PowerPoint - Test 5 Review and Self-Assessment For SLATE UPDATED
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dg6699workPowerPoint - Test 5 Review and Self-Assessment For SLATE UPDATED
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dg6699workTest 5 Review &
Self-Assessment
OADM29798 | Medical E-Billing &
Scheduling
Review for Final Test (Test 5)
• The test is in class, in our final class of the term (see weekly outline)
• Worth 10% and is CLOSED BOOK
• It is a theory test. There is no billing to complete in YorkMed and you will
not need to look up service codes or diagnostic codes.
• Respondus LockDown browser with Respondus Monitor (if virtual) are
required.
• Includes material covered in class throughout the term.
• To study review class content and look over your notes from the term
• Focus on review the material in the first 2 weeks of classes plus the content covered in classes 12 and 13
• IMPORTANT: the test will include material about billing from the entire course (not just the classes noted
above)
• To prepare to study, we are going to conduct a self-assessment exercise
next class …
Review for Final Test (Test 5)
• The following questions are available in the “Quiz Review (for Final Test #5)”
• It is posted in the Class 13 Folder on SLATE
• Each slide presents a question that is similar to the types of questions that will
be on the final test (Test 5)
• The answers are on the slide that immediately follows each set of questions
• Treat this as a practice test. Read each slide, select your answer, then move to
the next page to check if you are correct
• Use this Review Quiz to guide your studies – which areas of the course are you
strong in? In which areas could you use more review?
Quiz
Are you ready for Test 5????
What is the remittance advice report?
A monthly statement from the ministry of
a)
approved claims
Explanation of health cards that have new
b)
version codes
A message indicating what software is necessary
c) to provide readable claims to the ministry
computers
A list of patients who have not been seen in the
d)
past year
• A. A monthly statement from the ministry of approved
claims
Answer
True or False?
When entering claims into York-Med, the
order in which you enter the service codes is
not important. What is important is the
accuracy (and proper coding) of the service
performed.
• FALSE – ORDER DOES MATTER!!
Answer
What does the alpha suffix in the service code
represent?
a) The patient's diagnosis
The length of time the client was in the doctor’s
b)
office
The person who provided the service or
c)
examination
The deregulated services on the schedule of
d)
benefits
• C. The person who provided the service or examination
Answer
True or False?
• A patient was seen in the Out Patient
Department for a Partial Assessment for
hypertension. A referral is necessary for
this visit and the referring doctor field must
be entered into York-Med when entering
this health claim.
• False! A referral is not needed for
assessments.
Answer
Which of the following is FALSE about health claims
for the Surgical Assistant?
a. When entering health claims, a “B” suffix must be
used with the service codes.
b. When entering health claims, it is necessary to
record the surgery times.
c. The number of ‘basic units’ for the Assistant can be
found in the Schedule of Benefits.
d. Neither OHIP or WSIB will pay the claim for an
Assistant.
D. Neither OHIP or WSIB will pay the claim
for an Assistant.
Answer
Which of the following is TRUE about WCB claims?
a. When a doctor assesses a client for a workers’
compensation matter AND provides a service unrelated
to the visit, the claims must be submitted together under
OHIP.
b. When a doctor assesses a client for a workers’
compensation matter AND provides a service unrelated
to the visit, the claims must be submitted together under
WCB.
c. When a doctor assesses a client for a workers’
compensation matter AND provides a service unrelated
to the visit, the claims must be submitted separately.
d. Neither OHIP or WCB will pay the claim.
C. When a doctor assesses a client for a
workers’ compensation matter AND provides a
service unrelated to the visit, the claims must be
submitted separately.
Answer
True or False?
• For reciprocal medical billing (RMB),
it is not necessary to enter the
patient’s province when registering
the patent, as long as their health card
is validated upon being seen.
FALSE!
• The province must be recorded
properly in the ‘province’ field
upon registration AND the health
card must be validated at that
time.
Answer
Which of the following is TRUE about the billing cycle?
a. Rejected and underpaid claims can not be sent
back to the MOH for payment
b. Rejected and underpaid claims should be
reviewed individually and re-submitted within 6
months of the service date
c. Rejected and underpaid claims have no due-date
for re-submission if the error is found to be that
of the MOH’s
d. Claims that are rejected should be deleted from
system
B. Rejected and underpaid claims should
be reviewed individually and re-submitted
within 6 months of the service date
Answer
True or False?
• Out-Patient health claims must always
have an SLI and Admit date entered in
the claim.
False!
No admit date is needed.
Answer
True or False?
• Consultation codes are the same for
all specialties.
False!
Consultation codes are different for each
specialty.
Answer
Which of the following is a diagnostic
code?
a. Pap smear
b. Gastroscopy
c. Immunization
d. Cesarean section
e. None of the above
f. All of the above
e. None of the above.
Answer
Which of the following is FALSE about G700 claims?
a. G700A is a premium that the doctor can claim if the
procedure has a + sign in front of the code AND the
there is no visit (consultation or assessment)
accompanying the claim.
b. G700A is a premium that the doctor can claim if the
procedure has a + sign in front of the code AND the
doctor sees the patient for the same procedure.
c. Diagnostic procedures are entered AFTER the
service codes in York-Med
d. If a doctor is claiming for an assessment code, you
can NOT claim a G700A.
B. G700A is a premium that the doctor can
claim if the procedure has a + sign in front
of the code AND the doctor sees the patient
for the same procedure
Answer
• Chronic Disease Assessment Premiums can be added to a
claim when:
a. The doctor is one of the specialties listed in the SOB
b. The assessment is a medical specific assessment, medical
specific re-assessment, complex medical assessment,
partial assessment or level 2 paediatric assessment
c. The patient has an established diagnosis as specified by
OHIP and found in the SOB
d. The assessment is rendered in an office or out-patient
setting
e. All of the above must be true for the premium to be added
to a claim
E. All of the above must be true for the premium to be
added to a claim
Answer
