Exam (elaborations)
ADVANCED MEDICAL CODING QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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ADVANCED MEDICAL CODING QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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ADVANCED MEDICAL CODINGQUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
AAPC - ANSWER American Academy of Professional Coders; the national organization that provides
education and professional certification to medial coders in the specialized areas of physician's office
American Health Information Management Association (AHIMA) - ANSWER National organization that
focuses on the management of personal health information required in healthcare settings
case-mix- index - ANSWER average relative weight of all cases treated at a given healthcare facility, which
reflects the intensity of the resources utilized or clinical severity
centers for Medicare and Medicaid Services (CMS) - ANSWER the division of the Department of Health
and Human Services that is responsible for developing healthcare policy in the US and for administering
the Medicare program and the federal portion of the Medicaid program
charge description master (CDM) or chargemaster - ANSWER comprehensive list of eligible charges for
an individual provider or healthcare facility
classification system - ANSWER system that takes identified nomenclatures and arranges relate entries.
clinical terminology - ANSWER set of standardized terminology used for a nomenclature
Commission on Accreditation - ANSWER accrediting organization for educational progams in health
informatics and information management
completeness - ANSWER degree to which a professional coder captures all of the diagnosis and
procedures documented by the physician in the health record
compliance plan - ANSWER provides the mechanism by which a facility or provider ensures that they are
providing and billing for services according to the laws, regulations, and guidelines that govern billing
and coding practices to prevent fraud and abuse
, decision support system - ANSWER utilized for administrative and business activities in a healthcare
organization or physician practice to produce information regarding the actual cost
Department of Health and Human Services (DHHS) - ANSWER cabinet-level federal agency that oversees
all of the health and human services activities of the federal government and administers federal
regulations
fiscal intermediary (FI) - ANSWER third party payer that has the Medicare contract for a specific state and
administers the state's Medicare program, including processing the state's Medicare claims
hard coding - ANSWER coding that is not done by a coder, but is instead done by a facility's chargemaster
system.
Health Insurance Portability and Accountability Act of 1996 (HIPPA) - ANSWER federal legislation enacted
to provide continuity of health coverage, control fraud and abuse in healthcare
health record - ANSWER document created to record a patient's health and the services received during
healthcare visits
Medicare Code Edits (MCE) software - ANSWER software that finds and reports errors in the coding of
claims data
National Correct Coding Initiative (NCCI) - ANSWER a series of code edits on Medicare Part B claims that
identifies incorrect CPT-4
nomenclature - ANSWER set of terms used in a particular discipline
patient record - ANSWER the health record for a patient in a hospital setting
prospective payment system (PPS) - ANSWER a reimbursement methodology that uses a predetermined
payment amount rate based on the treatment for a specific illness
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