COMPLETE WITH INSTRUCTIONS
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
· split/shared services.
· incident to.
· assistant surgeon.
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.
· Outpatient surgery
· Outpatient clinic
· Observation
Provider-based or Hospital-based facility services are defined as:
· 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?
· 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
Services provided in the teaching facility are reimbursable when:
· 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:
· 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?
· 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?
· Merck’s Manual
· HCPCS Coding Clinic
· CPT Assistant
What claim form is utilized for reporting physician services?
· Explanation of Benefits
· CMS 1500
· Ambulatory Payment Classifications
What is the name of the reimbursement system utilized for categorizing payments for outpatient facility services?
· Payment status indicators
· MS-DRGs
· Ambulatory Payment Classifications