Medical Baillind &Coding Exam Questions & Answers Latest Updated

HIPAA (part 1) - Answer Health Insurance Portability and Accountability Act ICD - Answer International Classification of Diseases required by Medicaid and Medicare CPT - Answer Current Procedural Terminology ( CDM - Answer Charge Description Manager Has all the info about health care services that patients have received and financial transactions that have taken place Makes sure that the provider accurately charges the patient for routine services and supplies Claim - Answer A claim is a complete record of all the services provided to a patient forms of info needed for a claim - Answer full name and demographic information. account number - Answer Number on an invoice that identifies specific episode of care, date of service or patient Medicare summary notice (MSN) - Answer document that outlines the amounts billed by the provider and what the patient must pay the provider what does HIPAA mean? (part 2) - Answer Fed Act to ensure the privacy of Protected Health Information (PHI) defines the permitted uses and disclosures of PHI Enforces rules and regs set forth in this Act by civil and criminal penalties What is Protected Health Information? - Answer PHI is all individually identifiable healthcare information in all forms: (VOWE) -Visual -Oral -Written -Electronic Individually Identifiable Information - Answer Info is individually identifiable if: -It id's the individual or offers a reasonable basis for id -It is created or received by a covered entity or an employer -Relates to the past, present or future physical or mental health or condition, the provision of health care, or the payment for heath care Permitted uses and disclosures of PHI - Answer -Directly to the individual who is the subject of the PHI -To any person for purposes of Treatment, Payment or health care Operations (TPO) -for reporting purposes as permitted by law or regulation -Family/friends acting as caregivers -Any person providing a HIPAA valid authorization PHI Use vs Disclosure - Answer Use = the way PHI is handled internally be a covered entity or its BA Disclosure =The way PHI is disseminated from a covered entity or its BA to an outside person or organization. The privacy Rule applies to PHI requests by covered entities and their BAs HIPAA Valid Authorization - Answer -contains description of the info to be released -name/id of person requesting the disclosure -name/id of person whom the PHI will be released -description of the purpose of the use or disclosure -Expiration date- limit of time for the authorization -signature and date -a statement notifying the individual of the right to revoke at anytime - a statement regarding the ability or inability to condition treatment or payment on the authorization Incidental Uses and Disclosures - Answer HIPAA explicitly permits certain incidental uses and disclosures that occur as a by-product of a us or disclosure otherwise permitted by HIPAA Examples of incidental uses and disclosures - Answer -calling out name of patient names is waiting area -discussing a patient at a nursing station where visitors my overhear -discussing treatment in a room shared by more that one patient REASONABLE SAFEGUARDS TO BE USED TO PROTECT PHI - Answer -speak quietly when discussing a pts condition where it may be overheard -avoid using a pts name in public or hallways or elevators -posting signs to remind employees to protect pt confidentiality -Isolating or locking file cabinets or record rooms -providing security such as passwords, screen savers, automatic log-off's, etc on computers where personal information is maintained 7 PRIVACY RIGHTS (relate to pts) - Answer -The right to Notice of Privacy Practices -The right to request Restrictions in PHI -The Right to Confidential Communications -The Right to inspect and get copies of PHI - The Right to Request Amendments to the PHI - The Right to an Accounting of Disclosures of th ePHI (Who else saw the medical records) - The Right to Complain HCPCS CODES BACKGROUND - Answer have 3 levels -cpt codes -hcpcs level ii codes (separate book, ambulance transport, drugs -category iii codes - tracking ends in "T" for temporary HCPCS means - Answer Healthcare Financing Administration Common Procedure Coding System Created by Medicare in 1983. Used by Medicaid system also CPT - Answer Current Procedural Terminology -5-digit numeric codes -Physician services (E&M codes) Evaluation and Management -Procedures, Diagnostic and Therapeutic -2 digit modifiers -modifiers faciliate alteration of a service/procedure due to specific circumstances FIRST PUBLISHED IN 1966 nomenclature - Answer The devising or choosing of names for things especially in science AMA - Answer American Medical Association