Download AAPC CPC Chapter 1 Practice Exam: Medical Coding Fundamentals and more Exams Nursing in PDF only on Docsity!
AAPC CPC CHAPTER 1 PRACTICE EXAM/ MOST
RECENT AND COMPLETE VERSION ALL
QUESTIONS AND CORRECT ANSWERS/ ALREADY
GRADED A + ASSURED PASS
process of translating a healthcare provider's documentation of a patient encounter into a series of numeric or alphanumeric codes - ANSWER: Medical coding coders who specialize in coding inpatient hospital services - ANSWER: Health information coders, medical record coders, coder/abstractors, coding specialists Medical Severity-Diagnosis Related Groups - ANSWER: MS-DRG determine the amount the hospital will be reimbursed if the patient is covered by Medicare or other insurance programs using the MS-DRG system - ANSWER: MS-DRG are used to: maintain facility, regional, and national databases of cancer patients - ANSWER: Cancer (or tumor) registrars electronic health record - ANSWER: EHR consultants, educators, medical auditors - ANSWER: Other roles coders can have: use CPT, HCPCS Level II, and ICD- 10 - CM codes; work in provider offices, outpatient clinics, and facility outpatient departments; also use Ambulatory Payment Classifications (APCs); have more interaction with providers - ANSWER: Outpatient coders
use ICD- 10 - CM and ICD- 10 - PCS codes; also use MS-DRGs for reimbursement; have less interation directly with providers - ANSWER: Inpatient coders explains the payer's determination in payment - ANSWER: Remittance advice (RA) / Explanation of Benefits (EOB) practice guidelines for each level of a provider individually dictated by states - ANSWER: Scope of practice include physician assistants (PA) and nurse practitioners (NP); aka physician extenders - ANSWER: Mid-level Provider (MLP) Works under the supervision of physicians; PA program takes approximately 26 1/2 months to complete after completion of a bachelor's degree - ANSWER: Physician Assistant (PA) have a master's degree in nursing - ANSWER: Nurse Practitioner (NP) private insurance plans and government insurance plans - ANSWER: Two types of payers: primary government payer in the U.S.; provides coverage for people 65 and older, blind, disabled, and people with permanent kidney failure or end-stage renal disease (ESRD) - ANSWER: Medicare Inpatient coverage, home health, hospice, skilled nursing facilities; also defines limits of Medicare usage - ANSWER: Medicare Part A
course of action - ANSWER: Plan Evaluation and Management - ANSWER: E/M
- Highlight unfamiliar words
- Use post-operative Dx for coding; if pathology report available, use pathology report for Dx
- Start with procedures listed
- Look for key words
- Read the body - ANSWER: Operative Report coding tips the lease radical service/procedure that allows for effective treatment of the pt's complaint or condition - ANSWER: Medical Necessity describes whether specific medical items, services, treatment, procedures, or technologies can be paid for under Medicare - ANSWER: National Coverage Determinations Manual explain when Medicare will pay for items or services - ANSWER: National Coverage Determination (NCD) responsible for interpreting national policies into regional policies - ANSWER: Medicare Administrative Contractor (MAC) decisions by MACs that define what codes are needed and when an item or service will be covered; have jurisdiction only within their region - ANSWER: Local Coverage Determination (LCD)
a standardized form that explains to the pt why Medicare may deny the service or procedure; protects the provider's financial interest - ANSWER: Advance Beneficiary Notice (ABN)
- Medicare doesn't pay for the procedure/service for the pt's condition
- Medicare doesn't pay for the procedure/service as frequently as proposed
- Medicare doesn't pay for experimental services - ANSWER: Common reasons Medicare denies a procedure or service: $100 or 25%, whichever is greater - ANSWER: Reasonable estimate on an ABN ABN - ANSWER: Non-Medicare payers may not recognize: provides federal protections for protection health information when held by covered entities; five part act - ANSWER: Health Insurance Portability and Accountability Act (HIPAA) doctors, clinics, psychologists, dentists, chiropractors, nursing homes, pharmacies, health insurance companies, HMOs, company health plans, government programs, healthcare clearinghouse - ANSWER: Covered entity under HIPAA Health Care Fraud and Abuse Control Program; designed to coordinate federal, state, and local law enforcement activities with respect to healthcare fraud and abuse - ANSWER: HCFAC Healthcare Common Procedure Coding System - ANSWER: HCPCS
Centers for Medicare and Medicaid Services - ANSWER: CMS promotes secure exchange of health information and the use of certified electronic health record technology for coordination of care - ANSWER: Promoting Interoperability (PI) Certified Electronic Health Record Technology - ANSWER: CEHRT Advanced Alternative Payment Models - ANSWER: APMs government agency tasked to protect the integrity of HHS programs, and the health and welfare ofthe beneficiaries of those programs; offers compliance program guidance - ANSWER: Office of the Inspector General (OIG) Seven key components:
- conducting internal monitoring and auditing through periodic audits
- implementing compliance and practice standards through development of written standards and procedures
- designating a compliance officer or contact
- conducting appropriate training and education
- responding appropriately to detected violations
- developing open lines of communication
- enforcing disciplinary standards through well-publicized guidelines - ANSWER: OIG Compliance Program Guidance sets forth a plan outlining its priorities for the fiscal year and beyond - ANSWER: OIG Work Plan
American Academy of Professional Coders (founded 1988) - ANSWER: AAPC Integrity, respect, commitment, competence, fairness, responsibility - ANSWER: AAPC Code of Ethics Department of Health and Human Services - ANSWER: HHS Patient Protection and Affordable Care Act of 2010 - ANSWER: PPACA Treatment, payment, and healthcare operations - ANSWER: TPO MS-DRG - ANSWER: Medicare Severity Diagnosis Related Group- Determines the amount the hospital will be reimbursed. EHR - ANSWER: Electronic Health Record APC - ANSWER: Ambulatory Payment Classification Outpatient coding - ANSWER: * Provider Services, use CPT, HCPC level II and ICD10-CM Codes.
- Work in provider offices, outpatient clinics, facility out patient department. *Also use APC's
- BCBS opperate in the state based Medicare - ANSWER: - Primary Gov't payer
- Fed health insurance program
- Admin by CMS
- Coverage for 65 and older
- Blind or disabled, perm kidney failure, ESRD Medicare programs - ANSWER: Part A- Inpatient, hospital care, skilled nursing, hospice, home health Part B- Med necessary provider services, preventative care (outpatient) Part C- Medicare advantage combines A, B, D CMS- HCC OMS Hierarchial condition category Part D- Prescription drug Medicaid - ANSWER: Health Insurance assist program sponsored by federal and state for low income. State funded insurance programs for children up to 21 - ANSWER: - Crippled Children's Services
- Children medical services
- Children indigent disability service
- CSHCS- Designed for specific chronic medical conditions
Evaluation and Management - ANSWER: E/M Documentation SOAP - ANSWER: S-Subjective- Patients statement about his or her health O-Objective- Exam and doc of patients illness using observation, palpitation, auscultation and percussion tests, and other services performed A- Assessment-Eval and conclusion P-Plan- course of action Operative Report documentation - ANSWER: Header- Date, time, name of docs, anesthesia & anesthesia provider, pre&Post Op dx, procedure, complications Body-Indication for surgery, details of procedure, findings Operative Report coding tips - ANSWER: 1) Highlight unfamiliar words and look up
- DX code reporting- Post op dx best or pathology report
- Start with procedure listed in header
- look for key words- Locations, anatomical structure, surgical approach, procedure method, procedure type (open/closed), size, number, surgical instrument
- Read the body NCD - ANSWER: National coverage determinations manual- Describes whether specific medical items, services, treatments, procedures or technologies can be paid under Medicare.
HIPPA Covered entity - ANSWER: Doctors, clinics, psychologists, dentists, chiropractors, nursing homes, pharmacies
- Health Plan= Ins co, HMO's, company health plans, Government programs HCPCS - ANSWER: Health care common procedure coding system CPT - ANSWER: Current procedural terminology CDT - ANSWER: Common dental terminology ICD- 10 - CM - ANSWER: Prior to 10/1/15 this was ICD- 9 - CM NPI - ANSWER: National provider identifier E/N - ANSWER: Employer identification number IRS - ANSWER: Internal Revenue Service OCR - ANSWER: Office of Civil Rights- Enforces HIPAA Privacy rules HTECH - ANSWER: Health Information Technology for Economic and Clinical Health act
- Promotes meaningful use of health information tech
- Allows patients to request audit trail
- Part of American Recover and Reinvestment Act of 2009 (ARRA)
MIPS - ANSWER: Merit Based Incentive Payment System- 4 Categories totaling 100
- Quality (replaces PQRS) (Most at 60)
- Advancing Care Information 25 (replaces meaningful use)
- Improvement Activités (New) 15
- Cost (replaces VM) Compliance Plan - ANSWER: Written process for coding and submitting accurate claims includes mechanism for detecting and correcting errors. OIG Compliance Program Guidance 7 components - ANSWER: 1) Conducting internal monitoring and auditing through performance audits.
- Implementing compliance and practice standard through developing written standard and procedures.
- Designate compliance officer.
- Training and education on practice standards and procedures
- Respond to violations
- Communicate in meetings bulletin boards how to avoid fraud.
- Enforcing disciplinary standards Clearing houses - ANSWER: Not considered a covered entity under HIPAA What document assist providers with developing compliance manuals - ANSWER: OIG Compliance Plan guidance
What document is referenced when looking for potential problem areas identified by the government indicating scrutiny of the services? - ANSWER: OIG work plan Which statement describes a medically necessary service? - ANSWER: Using the least radical service/procedure that allows for effective treatment of the patient's complaint or condition. Under HIPPA, what would be a policy requirement for "Minimum Necessary"? - ANSWER: Only individuals whose job requires it may have access to protected health information. Who would NOT be considered a covered entity under HIPAA? - ANSWER: Patients.
