AAPC CPC Chapter 1 Questions And
Answers.
MS-DRG -
\Medicare Severity Diagnosis Related Group- Determines the amount the hospital will
be reimbursed.
EHR -
\Electronic Health Record
APC -
\Ambulatory Payment Classification
Outpatient coding -
\* Provider Services, use CPT, HCPC level II and ICD10-CM Codes.
* Work in provider offices, outpatient clinics, facility out patient department.
*Also use APC's
*More interaction with physician
Inpatient hospital coding -
\*Use ICD10 CM & ICD10 PCS
*Also use MS-DRG's for reimbursement
*Less interaction with providers
Outpatient provider services bill on what claim form? -
\cms-1500 Claim form
RA -
\Remittance Advice
EOB -
\Explanation of benefits
Mid level providers -
\PA, NP
- Known as physician extenders
-Practice medicine with physician supervision
-PA takes 26 1/2 mo after bachelors
, -NP Masters in nursing
What are two types of payers? -
\1) Private insurance plans
2)Government plans
Commercial Carriers -
\- Private payers offer group and individual
- Contracts vary- include hospital, basic, and major medical
-BCBS opperate in the state based
Medicare -
\-Primary Gov't payer
-Fed health insurance program
-Admin by CMS
-Coverage for 65 and older
-Blind or disabled, perm kidney failure, ESRD
Medicare programs -
\Part A- Inpatient, hospital care, skilled nursing, hospice, home health
Part B- Med necessary provider services, preventative care (outpatient)
Part C- Medicare advantage combines A, B, D CMS- HCC OMS Hierarchial condition
category
Part D- Prescription drug
Medicaid -
\Health Insurance assist program sponsored by federal and state for low income.
State funded insurance programs for children up to 21 -
\-Crippled Children's Services
-Children medical services
-Children indigent disability service
-CSHCS- Designed for specific chronic medical conditions
Evaluation and Management -
\E/M Documentation
SOAP -
\S-Subjective- Patients statement about his or her health
O-Objective- Exam and doc of patients illness using observation, palpitation,
auscultation and percussion tests, and other services performed
Answers.
MS-DRG -
\Medicare Severity Diagnosis Related Group- Determines the amount the hospital will
be reimbursed.
EHR -
\Electronic Health Record
APC -
\Ambulatory Payment Classification
Outpatient coding -
\* Provider Services, use CPT, HCPC level II and ICD10-CM Codes.
* Work in provider offices, outpatient clinics, facility out patient department.
*Also use APC's
*More interaction with physician
Inpatient hospital coding -
\*Use ICD10 CM & ICD10 PCS
*Also use MS-DRG's for reimbursement
*Less interaction with providers
Outpatient provider services bill on what claim form? -
\cms-1500 Claim form
RA -
\Remittance Advice
EOB -
\Explanation of benefits
Mid level providers -
\PA, NP
- Known as physician extenders
-Practice medicine with physician supervision
-PA takes 26 1/2 mo after bachelors
, -NP Masters in nursing
What are two types of payers? -
\1) Private insurance plans
2)Government plans
Commercial Carriers -
\- Private payers offer group and individual
- Contracts vary- include hospital, basic, and major medical
-BCBS opperate in the state based
Medicare -
\-Primary Gov't payer
-Fed health insurance program
-Admin by CMS
-Coverage for 65 and older
-Blind or disabled, perm kidney failure, ESRD
Medicare programs -
\Part A- Inpatient, hospital care, skilled nursing, hospice, home health
Part B- Med necessary provider services, preventative care (outpatient)
Part C- Medicare advantage combines A, B, D CMS- HCC OMS Hierarchial condition
category
Part D- Prescription drug
Medicaid -
\Health Insurance assist program sponsored by federal and state for low income.
State funded insurance programs for children up to 21 -
\-Crippled Children's Services
-Children medical services
-Children indigent disability service
-CSHCS- Designed for specific chronic medical conditions
Evaluation and Management -
\E/M Documentation
SOAP -
\S-Subjective- Patients statement about his or her health
O-Objective- Exam and doc of patients illness using observation, palpitation,
auscultation and percussion tests, and other services performed
