AAPC CPC Chapter 1 Exam Questions with Verified Solutions Latest Version (Rated A+)

AAPC CPC Chapter 1 Exam Questions with Verified Solutions Latest Version (Rated A+) Medical coding - Answers 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 - Answers coders who specialize in coding inpatient hospital services MS-DRG - Answers Medical Severity-Diagnosis Related Groups MS-DRG are used to: - Answers 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 - Answers maintain facility, regional, and national databases of cancer patients EHR - Answers electronic health record Other roles coders can have: - Answers consultants, educators, medical auditors Outpatient coders - Answers 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 - Answers 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) - Answers explains the payer's determination in payment Scope of practice - Answers practice guidelines for each level of a provider individually dictated by states Mid-level Provider (MLP) - Answers include physician assistants (PA) and nurse practitioners (NP); aka physician extenders Physician Assistant (PA) - Answers 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) - Answers have a master's degree in nursing Two types of payers: - Answers private insurance plans and government insurance plans Medicare - Answers 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 - Answers Inpatient coverage, home health, hospice, skilled nursing facilities; also defines limits of Medicare usage Medicare Part B - Answers 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) - Answers 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 - Answers Centers for Medicare & Medicaid Services-Hierarchical Condition Category Medicare Part D - Answers Prescription drug coverage Medicaid - Answers health insurance assistance program sponsored by federal and state governments for low-income people Limiting charge - Answers set limits on what the patient can be charged SOAP - Answers subjective, objective, assessment, plan Subjective - Answers patient's statement about his or her health, includes symptoms Objective - Answers provider's examination and documentation of the patient's illness Assessment - Answers evaluation and conclusion made by the provider; where you find the diagnoses Plan - Answers course of action E/M - Answers Evaluation and Management Operative Report coding tips - Answers 1. Highlight unfamiliar words 2. Use post-operative Dx for coding; if pathology report available, use pathology report for Dx 3. Start with procedures listed 4. Look for key words 5. Read the body Medical Necessity - Answers the lease radical service/procedure that allows for effective treatment of the pt's complaint or condition National Coverage Determinations Manual - Answers describes whether specific medical items, services, treatment, procedures, or technologies can be paid for under Medicare National Coverage Determination (NCD) - Answers explain when Medicare will pay for item