· 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

WK4QUESTION4HP-216.docx

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