Coding medical necessity - Study guides, Class notes & Summaries

ICD-10-CM Coding Chapter Six with Complete Solutions ICD International Classification of Diseases (ICD) is published by the World Health Organization (WHO) and is used to classify mortality (death) data from death certificates. In 1994, WHO published the 10th revision of ICD with a new name, International Statistical Classification of Diseases and Related Health Problems, and reorganized its three-digit categories. (Although the name of the publication was changed, the familiar abbrevi...

What are the roles of physician advisor? - Regulatory oversight, cost containment, Medicare audits and denials, commercial insurance denials, length of stay management, clinical documentation improvement, and ICD-10 implementation. Done with concurrent reviews, daily MDR rounds, patient quality and safety initiatives, compliance, coding, CDI and physician education. PSROs- Professional standards review organizations - Created to review the quality, quantity, and cost of hospital care provided...

NR511 Midterm Exam Questions With 100% Verified Answers Define diagnostic reasoning - answerReflective 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? - answerAnything the patient tells you or complains of regarding their symptoms Chief complaint HPI ROS What is objective data? - answe...

Medical billing and coding Test with correct Answers Medical Insurance Policyholder Health Plan Benefits. Medical Necessity. Covered Services Non-covered Services Individual Health Plan (I H P) Group Health Plan (G H P) Disability Insurance Workers' Compensation Insurance Indemnity Insurance Managed care Premium. Deductible Coinsurance Health Maintenance Organizations (HMOs) capitation Method Per member per month, (PMPM) Point of Service Plan (PPO) ...

NR 599 FINAL STUDY GUIDE UPDATED 2024. ● Ethical decision making ○ When making choices about ethical issues based on the standards of right vs wrong. ○ It requires a systematic framework for addressing the complex and often controversial moral questions. ● Bioethical standards ○ The study of healthcare ethics ○ Bioethics takes on relevant ethical problems seen by healthcare providers in relation to care ● Telehealth ○ wide range of health services that are delivered by...

abstracting - ️️Reviewing medical record documentation to discover clinical concepts that support assigning codes to the highest level of specificity. clinical documentation - ️️Information recorded in the medical record pertaining to the health status of a patient as determined by a health care provider. CPT - ️️Current Procedural Terminology. Codes for services and procedures. electronic health record (EHR) - ️️A digital version of a patient's chart that includes info...

Abstractor - hospital employee who converts documented procedurs and diangoses into medical codes Abuse - 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 - an examination process the healthcare facility goes through to evaluate the facilities policies, procedures, and performance to meet higher standards. Accredited - Having seal of approval after being evaluated and de...

Healthcare Reimbursement Chapter 1 Review Quiz with Complete Solutions How do value-based reimbursement models differ from traditional models? Value-based reimbursement models focus on the quality of care and patient outcomes rather than the quantity of services provided, incentivizing providers to improve care delivery. What factors can lead to claim denials in the reimbursement process? Common factors that lead to claim denials include incomplete documentation, incorrect coding,...

NHA CBCS Module 3 Coding And Coding Guidelines Questions and Answers (2024 / 2025) (Verified Answers) abstracting Reviewing medical record documentation to discover clinical concepts that support assigning codes to the highest level of specificity. clinical documentation Information recorded in the medical record pertaining to the health status of a patient as determined by a health care provider. CPT Current Procedural Terminology. Codes for services and procedures. electroni...

NR511 Final study guide with complete solutions Define diagnostic reasoning - Answer- A list of possible diagnoses based on historical and clinical presentation listed in order of priority Identify subjective and objective data - Answer- Subjective data is what the patient tells you (SAYS) objective data is what you see: labs, etc. (OBSERVE) Identify the components of the HPI - Answer- OLDCARTS onset location duration characteristics aggravating factors relieving factors timing and...