unbundling?

19. Services commonly furnished in a physician’s office by a nurse practitioner in which there is direct physician personal supervision and are billed under the physician’s provider number

20. What is “Incident To” Services?

21. A written form that a provider gives to a Medicare beneficiary that informs the beneficiary that Medicare may not pay for a item or service

22. What is an Advance Beneficiary Notice or ABN?

23. Used to identify the correct insurance company that must pay health care bills first when Medicare pays second

24. What is a Medicare Secondary Payer Questionnaire?

25. (1) History (2) Examination (3) Medical Decision Making

26. What are the three key components of Evaluation and Management (E&M) Services?

27. Problem Focused Expanded Problem Focus Detailed Comprehensive

28. What are the types of History or Examination?

29. Straight-forward Low complexity Moderate complexity High complexity

30. What are the Complexities of Medical Decision Making?

31. 3 out of 3 key elements of E & M Services must be met or exceeded in order to bill for this type of visit

32. What is an initial patient visit?

33. 2 out of 3 key elements of E & M Services must be met or exceeded in order to bill for this type of visit

34. What is an established patient visit?

35. Part of Medicare that reimburses primarily for inpatient services provided by institutions such as hospitals and skilled nursing facilities

36. What is Medicare Part A?

37. Part of the Medicare program that reimburses covered physician and supplier services

38. What is Medicare Part B?

39. Formerly known as "Medicare+Choice”

40. What is Medicare Part C or Medicare Advantage?

41. Part of Medicare that reimburses for outpatient prescription drugs

42. What is Medicare Part D?

43. State health insurance that helps many people who can't afford medical care and pays for some or all of their medical bills

44. What is Medicaid?

45. Non-institutional providers use this form to bill Medicare, Medicaid, CHAMPUS, and most private insurance companies

46. What is a 1500 Form?

47. Institutional providers use this form to bill Medicare, Medicaid, CHAMPUS, and most private insurance companies

48. What is a CMS 1450 or a UB-04?

49. An insurance company that contracts with CMS to process Medicare Part A claims

50. What is a Fiscal Intermediary (FI)?

51. An insurance company that contracts with CMS to process Medicare Part B claims

52. What is a Carrier?

53. HHS Agency that establishes payment policies for providers Conducts research Evaluates the quality of care provided to beneficiaries

54. What is the Centers for Medicare and Medicaid Services?

56. Geographic areas that have been designated as primary medical care shortage areas where physicians who furnish medical care are entitled to a Medicare incentive payment.

57. What is Health Professional Shortage Area?