Chapter 1 - The Business of Medicine Flashcards
What is Medical Coding?
The process of translating written or dictated medical records into a series of numeric/alphanumeric codes.
What 2 things are the focus of outpatient coding?
- Physician professional services
2. Outpatient facility coding
What code sets does outpatient coding focus on?
CPT, HCPCS Level II, and ICD-10-CM
What code sets does hospital inpatient coding focus on?
ICD-10-CM and ICD-10-PCS
What are NPPs?
Non-physician providers
What are 2 different kinds of NPP?
- Nurse Practitioner
2. Physician’s assistant
What are commercial payers?
Private payers that may offer both group and individual plans. Contracts may include differing levels of protection for basic, major, and hospitalization coverage.
What entity administers Medicare?
(CMS) Center for Medicare and Medicaid Services
Who qualifies for Medicare?
- 65/+
- Blind/Disabled
- Permanent kidney failure/(ESRD) End-stage renal disease
Whose regulations determine coding requirements for both Medicare and non-Medicare payers?
(CMS) Center for Medicare and Medicaid Services
What is Medicare Part A coverage?
Hospital inpatient, skilled nursing facility, hospice, and home healthcare coverage
What is Medicare Part B coverage?
Medically necessary physician’s services, outpatient care, some other services not included in Part A (Part B is optional and typically requires premium, deductible, and copayment)
What is Medicare Part C coverage?
(AKA Medicare Advantage) Combines Part A, Part B, and sometimes Part D coverage. Managed by private insurers approved by Medicare.
What is Medicare Part D Coverage?
A prescription drug program available to all Medicare beneficiaries. Coverage provided by private companies approved by Medicare.
What is Medicaid?
Medicaid is a health insurance assistance program for low-income (especially children and pregnant women) sponsored by federal and state governments.
