Chapter 1 The Business of Medicine Exercise 1 Quiz

Career Opportunities for Coders

• Skilled coders can enter professions like consultants, educators, and medical auditors.

Outpatient vs Inpatient Coding

• Outpatient coders focus on CPT, HCPCS Level II, and ICD-10-CM codes, and work in provider offices, outpatient clinics, and facility outpatient departments.
• Outpatient facility coders also work with ambulatory payment classifications (APCs).
• Inpatient hospital coding involves working with ICD-10-CM and ICD-10-PCS, and assigning Medicare severity-diagnosis related groups (MS-DRGs) for reimbursement.
• Outpatient coders have more interaction throughout the day and must communicate well with providers, whereas inpatient coders tend to have less interaction.

Mid-Level Providers

• Mid-level providers include physician assistants (PA) and nurse practitioners (NP).
• They are also known as physician extenders because they extend the work of a physician.

Medicare Programs

• Medicare Part A covers inpatient hospital care, skilled nursing facilities, hospice care, and home healthcare.
• Medicare Part B covers medically necessary provider services and preventive services, and is an optional benefit for which the patient pays a premium, annual deductible, and 20% co-insurance.
• Medicare Part C (Medicare Advantage) combines the benefits of Medicare Part A, Part B, and sometimes Part D, and is managed by private insurers approved by Medicare.
• Medicare Part D is a prescription drug coverage program available to all Medicare beneficiaries for a fee.

Privacy Rule Exemptions

• The minimum necessary standard does not apply to disclosures to or requests by a healthcare provider for treatment purposes, the individual who is the subject of the information, uses or disclosures made pursuant to an individual's authorization, uses or disclosures required for compliance with HIPAA Administrative Simplification Rules, disclosures to the U.S. Department of Health & Human Services (HHS) for enforcement purposes, and uses or disclosures required by other law.

Internal Compliance Plan Components

• Conducting internal monitoring and auditing through periodic audits.
• Implementing compliance and practice standards through written standards and procedures.
• Designating a compliance officer or contact to monitor compliance efforts and enforce practice standards.
• Conducting appropriate training and education on practice standards and procedures.
• Responding appropriately to detected violations through investigation and disclosure to government entities.
• Developing open lines of communication, such as discussions at staff meetings and community bulletin boards.
• Enforcing disciplinary standards through well-publicized guidelines.