Advanced Medical Coding Questions and Answers with complete solutions

Advanced Medical Coding Questions and Answers with complete solutions AAPC - American Academy of Professional Coders; the national organization that provides education and professional certification to medial coders in the specialized areas of physician's office American Health Information Management Association (AHIMA) - National organization that focuses on the management of personal health information required in healthcare settings case-mix- index - average relative weight of all cases treated at a given healthcare facility, which reflects the intensity of the resources utilized or clinical severity centers for Medicare and Medicaid Services (CMS) - the division of the Department of Health and Human Services that is responsible for developing healthcare policy in the US and for administering the Medicare program and the federal portion of the Medicaid program charge description master (CDM) or chargemaster - comprehensive list of eligible charges for an individual provider or healthcare facility classification system - system that takes identified nomenclatures and arranges relate entries. clinical terminology - set of standardized terminology used for a nomenclature Commission on Accreditation - accrediting organization for educational progams in health informatics and information management completeness - degree to which a professional coder captures all of the diagnosis and procedures documented by the physician in the health record compliance plan - provides the mechanism by which a facility or provider ensures that they are providing and billing for services according to the laws, regulations, and guidelines that govern billing and coding practices to prevent fraud and abuse decision support system - utilized for administrative and business activities in a healthcare organization or physician practice to produce information regarding the actual cost Department of Health and Human Services (DHHS) - cabinet-level federal agency that oversees all of the health and human services activities of the federal government and administers federal regulations fiscal intermediary (FI) - third party payer that has the Medicare contract for a specific state and administers the state's Medicare program, including processing the state's Medicare claims hard coding - coding that is not done by a coder, but is instead done by a facility's chargemaster system. Health Insurance Portability and Accountability Act of 1996 (HIPPA) - federal legislation enacted to provide continuity of health coverage, control fraud and abuse in healthcare health record - document created to record a patient's health and the services received during healthcare visits Medicare Code Edits (MCE) software - software that finds and reports errors in the coding of claims data National Correct Coding Initiative (NCCI) - a series of code edits on Medicare Part B claims that identifies incorrect CPT-4 nomenclature - set of terms used in a particular discipline patient record - the health record for a patient in a hospital setting prospective payment system (PPS) - a reimbursement methodology that uses a predetermined payment amount rate based on the treatment for a specific illness reliability - the degree to which the same codes are consistently assigned to the same health record by different coding professionals resident record - the health record for a patient in a long-term care setting resource-based relative value scale (RBVS) - medicare payment system that reimburses physicians treating Medicare patients timeliness - amount of time it takes for the health cord to be coded validity - degree to which the codes assigned accurately reflect the physician documentation for diagnoses and procedures in an episode of care World Health Organization (WHO) - the United Nations coordinating authority on international public health administrative documentation - information documented in the healthcare record regarding patient name, address, date of birth, age, etc. chief complaint - patient-provided subjective description of the events/reason why the patient sought medical treatment