AAPC CPC Chapter 1 correctly answered 2023

AAPC CPC Chapter 1 correctly answered 2023MS-DRG Medicare Severity Diagnosis Related Group- Determines the amount the hospital will be reimbursed. EHR Electronic Health Record APC Ambulatory Payment Classification Outpatient coding * Provider Services, use CPT, HCPC level II and ICD10-CM Codes. * Work in provider offices, outpatient clinics, facility out patient department. *Also use APC's *More interaction with physician Inpatient hospital coding *Use ICD10 CM & ICD10 PCS *Also use MS-DRG's for reimbursement *Less interaction with providers Outpatient provider services bill on what claim form? cms-1500 Claim form RA Remittance Advice EOB Explanation of benefits Mid level providers PA, NP - Known as physician extenders -Practice medicine with physician supervision -PA takes 26 1/2 mo after bachelors -NP Masters in nursing What are two types of payers? 1) Private insurance plans 2)Government plans Commercial Carriers - Private payers offer group and individual - Contracts vary- include hospital, basic, and major medical -BCBS opperate in the state based Medicare -Primary Gov't payer -Fed health insurance program -Admin by CMS -Coverage for 65 and older -Blind or disabled, perm kidney failure, ESRD Medicare programs Part A- Inpatient, hospital care, skilled nursing, hospice, home health Part B- Med necessary provider services, preventative care (outpatient) Part C- Medicare advantage combines A, B, D CMS- HCC OMS Hierarchial condition category Part D- Prescription drug Medicaid Health Insurance assist program sponsored by federal and state for low income. State funded insurance programs for children up to 21 -Crippled Children's Services -Children medical services -Children indigent disability service -CSHCS- Designed for specific chronic medical conditions Evaluation and Management E/M Documentation SOAP S-Subjective- Patients statement about his or her health O-Objective- Exam and doc of patients illness using observation, palpitation, auscultation and percussion tests, and other services performed A- Assessment-Eval and conclusion P-Plan- course of action Operative Report documentation Header- Date, time, name of docs, anesthesia & anesthesia provider, pre&Post Op dx, procedure, complications Body-Indication for surgery, details of procedure, findings Operative Report coding tips 1) Highlight unfamiliar words and look up 2) DX code reporting- Post op dx best or pathology report 3) Start with procedure listed in header 4) look for key words- Locations, anatomical structure, surgical approach, procedure method, procedure type (open/closed), size, number, surgical instrument 5) Read the body