Aapc Medical Coding Training: Cpc Chapter 1

Front 1

Description of a Medically necessary service

Back 1

Using the least radical service/procedure that allows for effective treatment of the patient's complaint or condition.

Front 2

What form is provided to a patient to indicate a service may not be covered by Medicare and the patient may be responsible for the charge?

Back 2

ABN

Front 3

ABN's may not be recognized by?

Back 3

non-Medicare payers

Front 4

When presenting a cost estimate on an ABN for a potentially noncovered service, the cost estimate should be within what range of the actual cost?

Back 4

$100. or 25% whichever is greater

Front 5

Who would NOT be considered a covered entity under HIPAA?

Back 5

Patient

Front 6

Under HIPAA, what would be a policy requirement for "Minimum Necessary?"

Back 6

Only individuals whose job requires it may have access to protected health information.

Front 7

Which Act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and affected privacy and security?

Back 7

HITECH

Front 8

What document has been created to assist physician offices with the development of compliance manuals?

Back 8

OIG Compliance Plan Guidance

Front 9

What document should be referred to when looking for potential problem areas identified by the government indicating scrutiny of the service within the coming year?

Back 9

OIG Work Plan

Front 10

ABN

Back 10

ADVANCE BENEFICIARY NOTICE

Front 11

AMA

Back 11

AMERICAN MEDICAL ASSOCIATION

Front 12

APC

Back 12

AMBULATORY PAYMENT CLASSIFICATION

Front 13

ARRA

Back 13

AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009

Front 14

ASC

Back 14

AMBULATORY SURGICAL CENTERS

Front 15

CDT

Back 15

CURRENT DENTAL TERMINOLOGY

Front 16

CMS

Back 16

CENTERS FOR MEDICARE & MEDICAID SERVICES

Front 17

CMS-HCC

Back 17

CENTERS FOR MEDICARE & MEDICAID SERVICES - HIERARCHICAL CONDITION CATEGORY

Front 18

CPC

Back 18

CERTIFIED PROFESSIONAL CODER

Front 19

CPT

Back 19

CURRENT PROCEDURAL TERMINOLOGY

Front 20

EHR

Back 20

ELECTRONIC HEALTH RECORD

Front 21

EIN

Back 21

EMPLOYER IDENTIFICATION NUMBER

Front 22

E/M OR E&M

Back 22

EVALUATION AND MANAGEMENT

Front 23

HCPCS

Back 23

HEALTHCARE COMMON PROCEDURE CODING SYSTEM

Front 24

HHS

Back 24

DEPARTMENT OF HEALTH & HUMAN SERVICES

Front 25

HIPAA

Back 25

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996

Front 26

HITECH

Back 26

HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT

Front 27

HMO

Back 27

HEALTH MAINTENANCE ORGANIZATION

Front 28

ICD-9-CM

Back 28

INTERNATIONAL CLASSIFICATION OF DISEASE, 9TH CLINICAL MODIFICATION

Front 29

ICD-10-CM

Back 29

INTERNATIONAL CLASSIFICATION OF DISEASE, TENTH EDITION, CLINICAL MODIFICATION

Front 30

LCD

Back 30

LOCAL COVERAGE DETERMINATION

Front 31

MAC

Back 31

MEDICARE ADMINISTRATIVE CONTRACTOR

Front 32

MS-DRG

Back 32

MEDICARE SEVERITY DIAGNOSTIC RELATED GROUP

Front 33

NCD

Back 33

NATIONAL COVERAGE DETERMINATION

Front 34

NP

Back 34

NURSE PRACTITIONER

Front 35

NPI

Back 35

NATIONAL PROVIDER IDENTIFIER

Front 36

OCR

Back 36

OFFICE FOR CIVIL RIGHTS

Front 37

OIG

Back 37

OFFICE OF INSPECTOR GENERAL

Front 38

PA

Back 38

PHYSICIAN ASSISTANT

Front 39

PHI

Back 39

PROTECTED HEALTH INFORMATION

Front 40

PPACA

Back 40

PATIENT PROTECTION AND AFFORDABLE CARE ACT

Front 41

SOAP

Back 41

STANDARD FORMAT FOR E/M SERVICES - SUBJECTIVE, OBJECTIVE, ASSESSMENT, PLAN

Front 42

TPO

Back 42

TREATMENT, PAYMENT, AND HEALTHCARE OPERATIONS

Front 43

According to the example LCD from Novitas Solutions, measurement of vitamin D levels is indicated for patients with which condition?

Back 43

Fibromyalgia

Front 44

What document has been created to assist physician offices with the development of Compliance Manuals?

Back 44

OIG Compliance Plan Guide

Front 45

What document should be referred to when looking for potential problem areas identified by the government indicating scrutiny of the services within the coming year?

Back 45

OIG Work Plan

Front 46

What type of professional might skilled coders become?

Back 46

Consultants, educators, medical auditors

Front 47

What is the difference between outpatient and inpatient coding?

Back 47

Inpatient coders use ICD-10-CM and ICD-10-PCS

Front 48

What is a mid-level provider?

Back 48

physician assistants (PA), and nurse practitioners (NP)

Front 49

What are the different parts of Medicare?

Back 49

Part A, B, C, D

Front 50

Evaluation and management services are often provided and documented in a standard format such as SOAP, What does SOAP represent?

Back 50

Subjective Objective Assessment Plan

Front 51

What are five tips for coding operative reports?

Back 51

Diagnosis code reporting, Start with the procedure listed, Look for key words, Highlight unfamiliar words, Read the body

Front 52

What is medical necessity?

Back 52

Relates to whether a procedure or service is considered appropriate in a given circumstance

Front 53

What is not a common reason Medicare may deny a procedure or service?

Back 53

Covered Service

Front 54

Under the Privacy Rule, the minimum necessary standard does not apply to these types of disclosures except?

Back 54

Uses or disclosures that are not required by other law

Front 55

When coding an operative report, what action would NOT be recommended?

Back 55

Coding from the header without reading the body of the report.

Front 56

HIPAA was made into law in what year?

Back 56

1996

Front 57

A medical record contains information on all but what areas?

Back 57

Financial records

Front 58

LCD's only have jurisdiction in their _________area.

Back 58

Regional

Front 59

Although voluntary, a compliance plan may offer several benefits such as?

Back 59

faster, more accurate payment of claims fewer billing mistakes diminished chances of a payer audit chances of running afoul of self-referral and anti-kickback statutes

Front 60

Technicians who specialize in coding are called?

Back 60

Coding Specialists

Front 61

AAPC credentialed coders have proven mastery of?

Back 61

all code sets evaluation and management principles documentation guidelines

Front 62

Accurate and thorough diagnosis coding is important for Medicare Advantage (Part C) claims because reimbursement is impacted by?

Back 62

The patient's health status. CMS-HCC risk adjustment model provides adjusted payments based on a patient's diseases and demographic factors.

Front 63

According to the 2014 AAPC _______, it shows coders salaries rose 2 percent to an average of $50,020 for credential professional coders.

Back 63

Salary Survey

Front 64

Healthcare providers are responsible for developing ____________ ______________ and policies and procedures regarding privacy in their practices.

Back 64

Notices of Privacy Practices

Front 65

According to AAPC's Code of Ethics, a member shall use only __________ and ___________ means in all professional dealings.

Back 65

legal and ethical

Front 66

The OIG recommends that the physician's practice enforcement and disciplinary mechanisms be?

Back 66

Consistent

Front 67

Each October the OIG releases a __________ outlining its priorities for the fiscal year ahead.

Back 67

Work Plan

Front 68

National Coverage Determinations serve what purpose?

Back 68

To spell out CMS policies on when Medicare will pay for items or services

Front 69

The ___________ describes whether specific medical items, services, treatment procedures, or technologies are considered medically necessary under Medicare.

Back 69

National Coverage Determination Manual

Front 70

HITECH provides a ___________ day window which any violation not due to willful neglect may be corrected without penalty?

Back 70

30

Front 71

What type of health insurance provides coverage for low-income families?

Back 71

Medicaid

Front 72

What is the definition of coding?

Back 72

Translating documentation into numerical/alphanumerical codes used to obtain reimbursement