Chapter 1 Flashcards
Which statement describes a medically necessary service?
Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition.
Under HIPAA, what would be a policy requirement for “minimum necessary”
Only individuals whose job requires it may have access to protected health information.
According to the example LCD from Novitas Solutions, which of the following conditions is considered a systemic condition that may result in the need for routine foot care?
Chronic venous insufficiency
What form is provided to a patient to indicate a service may not be covered by Medicare and the patient may be responsible for the charges?
Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare beneficiary requests or agrees to receive a procedure or service that Medicare may not cover. This form notifies the patient of potential out of pocket costs for the patient.
What document assists provider offices with the development of Compliance Manuals
OIG Compliance Program Guidance
Select the TRUE statement regarding ABNs.
Rationale: ABNs may not be recognized by non-Medicare payers. Providers should review their contracts to determine which payers will accept an ABN for services not covered.
Who would NOT be considered a covered entity under HIPAA
Rationale: Covered entities in relation to HIPAA include Health Care Providers, Health Plans, and Health Care Clearinghouses. The patient is not considered a covered entity although it is the patient’s data that is protected.
Which act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and affected privacy and security?
Rationale: The Health Information Technology for Economic and Clinical Health Act (HITECH) was enacted as a part of the American Recovery and Reinvestment Act of 2009 (ARRA) to promote the adoption and meaningful use of health information technology. Portions of HITECH strengthen HIPAA rules by addressing privacy and security concerns associated with the electronic transmission of health information.
What document is referenced to when looking for potential problem areas identified by the government indicating scrutiny of the services?
Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for the fiscal year ahead. Within the Work Plan, potential problem areas with claims submissions are listed and will be targeted with special scrutiny.
When presenting a cost estimate on an ABN for a potentially noncovered service, the cost estimate should be within what range of the actual cost?
Rationale: CMS instructions stipulate, “Notifiers must make a good faith effort to insert a reasonable estimate…the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.”
What type of profession, other than coding, might skilled coders enter?
Consultants, educators, medical auditors
What is the difference between outpatient and inpatient coding
Inpatient coders use ICD-10-CM and ICD-10-PCS.
What is a mid-level provider?
Mid-level providers include physician assistants (PA) and nurse practitioners (NP).
What are the different parts of Medicare
Part A, B, C, D
Evaluation and management (E/M) services are often provided and documented in a standard format. One such format is SOAP notes. What does SOAP represent?
Subjective, Objective, Assessment, Plan
