AAPC - Chapter 1 Review Exam Already Passed

AAPC - Chapter 1 Review Exam Already Passed What type of health insurance provides coverage for low-income families? ✔✔Medicaid Rationale: Medicaid is a health insurance assistance program for some low-income people ...

AAPC - Chapter 1 Review Exam Already Passed What type of health insurance provides coverage for low-income families? ✔✔Medicaid Rationale: Medicaid is a health insurance assistance program for some low-income people (especially children and pregnant women) sponsored by federal and state governments. The minimum necessary rule applies to ✔✔Covered entities taking reasonable steps to limit use or disclosure of PHI Rationale: The Privacy Rule generally requires covered entities to take reasonable steps to limit the use or disclosure of, and requests for, protected health information to the minimum necessary to accomplish the intended purpose. The minimum necessary standard does not apply to the following: · Disclosures to or requests by a health care provider for treatment purposes. · Disclosures to the individual who is the subject of the information. · Uses or disclosures made pursuant to an individual's authorization. · Uses or disclosures required for compliance with the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Rules. · Disclosures to the Department of Health & Human Services (HHS) when disclosure of information is required under the Privacy Rule for enforcement purposes. · Uses or disclosures that are required by other law. Which type of information is NOT maintained in a medical record? ✔✔Financial records Rationale: Every time a patient receives health care, a record is maintained of the observations, medical or surgical interventions and treatment outcomes. Administrative data, such as financial records, should not be included in the medical record or provided in response to a subpoena or request for health records. Which of the following is a BENEFIT of electronic transactions? ✔✔Timely submission of claims Rationale: Electronic claims benefit the provider office by allowing timely submissions to the insurance carrier and proof of transmission of the claims. AAPC credentialed coders have proven mastery of what information? ✔✔All of the above Rationale: AAPC credentialed coders have proven mastery of all code sets, evaluation and management principles, and documentation guidelines. What is the definition of medical coding? ✔✔Translating documentation into numerical/alphanumerical codes used to obtain reimbursement. Rationale: Medical coding is the process of translating a healthcare provider's documentation of a patient encounter into a series of numeric or alphanumeric codes. In what year did HIPAA become law? ✔✔1996 Rationale: HIPAA was adopted into law in 1996. HIPAA stands for ✔✔Health Insurance Portability and Accountability Act In what year was HITECH enacted as part of the American Recovery and Reinvestment Act? ✔✔2009 Rationale: The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. Local Coverage Determinations are administered by whom? ✔✔Each regional MAC Rationale: Each Medicare Administrative Contractor (MAC) is responsible for interpreting national policies into regional policies. What is the value of a remittance advice? ✔✔It states what will be paid and why any changes to charges were made. Rationale: The determination of the payer is sent to the provider in the form of a remittance advice. The remittance advice explains the outcome of the insurance adjudication on the claim, including the payment amount, contractual adjustments and reason(s) for denial. A covered entity does NOT include ✔✔Patients A covered entity may obtain consent from an individual to use or disclose protected health information to carry out all of the following EXCEPT what? ✔✔Research Rationale: A covered entity may obtain consent of the individual to use or disclose protected health information to carry out treatment, payment or healthcare operations. When are providers responsible for obtaining an ABN for a service NOT considered medically necessary? ✔✔Prior to providing a service or item to a beneficiary. Rationale: Providers are responsible for obtaining an ABN prior to providing the service or item to a beneficiary. Evaluation and management services are often provided in a standard format such as SOAP notes. What does the acronym SOAP stand for? ✔✔Subjective, Objective, Assessment, Plan What type of insurance is Medicare Part D? ✔✔Prescription drug coverage available to all Medicare beneficiaries. Rationale: Medicare Part D is a prescription drug program available to all Medicare beneficiaries for a fee. Private companies approved by Medicare provide the coverage. According to AAPC's Code of Ethics, an AAPC member shall use only ____ and ____ means in all professional dealings. ✔✔legal and ethical Rationale: AAPC members shall use only legal and ethical means in all professional dealings and shall refuse to cooperate with, or condone by silence, the actions of those who engage in fraudulent, deceptive or illegal acts. Which option below is NOT a covered entity under HIPAA? ✔✔Workers' Compensation Rationale: The definition of health plan in the HIPAA regulations excludes any policy, plan or program that provides or pays for the cost of excepted benefits. Excepted benefits include: • Coverage only for accident or disability income insurance, or any combination thereof; • Coverage issued as a supplement to liability insurance; • Liability insurance, including general liability insurance and automobile liability insurance; • Workers' compensation or similar insurance; • Automobile medical payment insurance; • Credit-only insurance; • Coverage for on-site medical clinics; • Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits. What will the scope of a compliance program depend on? ✔✔The size and resources of the provider's practice. Rationale: The scope of a compliance program will depend on the size and resources of the provider practice. What is PHI? ✔✔Protected health information Rationale: Protected health information under the Health Information Portability and Accountability Act (HIPAA) is any information, whether oral or recorded, in any form or medium that is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university or health care clearinghouse relating to the past, present or future physical or mental health or condition of an individual, the provision of health services to that individual or payment around those services. Only health information at the individual level is covered; health information of groups is not. LCDs only have jurisdiction in their ____. ✔✔Region Rationale: LCDs only have jurisdiction within their region. What is the purpose of National Coverage Determinations? ✔✔To explain CMS policies on when Medicare will pay for items or services. Rationale: National Coverage Determinations (NCD) explain CMS policies on when Medicare will pay for items or services. Which coding manuals do outpatient coders focus on learning? ✔✔CPT®, HCPCS Level II and ICD-10-CM Rationale: Outpatient coding focuses on provider services. Outpatient coders will focus on learning CPT®, HCPCS Level II and ICD-10-CM. When coding an operative report, what action would NOT be recommended? ✔✔Coding from the header without reading the body of the report. Rationale: Operative report coding tips include reviewing the documentation in the detail of the procedure to further clarify or define both procedures and diagnoses. What does CMS-HCC stand for? ✔✔Centers for Medicare and Medicaid Services - Hierarchal Condition Category