AAPC CPC Chapter 1 questions and answers, graded A+. updated

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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 c ... oders, 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 - ☑☑patient's statement about his or her health, includes symptoms Objective - ☑☑provider's examination and documentation of the patient's illness Assessment - ☑☑evaluation and conclusion made by the provider; where you find the diagnoses Plan - ☑☑course of action [Show More]

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