Chapter 1 - Quiz

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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


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