Coding medical necessity - Study guides, Class notes & Summaries

physician's office can improve their copayment collections and increase revenue by using an electronic health record to assist them in: Benefits and eligibility checking Under RBRVS, all of the following are separate relative value units (RVUs) assigned for each CPT/HCPCS code, except for: Geographic practice cost indices: Each of the three RVUs is adjusted through the GPCIs to adjust for costs in different areas of the country. GPCIs are not relative value units The clinical do...

HIM 2430 -- Principles of Healthcare Reimbursement FINAL Exam with Complete Solutions How do diagnosis-related groups (DRGs) affect hospital reimbursement? Diagnosis-related groups categorize hospital cases into groups that are expected to have similar hospital resource use, impacting how hospitals are reimbursed based on patient diagnoses. What is the impact of the Affordable Care Act on healthcare reimbursement models? The Affordable Care Act expanded access to insurance, promo...

NR511 Midterm Questions and Answers 100% Pass Define diagnostic reasoning Reflective thinking because the process involves questioning one's thinking to determine if all possible avenues have been explored and if the conclusions that are being drawn are based on evidence. Seen as a kind of critical thinking. What is subjective data? Anything the patient tells you or complains of regarding their symptoms Chief complaint HPI ROS What is objective data? Anything YOU can see, touch, feel, hear,...

Define diagnostic reasoning - A list of possible diagnoses based on historical and clinical presentation listed in order of priority Identify subjective and objective data - Subjective data is what the patient tells you (SAYS) objective data is what you see: labs, etc. (OBSERVE) Identify the components of the HPI - OLDCARTS onset location duration characteristics aggravating factors relieving factors timing and severity Develop an appropriate differential: - Confirm or rule out...

RHIA Domain 4 Practice Exam Questions and Answers All Correct The process in which a healthcare entity addresses the provider documentation issues of legibility, completeness, clarity, consistency, and precision is called: a. Query process b. Release of information process c. Coding process d. Case-finding process - Answer-A Healthcare entities should consider a policy in which queries may be appropriate when documentation in the patient record fails to meet one of the following five cri...

What type of profession, other than coding, might skilled coders enter? Consultants, educators, medical auditors What is the difference between outpatient and inpatient coding? Outpatient coding focuses on physician services. Outpatient coders focus on assigning CPT, HCPCS Level II, and ICD-10-CM codes. They work in provider offices, outpatient clinics and facility outpatient departments. Outpatient facility coders also work with ambulatory payment classifications (APCs). Inpatient hospital ...

CMM FINAL EXAM STUDY GUIDE – With Questions & Answers (Rated A+) CMM FINAL EXAM STUDY GUIDE – With Questions & Answers (Rated A+) What type of codes reflect the accurate level of medical necessity that justfies each CPT and HCPC level II code? - ANSWER - ICD-10 Why is it important to have accurate coding - ANSWER - minimizes denials and rejections while ensuring the practice is reimbursed the full amount All electronic opportunities to verfy active patient insurance and benefits sh...

NR511 Midterm 2024 Exam Questions And Answers Define diagnostic reasoning - ANSWER Reflective thinking because the process involves questioning one's thinking to determine if all possible avenues have been explored and if the conclusions that are being drawn are based on evidence. Seen as a kind of critical thinking. What is subjective data? - ANSWER Anything the patient tells you or complains of regarding their symptoms Chief complaint HPI ROS What is objective data?...

NR 511 Final Exam Questions Marking Scheme Define Diagnostic Reasoning - Answer -To solve problems, to promote health, and to screen for disease or illness. All require a sensitivity to complex stories, to contextual factors, and to sense of probability and uncertainty. Can be seen as a kind of critical thinking. Discuss and identify subjective data - Answer -reports, complaints of , replies to provider questions, includes ROS, CC, HPI Discuss and identify objective data - Answer -w...

Abstractor - Correct hospital employee who converts documented procedurs and diangoses into medical codes Abuse - Correct coding practices that lead to improper reimbursement by error because they do not meet medical necessity, ex. changing diagnosis to be covered by insurance Accreditation - Correct an examination process the healthcare facility goes through to evaluate the facilities policies, procedures, and performance to meet higher standards. Accredited - Correct Having seal of app...