Medical Coding exam | 87 Questions With Complete Solutions.

HIPAA (part 1) - Health Insurance Portability and Accountability Act ICD - International Classification of Diseases required by Medicaid and Medicare CPT - Current Procedural Terminology ( CDM - 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 - A claim is a complete record of all the services provided to a patient forms of info needed for a claim - full name and demographic information. account number - Number on an invoice that identifies specific episode of care, date of service or patient Medicare summary notice (MSN) - document that outlines the amounts billed by the provider and what the patient must pay the provider what does HIPAA mean? (part 2) - 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? - PHI is all individually identifiable healthcare information in all forms: (VOWE)-Visual -Oral -Written -Electronic Individually Identifiable Information - 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 - -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 - 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