Aapc stuvia - Study guides, Class notes & Summaries

You are performing an audit of evaluation and management services for a family practice office. In the encounter, you read the physician ordered and reviewed a differential WBC. Which of the following best describes what you would expect to see in the medical record? - ANSWER Patient identification, assignment of benefits, patient's medical history, immunizations, physical examination, lab report, clinical impression, and physician orders. As an auditor, who of the following would NOT be exp...

A covered entity does NOT include a. Healthcare providers b. Health plans c. Patients d. Clearinghouses - ANSWERSc. Patients What does MAC stands for? a. Medicare Administrative Contractor b. Medicare Advisory Contractor c. Medicaid Administrative Contractor d. Medicaid Alert Contractor - ANSWERSa. Medicare Administrative Contractor When are providers responsible for obtaining an ABN for a service NOT considered medically necessary? a. After providing a service or item to...

Local Coverage Determinations are administered by whom? a. State Law b. NCDs c. Each regional MAC d. LMRPs - ANSWERSc. Each regional MAC ABN stands for _____. a. Advanced Benefits Notification b. Advisory Beneficial Notice c. Admitting Beneficiary Notice d. Advance Beneficiary Notice - ANSWERSd. Advance Beneficiary Notice What type of health insurance provides coverage for low-income families? a. Commercial HMO b. Medicaid c. Medicare d. Commercial PPO - ANSWERSb. Med...

AAPC Official CPC Certification Study Guide Notes "hold harmless clause" - ANSWER * found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-pays. A compliance plan may offer several benefits, including: - ANSWER * more accurate payment of claims * fewer billing mistakes * improved documentation and more accurate coding * less chance of violating self-referral and anti-kickback status A healthcare clearing house is a -...

When coding in operative report what action would NOT be recommended? - ANSWERSCoding from the header with out reading the body of the report If an NCD doesn't exist for a particular service/procedure performed on a Medicare patient who determines coverage? - ANSWERSMedicare administrative contractor (MAC) MAC stands for what!? - ANSWERSMedicare administrative contractor What is the definition of coding? - ANSWERSTranslating documentation into numerical/alphabetical codes used to obtai...

The minimum necessary rule is based on sound current practice that protected health information should NOT be used or disclosed when it is not necessary to satisfy a particular purpose or carry out a function. What does this mean? a. Staff members are allowed to access any medical record without restriction b. Providers should develop safeguards to prevent unauthorized access to protected health information. c. Practices should only provide minimum necessary information to patients. d. All...

Local Coverage Determinations are administered by whom? a. State Law b. NCDs c. Each regional MAC d. LMRPs - ANSWERSc. Each regional MAC ABN stands for _____. a. Advanced Benefits Notification b. Advisory Beneficial Notice c. Admitting Beneficiary Notice d. Advance Beneficiary Notice - ANSWERSd. Advance Beneficiary Notice What type of health insurance provides coverage for low-income families? a. Commercial HMO b. Medicaid c. Medicare d. Commercial PPO - ANSWERSb. Med...

AAPC CPB - Chapter 10 ReviewAAPC CPB - Chapter 10 ReviewWhich statement is TRUE regarding the Prompt Payment Act? a. Patients are required to pay patient balances within 30 days. b. Patient balances are dismissed if a statement is not sent to the patient within 30 days. c. Federal agencies are not required to respond to all clean claims within 30 days of receipt. d. Federal agencies are required to pay clean claims within 30 days of receipt. - ANSWER-d. Federal agencies are required to pay...

AAPC CPB - Chapter 2 ReviewAAPC CPB - Chapter 2 ReviewWhat is the largest health program in the United States? a. Blue Cross Blue Shield b. Medicare c. Medicaid d. TRICARE - ANSWER-b. Medicare Which of the following services is NOT covered under Medicare Part B? a. Cardiovascular disease screening b. Diabetes self-management c. Nutrition therapy services d. Home Health services - ANSWER-d. Home Health services Health Savings Account (HSA) is ____________________ to employees. ...

What form is provided to a patient to indicate a service may not be covered by medicare and the patient may be responsible for the charges? - ANSWERSABN Under HIPAA what would be a policy requirement for "minimum necessary"? - ANSWERSOnly individuals whos job requires it may have access to protected health information What document is referenced to when looking for potential problem areas indentified by the government indicating scrutiny of the service? - ANSWERSOIG work plan Select t...