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WK4 QUESTION4 HP-216

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WK4 QUESTION4 HP-216


Services performed in the office setting where a non-physician provider performs a service under direct physician supervision when all requirements are met are referred to as


Responses

· split/shared services.


.

· incident to.


.

· assistant surgeon.



·
supervised services.



Services performed in this department within the hospital are available 24 hours a day and provide unscheduled episodic services for patients needing immediate medical attention.


Responses

· Outpatient surgery



· Outpatient clinic



· Observation



·
Emergency Department



Provider-based or Hospital-based facility services are defined as:


Responses

· Supplied by a provider outside the hospital venue.


.

· Supplied by a provider located in the outpatient area of the hospital.


.

· Supplied by a provider located in the ancillary area of the hospital.



·
Supplied by a provider owned and operated by a facility or hospital.



Assistant surgeon charges are appropriate in what instances?


Responses

· when the assistant surgeon is medically indicated



· when the name of the assistant surgeon is listed in the operative report



· when documentation that details what the assistant surgeon contributed to the case is present



·
all of these



Services provided in the teaching facility are reimbursable when:


Responses

· furnished by a resident when the teaching physician is present during critical or key portions of the service.



· never reimbursable in the hospital setting.



· statement of “seen, agree with plan” are documented by the physician.


.

·
services are performed and documented by a medical student.



Split/shared services are reimbursable when:


Responses

· both the physician and non-physician “share” the services and the billable provider performed a substantive portion of the MDM or greater than half the total time spent as of 2024.


.

· the non-physician performs the service without the need for a physician to assist in providing the service.



· performed in the office setting.



·
a minimum of 20 minutes is documented.



What is the authoritative source for reporting procedures/services performed by the physician?


Responses

· CPT Assistant



· HCPCS Coding Clinic



· Coding Clinic



·
ICD-10 Official Guidelines for Coding and Reporting



What is the authoritative source for reporting facility procedures/services?


Responses

· Merck’s Manual



· HCPCS Coding Clinic



· CPT Assistant



·
Coding Clinic



What claim form is utilized for reporting physician services?


Responses

· Explanation of Benefits



· CMS 1500



· Ambulatory Payment Classifications



·
CMS 1450



What is the name of the reimbursement system utilized for categorizing payments for outpatient facility services?


Responses

· Payment status indicators



· MS-DRGs



· Ambulatory Payment Classifications



·
Diagnosed Related Groups

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