Questions and Answers
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
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?
What form is provided to a patient to indicate a service may not be covered by Medicare and that the patient may be responsible for the charges?
ABN
ABNs may be recognized by non-Medicare payers.
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When presenting a cost estimate on an ABN for a potentially non-covered service, the cost estimate should be within what range of the actual cost?
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Who would NOT be considered a covered entity under HIPAA?
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Under HIPAA, what would be a policy requirement for minimum necessary?
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Which Act was enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009 and affected privacy and security?
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What document assists provider offices with the development of compliance manuals?
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What document is referenced when looking for potential problem areas identified by the government indicating scrutiny of the services within the coming year?
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What type of profession, other than coding, might skilled coders enter?
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What is the difference between outpatient and inpatient coding?
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What is a mid-level provider?
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What are the different parts of Medicare?
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Evaluation and Management (E/M) services are often provided and documented in a standard SOAP format. What does SOAP represent?
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What are 5 tips for coding operative reports?
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What is medical necessity?
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Covered service is a common reason Medicare may deny a procedure or service.
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Under the privacy rule, the minimum necessary standard applies to disclosures to the individual who is the subject of the information.
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Conduct training but not perform education on practice standards and procedures is one of the seven key components of an internal compliance plan.
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What is the value of a remittance advice?
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The ____________ describes whether specific medical items, services, treatment procedures or technologies are considered medically necessary under Medicare?
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Which option is NOT a covered entity under HIPAA?
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What type of insurance is Medicare Part D?
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A covered entity does NOT include patients.
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According to AAPC's Code of Ethics, an AAPC member shall use only _______ and _______ means in all professional dealings?
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Voluntary compliance programs also provide benefits by not only helping to prevent erroneous or _________, but also by showing that the provider is making additional good faith efforts to submit claims appropriately?
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Which provider is NOT a mid-level provider?
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What does HIPAA stand for?
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Study Notes
Medical Necessity
- Medically necessary services use the least radical procedure for effective treatment.
- Chronic venous insufficiency is a systemic condition that may necessitate routine foot care.
Medicare Coverage and ABN
- The Advance Beneficiary Notice (ABN) informs patients of potential non-coverage by Medicare, making them responsible for charges.
- ABNs may not be recognized by non-Medicare payers.
Cost Estimates
- When providing a cost estimate on an ABN, it must be within $100 or 25% of the actual cost.
HIPAA Regulations
- Patients are not considered covered entities under HIPAA.
- The minimum necessary policy allows access to protected health information only to those whose job requires it.
- The HITECH Act, part of the ARRA of 2009, impacts privacy and security regulations.
Compliance and OIG Documents
- The OIG Compliance Plan Guidance aids in developing compliance manuals for healthcare providers.
- The OIG Work Plan identifies potential problem areas for scrutiny in the coming year.
Career Opportunities for Coders
- Skilled coders may transition into roles as consultants, educators, or medical auditors.
Coding Differences
- Inpatient coding uses ICD-10-CM and ICD-10-PCS, while outpatient coding follows different guidelines.
Mid-Level Providers
- Mid-level providers include physician assistants (PAs) and nurse practitioners (NPs).
Medicare Parts
- Medicare comprises four parts: A, B, C, and D.
E/M Services Documentation
- Evaluation and Management (E/M) services follow the standard SOAP format: Subjective, Objective, Assessment, Plan.
Tips for Coding Operative Reports
- Key tips include accurate diagnosis reporting, starting with listed procedures, identifying keywords, highlighting unfamiliar terms, and thoroughly reading the report body.
Understanding Medical Necessity
- Medical necessity assesses the appropriateness of a procedure under specific circumstances.
Medicare Denials
- A common reason for Medicare denial is the procedure or service being covered.
Privacy Rule Disclosures
- The minimum necessary standard does not apply to disclosures made to individuals who are the subject of the information.
Internal Compliance Plan
- One of the seven components of an internal compliance plan does not include conducting training without educational support on practice standards.
Remittance Advice
- Remittance advice details payment amounts and explains any adjustments to charges.
National Coverage Determinations
- The National Coverage Determinations Manual outlines which medical services are deemed medically necessary by Medicare.
Health Insurance Portability and Accountability Act (HIPAA)
- HIPAA stands for the Health Insurance Portability and Accountability Act, protecting patient information.
Voluntary Compliance Benefits
- Voluntary compliance programs help prevent fraudulent claims and show providers’ commitment to appropriate claims submission.
Mid-Level Providers Exclusion
- An anesthesiologist is not classified as a mid-level provider.
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Description
This quiz focuses on the essential concepts found in Chapter 1 of the AAPC curriculum, specifically addressing the business aspects of medicine. It includes key definitions and examples related to medically necessary services and systemic conditions. Perfect for students preparing for their exams in medical coding and billing.
