Chapter 1 - Quiz
What is the value of a remittance advice
It states what will be paid and why any changes to charges were made
Who are mid level providers
Physician Assistant (PA) and Nurse Practioner (NP)
In what year was the AAPC founded
1988
In what year did HIPAA become law
1996
In what year was HITECH enacted as part of the American Recovery and Reinvestment Act
2009
HITECH provides how many days to correct violations not due to willful neglect
30
How many components are included in an effective compliance plan
7
ABN stands for
Advance Beneficiary Notice
What form is used to submit a provider's charge to the insurance carrier
CMS-1500
Which coding manuals do outpatient coders focus on learning
CPT, HCPCS Level II and ICD-10-CM
What does CMS-HCC stand for?
Centers for Medicare and Medicaid Services - Hierarchal Condition Category
When coding an operative report, what action would NOT be recommended?
Coding from the header without reading the body of the report
The minimum necessary rule applies to
Covered entities taking reasonable steps to limit use or disclosure of PHI
Local Coverage Determinations are administered by
Each regional MAC
According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of professional conduct?
Efficiency
What is not a benefit of an active compliance plan
Eliminates risk of an audit
HIPPA stands for
Health Insurance Portability and Accountability Act of 1996
If an NCD does not exist for a particular service/procedure performed on a Medicare patient, who determines coverage?
MAC-Medicare Administrative Contractor
What type of health insurance provides coverage for low income families
Medicaid
What manual describes whether specific medical items, services, treatment procedures or technologies are considered medically necessary under Medicare
National Coverage Determinations Manual
Healthcare providers are responsible for developing______ and policies & procedures regarding privacy in their practices
Notices of Privacy Practices
Who is responsible for enforcing the HIPAA security rule
OCR-Office of Civil Rights
The Medicare program is made up of several parts-which part covers provider fees without the use of a private insurer
Part B
The Medicare program is made up of several parts-which part is affected by the Centers for Medicare & Medicaid Services-Hierarchical Condition Categories (CMS-HCC)
Part C
A covered entity does NOT include
Patients
According to the OIG, internal monitoring and auditing should be performed by what means?
Periodic Audits
What type of provider goes through approximately 26.5 months of education and is licensed to practice medicine with the oversight of a physician?
Physician Assistant (PA)
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
What is PHI
Protected Health Information
The minimum necessary rule means
Providers should develop safeguards to prevent unauthorized access to protected health information
What will the scope of a compliance program depend on?
The size and resources of the provider's practice
What is the purpose of National Coverage Determinations
To explain CMS policies on when Medicare will pay for items or services
What is the definition of medical coding
Translating documetation into numerical/alphnumerical codes used to obtain reimbursement
Twice a year the OIG releases a ____ outlining its priorities for the fiscal year ahead
Work Plan
AAPC credentialed coders have proven mastery of what information?
code sets, evaluation & management principles & documentation guidelines
Professionals who specialize in coding are called
coding specialists
The OIG recommends that provider practices enforce disciplinary actions through well publicized compliance guidelines to ensure actions that are ______.
consistent and appropriate
Many coding professionals go on to find work as
consultants
The AAPC offers over 500 local chapters across the country for the purpose of
continuing education and networking
EHR stands for
electronic health record
Which type of information is NOT maintained in a medical record
financial records
Voluntary compliance programs also provide benefits by not only helping to prevent erroneous or ___, but also by showing that the physician practice is making additional good faith efforts to submit claims appropriately.
fraudulent claims
According to AAPC's Code of Ethics, a member shall use only __ and ___ means in all professional dealings.
legal and ethical
According to AAPC's Code of Ethics, a member shall use only __ and ___ means in all professional dealings.
legan and ethical
What is not a covered entity under HIPPA
patients and workers compensation
What type of insurance is Medicare Part D
prescription drug coverage available to all Medicare beneficiaries
LCD's only have jurisdiction in their __ area.
regional
A covered entity may not obtain consent from an individual to use or disclose protected health information for what
research
What does SOAP stand for
subjective, objective, assessment, plan
what is a benefit of electronic transactions
timely submission of claims