Chapter 1 The Business of Medicine

Question 1

CMS

Answer 1

Centers for Medicare & Medicaid Services

Question 2

NCD

Answer 2

National Coverage Determination

Question 3

MAC

Answer 3

Medicare Administrative Contractor

Question 4

LCD

Answer 4

Local Coverage Determination

Question 5

ABN

Answer 5

Advanced Beneficiary Notice

Question 6

HIPPA

Answer 6

Health Insurance Portability Accountability Act of 1996

Question 7

HCPS

Answer 7

Healthcare Common Procedure Coding System

Question 8

CPT

Answer 8

Current Procedural Terminology

Question 9

CDT

Answer 9

Common Dental Terminology

Question 10

ICD-9-CM

Answer 10

International Classification of Disease-9th Revision-Clinical Modification

Question 11

NDC

Answer 11

National Drug Codes

Question 12

NPI

Answer 12

National Provider Indentifier

Question 13

EIN

Answer 13

Employer Identification Number

Question 14

OCR

Answer 14

Office for Civil Rights

Question 15

PHI

Answer 15

Protected Health Information

Question 16

HITECH

Answer 16

Health Information Technology for Economic and Clinical Health Act

Question 17

OIG

Answer 17

Office of Inspector General

Question 18

HHS

Answer 18

Department of Health and Human Services

Question 19

Coding

Answer 19

The process of translating a written or dictated medical record into a series of numeric and/or alpha-numeric codes.

Question 20

Physician-Based Coding

Answer 20

Bill for physician work and overhead; they use CPT, HCPS, and ICD-9-CM volumes 1 and 2. Claim form used: CMS-1500

Question 21

Hospital-Based Coding

Answer 21

Bill for technical component of services provided; they use CPT, HCPCS, ICD-9-CM volumes 1,2, and 3. Claim form used: UB-04.

Question 22

EHR

Answer 22

Electronic Health Record

Question 23

Medicare Part A

Answer 23

In-patient hospital care, as well as care provided in a skilled nursing facility, hospice care, and home-health care.

Question 24

Medicare Part B

Answer 24

Medically necessary physician services, out-patient care, and other medical services note covered by Part A.

Question 25

Medicare Part C

Answer 25

Managed by private insurers and may include a combination of Part A, Part B, and sometimes Part D.

Question 26

Medicare Part D

Answer 26

Prescription drug coverage program available for Medicare beneficiaries.

Question 27

Medical Record

Answer 27

Recording of pertinent facts and observations about an individual’s health.

Question 28

Evaluation and Management Documentation

Answer 28

Subjective
Objective
Assessment
Plan

Question 29

Subjective

Answer 29

The patient’s statement about their health, including symptoms.

Question 30

Objective

Answer 30

The provider assesses and documents the patient’s illness using observation, palpation, auscultation, and percussion.

Question 31

Assessment

Answer 31

Evaluation and conclusion made by the provider.

Question 32

Plan

Answer 32

Course of action

Question 33

National Coverage Determination

Answer 33

Spells out the CMS policies on when Medicare will pay for items or services.

Question 34

Advanced Beneficiary Notice

Answer 34

Providers are responsible for obtaining an ABN prior to providing services or item to a beneficiary.

Question 35

OIG Workplan

Answer 35

1. Published yearly
2. Outlines priorities for CMS; the public health agencies; the Administrations for Children and Families; and Administration on Aging.
3. Target areas for improvement