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