Ch 1

Question 1

Outpatient coding

Answer 1

Focuses on physician professional services and our patient facility services. Cpt, hcpcs level II, and icd-10-cm codes.

Question 2

Hospital inpatient coding

Answer 2

Coders will work with icd-10-cm codes and icd-10-pcs codes. Will also assign medical severity diagnosis related groups (ms-drgs)

Question 3

Ms-drgs

Answer 3

Medical severity diagnosis related groups

Question 4

Apcs

Answer 4

Ambulatory payment classifications

Question 5

Risk adjustment coding

Answer 5

Focused on diagnosis coding using the icd-10-cm code set

Question 6

NPPs

Answer 6

Non-physician providers

Mid level providers or physician extenders. Physician assistants. Nurse practitioners

Question 7

Commercial insurance

Answer 7

Prívate payers that offer group and individual plans.

Question 8

Government insurance

Answer 8

Ex is Medicare. A federal insurance plan

Question 9

Medicare

Answer 9

Coverage for people over 65, disability or end stage renal disease. (Esrd)

Question 10

Medicare part a

Answer 10

Inpatient hospital care. Care from skilled nursing, hospice , and home health

Question 11

Medicare part b

Answer 11

Medically necessary physicians services, outpatient care, and other medical services.

Question 12

Cms

Answer 12

Centers for Medicare and Medicaid services

Question 13

Medicare part c
(Medicare advantage)

Answer 13

Also called Medicare advantage. Combined benefits of Medicare part A&Band sometimes D. Plans are managed by private insurers.

Question 14

Medicare part d

Answer 14

Prescription drug program

Question 15

Medicaid

Answer 15

For low income people. Especially children and pregnant women. Sponsored by state and federal government.

Question 16

Medicare necessity

Answer 16

Whether a procedure is “reasonable or necessary” for diagnosis or treatment of patient.

Question 17

NCD

Answer 17

National coverage determination. Explains when Medicare will pay for items or services.

Question 18

MAC

Answer 18

Medicare administrative contractor. Responsible for interpreting national policies into regional policies.

Question 19

LCD

Answer 19

Local coverage determination. They have jurisdiction only within their regional area. If an NCD doesn’t exist for an item, it’s up to the Mac to determine coverage.

Question 20

ABN
Advanced beneficiary notice

Answer 20

Is a standardized form that explains to the patient why Medicare may deny the service or procedure. It protects the providers financial interest by creating a paper trail that cms requires before a provider can bill the patient for payment if coverage is denied.

Estimate should be within $100 or 25% of the actual costs. Whichever is greater.

Question 21

Hold harmless

Answer 21

Prohibits the billing to the patient for anything other than co-pays or deductibles.

Question 22

HIPPA

Answer 22

Health insurance portability and accountability act.
Protects health information.

Question 23

HITECH

Answer 23

health technology for economic and clinical Health act.
Addressed privacy and security concerns associated with the electronic transmission of health information.

Question 24

OIG
Office if inspector general

Answer 24

Mandated by public law to engage in exhibited to test the efficiency and economy of. Government programs to include investigation of Suspected healthcare fraud or abuse.