AAPC CPC Chapter 1 Questions And
Answers.
Medical coding -
\process of translating a healthcare provider's documentation of a patient encounter into
a series of numeric or alphanumeric codes
Health information coders, medical record coders, coder/abstractors, coding specialists
-
\coders who specialize in coding inpatient hospital services
MS-DRG -
\Medical Severity-Diagnosis Related Groups
MS-DRG are used to: -
\determine the amount the hospital will be reimbursed if the patient is covered by
Medicare or other insurance programs using the MS-DRG system
Cancer (or tumor) registrars -
\maintain facility, regional, and national databases of cancer patients
EHR -
\electronic health record
Other roles coders can have: -
\consultants, educators, medical auditors
Outpatient coders -
\use CPT, HCPCS Level II, and ICD-10-CM codes; work in provider offices, outpatient
clinics, and facility outpatient departments; also use Ambulatory Payment
Classifications (APCs); have more interaction with providers
Inpatient coders -
\use ICD-10-CM and ICD-10-PCS codes; also use MS-DRGs for reimbursement; have
less interation directly with providers
Remittance advice (RA) / Explanation of Benefits (EOB) -
\explains the payer's determination in payment
Scope of practice -
\practice guidelines for each level of a provider individually dictated by states
Mid-level Provider (MLP) -
, \include physician assistants (PA) and nurse practitioners (NP); aka physician extenders
Physician Assistant (PA) -
\Works under the supervision of physicians; PA program takes approximately 26 1/2
months to complete after completion of a bachelor's degree
Nurse Practitioner (NP) -
\have a master's degree in nursing
Two types of payers: -
\private insurance plans and government insurance plans
Medicare -
\primary government payer in the U.S.; provides coverage for people 65 and older,
blind, disabled, and people with permanent kidney failure or end-stage renal disease
(ESRD)
Medicare Part A -
\Inpatient coverage, home health, hospice, skilled nursing facilities; also defines limits of
Medicare usage
Medicare Part B -
\The part of the Medicare program that pays medically necessary provider services,
preventative services, durable medical equipment, and other services and supplies.
Medicare Part C (Medicare Advantage Plans) -
\combines benefits of Part A, B, and sometimes D; managed by private insurers
approved by Medicare; may charge different copays, coinsurance, or deductibles
CMS-HCC -
\Centers for Medicare & Medicaid Services-Hierarchical Condition Category
Medicare Part D -
\Prescription drug coverage
Medicaid -
\health insurance assistance program sponsored by federal and state governments for
low-income people
Limiting charge -
\set limits on what the patient can be charged
SOAP -
\subjective, objective, assessment, plan
Subjective -
Answers.
Medical coding -
\process of translating a healthcare provider's documentation of a patient encounter into
a series of numeric or alphanumeric codes
Health information coders, medical record coders, coder/abstractors, coding specialists
-
\coders who specialize in coding inpatient hospital services
MS-DRG -
\Medical Severity-Diagnosis Related Groups
MS-DRG are used to: -
\determine the amount the hospital will be reimbursed if the patient is covered by
Medicare or other insurance programs using the MS-DRG system
Cancer (or tumor) registrars -
\maintain facility, regional, and national databases of cancer patients
EHR -
\electronic health record
Other roles coders can have: -
\consultants, educators, medical auditors
Outpatient coders -
\use CPT, HCPCS Level II, and ICD-10-CM codes; work in provider offices, outpatient
clinics, and facility outpatient departments; also use Ambulatory Payment
Classifications (APCs); have more interaction with providers
Inpatient coders -
\use ICD-10-CM and ICD-10-PCS codes; also use MS-DRGs for reimbursement; have
less interation directly with providers
Remittance advice (RA) / Explanation of Benefits (EOB) -
\explains the payer's determination in payment
Scope of practice -
\practice guidelines for each level of a provider individually dictated by states
Mid-level Provider (MLP) -
, \include physician assistants (PA) and nurse practitioners (NP); aka physician extenders
Physician Assistant (PA) -
\Works under the supervision of physicians; PA program takes approximately 26 1/2
months to complete after completion of a bachelor's degree
Nurse Practitioner (NP) -
\have a master's degree in nursing
Two types of payers: -
\private insurance plans and government insurance plans
Medicare -
\primary government payer in the U.S.; provides coverage for people 65 and older,
blind, disabled, and people with permanent kidney failure or end-stage renal disease
(ESRD)
Medicare Part A -
\Inpatient coverage, home health, hospice, skilled nursing facilities; also defines limits of
Medicare usage
Medicare Part B -
\The part of the Medicare program that pays medically necessary provider services,
preventative services, durable medical equipment, and other services and supplies.
Medicare Part C (Medicare Advantage Plans) -
\combines benefits of Part A, B, and sometimes D; managed by private insurers
approved by Medicare; may charge different copays, coinsurance, or deductibles
CMS-HCC -
\Centers for Medicare & Medicaid Services-Hierarchical Condition Category
Medicare Part D -
\Prescription drug coverage
Medicaid -
\health insurance assistance program sponsored by federal and state governments for
low-income people
Limiting charge -
\set limits on what the patient can be charged
SOAP -
\subjective, objective, assessment, plan
Subjective -
