AMCI Jeopardy Business of Medicine

Business of Medicine Chapter I

100

True or False, skilled coders could become coding consultants, educators, or auditors?

True

200

In terms of "tools of the trade" what is the difference between outpatient and inpatient coding?

Outpatient/ Professional Coders use - CPT, HCPCS, ICD-10 CM Inpatient/Facility Coders use - ICD-10-CM, and ICD-10 PCS

300

These medical providers are referred to as mid-level providers or physician extenders. List 2.

Physician Assistants, and Nurse Practitioners

400

Medicare has 4 parts. Name the part that provides coverage for inpatient hospital confinements.

Part A

500

What is Evaluation and management services are often provided in a standard format such as SOAP. What does SOAP represent?

S—Subjective O—Objective A—Assessment P—Plan

Business of Medicine Chapter I

100

True or False: Hospital or Facility coders code for all services during a hospital stay

False

200

This term refers to whether a procedure or service is considered appropriate in a given circumstance.

Medical Necessity

300

Medicare is administered by:

CMS - Centers for Medicare and Medicaid Services

400

What is PHI?

Protected Health Information This is anything that links the patient to his or her health status.

500

A Signed Disclosure by the patient applies to the following:

Treatment - Provided by the Physician Plan - Processing Health Insurance Administration of Business -

Business of Medicine Chapter I

100

True or False: Medical Coding is the process of translating written or dictated medical records into a series of numeric or alpha-numeric codes or nomenclature into Diagnosis, Procedure, and supplies using ICD-10 CM, CPC, and HCPCS code sets?

False: We use ICD-10 CM, CPT, and HCPCS code sets

200

This entity is responsible for interpreting national polices into regional policies

Medicare Administrative Contractor (MAC) Keyword Interpret

300

HCPCS Level II Codes is Nomenclature for:

Supplies and Drugs

400

Fraud or Abuse? Coder appends Modifier 59 to receive full payment for all multiple procedures.

Fraud - The definition of Fraud is to purposely bill for services that were never given or to bill for a service that has a higher reimbursement that the service provided Medicare established modifiers to be used in lieu of 59 XE - Separate Encounter XP - Separate Practitioner XS - Separate Structure XU - Unusual Non-Overlapping services ( Procedure that would typically be classified as incidental, but due to unusual circumstances it isn't)

500

List 2 key actions of an internal compliance plan?

Conduct internal monitoring and auditing through the performance of periodic audits. - Implement compliance and practice standards through the development of written standards and procedures. - Designate a compliance officer or contact(s) to monitor compliance efforts and enforce practice standards. - Conduct appropriate training and education on practice standards and procedures. - Respond appropriately to detected violations through the investigation of allegations and the disclosure of incidents to appropriate government entities.

Business of Medicine Chapter I

100

True or False: Coding is typically performed by either the biller or a coder

False: Coding is typically performed by a physician or a coder

200

This entity helps to spell out CMS policies on when Medicare will pay for items or services

National Coverage Determination (NCD) Key word is WHEN

300

Medicare determines payments for physician's services using this.

RBRVS - Resource-based relative value scale For Physicians: Work RVU + Work GPCI + Non-Facility PE RVU x PE GPCI + MP RVU x MP GPCI x (CF)

400

HIPAA is the Acronym for:

Health Insurance Portability and Accountability Act

500

According to PMCC: What are the steps required to look up a code?

When according to PMCC (Professional Medial Coding Curriculum by AAPC) coding operative reports, you code the following: 1. Code the diagnosis codes 2. Code the procedure codes 3. Look for the Key words 4. If a word is unfamiliar highlight it 5. Read the entire scenario

Business of Medicine Chapter I

100

True or False: Outpatient coding focuses on physician professional services and outpatient facility coding. Outpatient coders focus on CPT, HCPCs Level II, and ICD-10 CM Codes, they also work with Ambulatory Payment Classifications (APC)

True

200

What is In this statement, what does “os” stand for?

Documentation: The posterior vaginal fornix and outer cervical os were prepped with a cleansing solution. Ostium (Opening)

300

A Medicare patient is about to have a procedure could potentially be denied payment by Medicare. Under the law, the physician must do the following.

Present the patient with an Advanced Beneficiary Notice (ABN) form. An ABN explains why Medicare may deny the charges, and provide an estimate within $100.00 or 25% of the actual cost

400

When was HIPAA established

1996

500

What is What anatomic location does this diagnosis refer to? Kyphosis

"Thoracic Spine"