OUTPATIENT CODING CHAPTER 1 LATEST
QUESTIONS WITH COMPLETE SOLUTIONS!!
application service provider (ASP) Answer - third-party entity that manages and
distributes software-based services and solutions to customers across a wide
area network (WAN) from a central data center.
Assessment (A) Answer - judgment, opinion, or evaluation made by the health
care provider; considered part of the problem-oriented record (POR) SOAP
note.
assumption coding Answer - inappropriate assignment of codes based on
assuming, from a review of clinical evidence in the patient's record, that the
patient has certain diagnoses or received certain procedures/services even
though the provider did not specifically document those diagnoses or
procedures/services
Automated case abstracting software Answer - software program that is used
to collect and report inpatient and outpatient data for statistical analysis and
reimbursement purposes.
Centers for Medicare & Medicaid Services (CMS) Answer - a US government
organization that oversees services for the federally sponsored Medicare and
Medicaid insurance programs
Claims examiner Answer - Employed by a third-party payer reviews health-
related claims to determine whether the charges are reasonable and for
medical necessity.
,clearinghouse Answer - public or private entity that processes or facilitates the
processing of health information and claims from a nonstandard to a standard
format.
CMS-1500 Answer - Standard claim form used for outpatient reimbursement
CMS-1450 Answer - another name for the UB-04 uniform bill form.
code Answer - numerical and alphanumerical characters that are reported to
health plans for health care reimbursement and to external agencies (e.g., state
departments of health) for data collection, in addition to being reported
internally (e.g., acute care hospital) for education and research.
coder Answer - acquires a working knowledge of coding systems (e.g., CPT,
HCPCS Level II, ICD-10-CM, and ICD-10-PCS), coding principles and rules,
government regulations, and third-party payer requirements to ensure that all
diagnoses (conditions), services (e.g., office visit), and procedures (e.g., surgery
and x-ray) documented in patient records are coded accurately for
reimbursement, research, and statistical purposes.
coding Answer - assignment of codes to diagnoses, services, and procedures
based on patient record documentation.
coding system Answer - organizes a medical nomenclature according to similar
conditions, diseases, procedures, and services; it contains codes for each.
computer-assisted coding (CAC) Answer - uses computer software to
automatically generate medical codes by "reading" transcribed clinical
documentation; uses "natural language processing" theories to generate codes
that are reviewed and validated by coders for reporting on third-party payer
claims.
, concurrent coding Answer - review of records and/or use of encounter forms
and chargemasters to assign codes during an inpatient stay or an outpatient
encounter; typically performed for outpatient encounters because encounter
forms and chargemasters are completed in "real time" by health care providers
as part of the charge-capture process
Current Procedural Terminology (CPT) Answer - the standardized classification
system for reporting medical procedures and services
database Answer - contains a minimum data set of patient information
collected on each patient, including chief complaint; present conditions and
diagnoses; social data; past, personal, medical, and social history; review of
systems; physical examination; and baseline laboratory data; considered part of
the problem-oriented record (POR).
demographic data Answer - patient identification information that is collected
according to facility policy (e.g., patient's name, date of birth, mother's maiden
name, and Social Security number).
Diagnostic and Statistical Manual of Mental Disorders (DSM) Answer - manual
published by the American Psychiatric Association that contains diagnostic
assessment criteria used as tools to identify psychiatric disorders; DSM includes
psychiatric disorders and codes, provides a mechanism for communicating and
recording diagnostic information, and is used in the areas of research and
statistics.`
diagnostic/management plans Answer - information about the patient's
condition and the planned management of conditions; considered part of the
problem-oriented record (POR).
QUESTIONS WITH COMPLETE SOLUTIONS!!
application service provider (ASP) Answer - third-party entity that manages and
distributes software-based services and solutions to customers across a wide
area network (WAN) from a central data center.
Assessment (A) Answer - judgment, opinion, or evaluation made by the health
care provider; considered part of the problem-oriented record (POR) SOAP
note.
assumption coding Answer - inappropriate assignment of codes based on
assuming, from a review of clinical evidence in the patient's record, that the
patient has certain diagnoses or received certain procedures/services even
though the provider did not specifically document those diagnoses or
procedures/services
Automated case abstracting software Answer - software program that is used
to collect and report inpatient and outpatient data for statistical analysis and
reimbursement purposes.
Centers for Medicare & Medicaid Services (CMS) Answer - a US government
organization that oversees services for the federally sponsored Medicare and
Medicaid insurance programs
Claims examiner Answer - Employed by a third-party payer reviews health-
related claims to determine whether the charges are reasonable and for
medical necessity.
,clearinghouse Answer - public or private entity that processes or facilitates the
processing of health information and claims from a nonstandard to a standard
format.
CMS-1500 Answer - Standard claim form used for outpatient reimbursement
CMS-1450 Answer - another name for the UB-04 uniform bill form.
code Answer - numerical and alphanumerical characters that are reported to
health plans for health care reimbursement and to external agencies (e.g., state
departments of health) for data collection, in addition to being reported
internally (e.g., acute care hospital) for education and research.
coder Answer - acquires a working knowledge of coding systems (e.g., CPT,
HCPCS Level II, ICD-10-CM, and ICD-10-PCS), coding principles and rules,
government regulations, and third-party payer requirements to ensure that all
diagnoses (conditions), services (e.g., office visit), and procedures (e.g., surgery
and x-ray) documented in patient records are coded accurately for
reimbursement, research, and statistical purposes.
coding Answer - assignment of codes to diagnoses, services, and procedures
based on patient record documentation.
coding system Answer - organizes a medical nomenclature according to similar
conditions, diseases, procedures, and services; it contains codes for each.
computer-assisted coding (CAC) Answer - uses computer software to
automatically generate medical codes by "reading" transcribed clinical
documentation; uses "natural language processing" theories to generate codes
that are reviewed and validated by coders for reporting on third-party payer
claims.
, concurrent coding Answer - review of records and/or use of encounter forms
and chargemasters to assign codes during an inpatient stay or an outpatient
encounter; typically performed for outpatient encounters because encounter
forms and chargemasters are completed in "real time" by health care providers
as part of the charge-capture process
Current Procedural Terminology (CPT) Answer - the standardized classification
system for reporting medical procedures and services
database Answer - contains a minimum data set of patient information
collected on each patient, including chief complaint; present conditions and
diagnoses; social data; past, personal, medical, and social history; review of
systems; physical examination; and baseline laboratory data; considered part of
the problem-oriented record (POR).
demographic data Answer - patient identification information that is collected
according to facility policy (e.g., patient's name, date of birth, mother's maiden
name, and Social Security number).
Diagnostic and Statistical Manual of Mental Disorders (DSM) Answer - manual
published by the American Psychiatric Association that contains diagnostic
assessment criteria used as tools to identify psychiatric disorders; DSM includes
psychiatric disorders and codes, provides a mechanism for communicating and
recording diagnostic information, and is used in the areas of research and
statistics.`
diagnostic/management plans Answer - information about the patient's
condition and the planned management of conditions; considered part of the
problem-oriented record (POR).
