AAPC Chapter 1 Exam Review
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Questions and Answers

What does the acronym CMS-HCC represent in healthcare?

  • Centralized Medical Service - Health Condition Categorization
  • Consumer Management System - Hierarchical Care Code
  • Centers for Medicare & Medicaid Services - Hierarchical Condition Category (correct)
  • Centers for Medical Services - Health Care Coverage

    • Which of the following is NOT typically included in healthcare providers' procedures regarding privacy?

  • Marketing strategies for patient data (correct)
  • Disciplinary actions for privacy violations
  • Patient information management protocols
  • Notices of Privacy Practices

    • In the context of healthcare privacy, what is a primary purpose of Notices of Privacy Practices?

  • To detail the referral process for specialists
  • To provide guidelines for billing procedures
  • To outline patient financial obligations
  • To inform patients about their rights and the use of their information (correct)

    • What is a common requirement for healthcare providers regarding privacy and confidentiality?

    <p>Develop and enforce privacy policies and procedures</p> Signup and view all the answers

    What is the key focus of policies and procedures related to privacy in healthcare?

    <p>Protecting patient information from unauthorized access</p> Signup and view all the answers

    Which of the following activities is not permitted for a covered entity without obtaining consent from the individual?

    <p>Research</p> Signup and view all the answers

    What is the primary title for professionals who focus on coding in the medical field?

    <p>Coding specialists</p> Signup and view all the answers

    What key information does a remittance advice provide to a healthcare provider?

    <p>Payment determinations and reasons for adjustments</p> Signup and view all the answers

    In the absence of a National Coverage Determination (NCD), who is responsible for determining Medicare coverage for a service or procedure?

    <p>Medicare Administrative Contractor (MAC)</p> Signup and view all the answers

    Which one of the following is NOT considered a standard purpose for which a covered entity can disclose protected health information?

    <p>Research</p> Signup and view all the answers

    In which year was the HITECH Act introduced as a component of the American Recovery and Reinvestment Act?

    <p>2009</p> Signup and view all the answers

    What is NOT recommended when coding an operative report?

    <p>Coding from the header without reading the body of the report</p> Signup and view all the answers

    Which of the following is considered NOT a covered entity under HIPAA?

    <p>Workers' Compensation</p> Signup and view all the answers

    The HITECH Act was aimed at promoting what specific aspect of healthcare technology?

    <p>Adoption and meaningful use of health information technology</p> Signup and view all the answers

    When coding operative reports, which process should be prioritized?

    <p>Reviewing documentation in detail for clarity</p> Signup and view all the answers

    What legislation established standards for the protection of health information?

    <p>HIPAA</p> Signup and view all the answers

    Which health insurance program primarily targets low-income families and individuals?

    <p>Medicaid</p> Signup and view all the answers

    What year was the HIPAA legislation enacted?

    <p>1996</p> Signup and view all the answers

    What do AAPC credentialed coders demonstrate mastery in?

    <p>All code sets and documentation guidelines</p> Signup and view all the answers

    Which of the following is NOT a component typically covered under Medicaid?

    <p>Cosmetic surgery</p> Signup and view all the answers

    In which year was the AAPC established?

    <p>1988</p> Signup and view all the answers

    What is one of the primary purposes of the over 500 AAPC local chapters?

    <p>Continuing education and networking</p> Signup and view all the answers

    What does the acronym MAC represent?

    <p>Medicare Administrative Contractor</p> Signup and view all the answers

    What is the full form of the abbreviation ABN?

    <p>Advance Beneficiary Notice</p> Signup and view all the answers

    Which term is considered NOT to be an ethical principle of professional conduct according to the AAPC Code of Ethics?

    <p>Efficiency</p> Signup and view all the answers

    When must a provider obtain an ABN for a service that is not medically necessary?

    <p>Prior to providing a service or item to a beneficiary</p> Signup and view all the answers

    What does the acronym PHI stand for in healthcare terminology?

    <p>Protected health information</p> Signup and view all the answers

    Which medical professional is licensed to practice medicine with oversight and typically completes 26 1/2 months of training post-bachelor's degree?

    <p>Physician Assistant (PA)</p> Signup and view all the answers

    Protected health information (PHI) is restricted to which type of health data?

    <p>Individual health-related information</p> Signup and view all the answers

    What is required of providers regarding the provision of services that may not be considered medically necessary?

    <p>They are required to obtain an ABN beforehand</p> Signup and view all the answers

    What document outlines whether certain medical procedures or items are covered under Medicare?

    <p>National Coverage Determinations Manual</p> Signup and view all the answers

    What is one significant advantage of using electronic transactions in healthcare?

    <p>Timely submission of claims</p> Signup and view all the answers

    What does the acronym EHR stand for in healthcare?

    <p>Electronic health record</p> Signup and view all the answers

    What method does the Office of Inspector General (OIG) recommend for performing internal monitoring and auditing?

    <p>Periodic audits</p> Signup and view all the answers

    Which professional is licensed to practice medicine under physician supervision after achieving a Bachelor's degree?

    <p>Physician Assistant (PA)</p> Signup and view all the answers

    Which type of provider is classified as a mid-level provider?

    <p>Physician Assistant</p> Signup and view all the answers

    What is a primary benefit of conducting periodic audits in a compliance program?

    <p>To evaluate the effectiveness of the compliance program</p> Signup and view all the answers

    Which of the following roles extends the work of a physician?

    <p>Nurse Practitioner</p> Signup and view all the answers

    Which of the following best describes mid-level providers?

    <p>They work under the supervision of licensed physicians.</p> Signup and view all the answers

    What is NOT considered an essential activity in an effective compliance program?

    <p>Engaging in patient outreach programs</p> Signup and view all the answers

    Study Notes

    CMS-HCC

    • CMS-HCC stands for Centers for Medicare & Medicaid Services - Hierarchical Condition Category.

    HIPAA Compliance

    • Healthcare providers are responsible for developing Notices of Privacy Practices and policies and procedures regarding privacy in their practices.

    Key Roles in Healthcare

    • Professionals who specialize in coding are called medical coders or coding specialists.
    • A remittance advice explains the outcome of an insurance claim, including the payment amount and any changes to charges.

    Medicare Coverage

    • Medicare Administrative Contractor (MAC) determines coverage for services or procedures when a National Coverage Determination (NCD) doesn’t exist.

    HITECH Act

    • The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted as part of the American Recovery and Reinvestment Act of 2009 to promote the adoption of health information technology.

    Coding

    • Coding from the header of an operative report without reading the body is not recommended.
    • Operative report coding tips include reviewing the documentation in detail to clarify or define both procedures and diagnoses.

    Covered Entities under HIPAA

    • Workers' Compensation is not a covered entity under HIPAA.

    History of Regulations

    • HIPAA became law in 1996.

    Medicaid

    • Medicaid is a government-sponsored health insurance program for low-income people, especially children and pregnant women.

    AAPC Credentialing

    • AAPC credentialed coders have proven mastery of code sets, evaluation and management principles, and documentation guidelines.

    AAPC

    • The AAPC was founded in 1988 and offers over 500 local chapters across the country for continuing education and networking.

    MAC & ABN

    • MAC stands for Medicare Administrative Contractor.
    • ABN stands for Advance Beneficiary Notice.

    AAPC Code of Ethics

    • Efficiency is not listed as an ethical principle in the AAPC Code of Ethics.

    ABNs

    • Providers are responsible for obtaining an ABN prior to providing a service or item that is not considered medically necessary to a beneficiary.

    PHI

    • PHI stands for Protected Health Information. It includes any information related to an individual's physical or mental health, the provision of health services, or payment for those services. Only individual-level information is covered; group information is not.

    Physician Assistant (PA)

    • Physician Assistants (PA) are licensed to practice medicine with physician supervision. They complete approximately 26 1/2 months of education after a bachelor's degree.

    National Coverage Determinations Manual

    • The National Coverage Determinations Manual describes whether specific medical items, services, treatment procedures, or technologies are considered medically necessary under Medicare.

    Electronic Transactions

    • Electronic transactions benefit healthcare providers by allowing for timely submission of claims.

    EHR

    • EHR stands for Electronic Health Record.

    Compliance Program

    • Internal monitoring and auditing, performed through periodic audits, are key components of an effective compliance program.

    Mid-Level Providers

    • Mid-level providers, also known as physician extenders, include physician assistants (PA) and nurse practitioners (NP). An anesthesiologist is a physician.

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    Quiz Team

    Description

    Test your knowledge on key aspects of healthcare compliance, including CMS-HCC, HIPAA, and the HITECH Act. Additionally, explore the roles and responsibilities related to medical coding and Medicare coverage. This quiz is essential for anyone looking to sharpen their understanding of the healthcare system.

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