HCPCS, Coding, compliance & Auditing Exam Bank Solution Manual Already Passed
Source Documening - Answers Actual Pt health records, office noes, consultation report, progress note, operative report, or diagnosis evaluation
its imperative to become familiar with what constitutes correct documenta...
Source Documening - Answers Actual Pt health records, office noes, consultation report, progress note,
operative report, or diagnosis evaluation
its imperative to become familiar with what constitutes correct documentation because - Answers
reimbursement for the physician's services is based on WHAT IS DOCUMENTED
Sound Health records should be chronologically documented because these records serve the following
function - Answers They enable the physician and other healthcare professionals to plan and
evaluate the patient's treatment.
• They enhance communications and promote continuity of care among
physicians and other healthcare professionals involved in the patient's care.
• They facilitate claims review and payment.
• They reduce hassles related to medical review.
• They serve as a legal document to verify the care provided, which can be
helpful in defending against an alleged professional liability claim.
The physician should read, sign, and date all dictated medical records - Answers before they're placed in
the patient's chart. A signature alongside the note indicates that the physician read the transcription and
approved the information
When Medicare audits a medical record and the record can't be read by at least two people - Answers
considered illegible, and the services won't be reimbursed.
CMS - Answers administers Medicare, doesn't specify whether a full
signature is required or whether initials are permitted.
documentation of each patient encounter should include - Answers date, reason for the encounter,
appropriate history and physical exam, review of lab and/or x-ray data, assessment, and plan for care.
The CPT and ICD-9 codes reported on the health insurance claim form - Answers should reflect the
documentation in the medical
record and support the medical necessity. An important phrase to remember in the insurance world is,
"if it wasn't documented, it wasn't done!"
medically necessary services - Answers as those that adhere to standards of good medical practice,
match up with the diagnosis, and provide the most appropriate level of care in the most appropriate
, setting (may or may not be covered depending on plan)
It's important to understand medical necessity because it determines (1) whether how patients are
being treated is appropriate and (2) whether the services or
procedures are reimbursable.
Choosing the primary diagnosis and then linking the diagnosis to the procedure are critical steps -
Answers for proper reimbursement
codelinkage edits (ICD-9/CPT matching) - Answers built into their claims-processing systems
Coding from operative reports can be difficult - Answers You must have a good understanding of medical
terminology as well as a correct idea of the actual
procedure performed. Effective communication with the physician is essential for accurate coding.
Evaluation and Management (E/M) codes - Answers cover those services generally considered to be the
office visit, hospital visit, consultation, or ER visit. EX (pediatric or family practice,)
HCPCS (pronounced HIC-pics) - Answers is the Healthcare Common Procedure Coding System
stands for Healthcare Common Procedure Coding System. HCPCS was established in the 1980s to
provide a standardized coding system for describing the specific procedures and services in health care
Level II codes (national codes) - Answers used mainly to identify products, supplies, and services not
included in the CPT-4 codes. These can include
• Ambulance services
• Durable medical equipment
Prosthetics
• Orthotics
• Nonphysician supplies
created to provide reporting and billing mechanisms
for codes not covered under CPT.
Level II HCPCS codes consist of four digits preceded by an alphabetical character ranging from A through
V
Level I codes - Answers consist of five-digit codes, CPT level
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