Coding medical necessity - Study guides, Class notes & Summaries

ICD-10-CM: General Coding, Guidelines and Conventions Latest Update Graded A+ Define: medical necessity - Care that is reasonable, necessary, and/or appropriate - Evidence-based clinical standards of care What does ICD-10-CM stand for? - International Classification of Diseases - Tenth Revision - Clinical Modification What is the ICD-10-CM? - diagnosis code set used to report diagnoses in all clinical settings What does ICD-10-PCS stand for? - International Classification of Di...

Healthcare Reimbursement Final Exam Questions and Answers Already Passed What is the difference between direct and indirect costs in healthcare? Direct costs are expenses directly tied to patient care, such as salaries and medical supplies, while indirect costs are overhead expenses, like administrative salaries and utilities. What role do diagnosis-related groups (DRGs) play in reimbursement? DRGs categorize hospital cases into groups that determine the fixed payment amount for i...

True or False: The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). - Answer-True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) - Answer-1.Protect our programs 2.Protect your patients 3.Protect the Provider At which level of the Medicare Part A or Part B appeals process is the appea...

Healthcare Reimbursement Final Study Guide Questions with Verified Solutions How do Medicare and Medicaid influence healthcare reimbursement in the U.S.? a. By limiting coverage options for patients b. By providing fixed payment rates to healthcare providers c. By establishing guidelines that affect how services are billed and reimbursed d. By promoting only private insurance plans What coding system is primarily used for billing outpatient services? a. ICD-10-PCS b. CPT (Curr...

The accounts not selected for the billing report is a daily report used to track accounts that are: a. Awaiting payment in accounts receivable b. Paid at different rates c. In bill hold or in error and awaiting billing d. Pulled for quality review (Ans- c. In bill hold or in error and awaiting billing The accounts not selected for billing report is a daily report used to track the many reasons that accounts may not be ready for billing. This report is also called the discharged not fi...

CMM FINAL EXAM 2024 WITH 100% CORRECT ANSWERSSteps of Revenue Cycle - correct answer Patient Registration & Check in/ Clinical encounter/ Accurate Coding and Billing/ Claims Generation and Transmittal/ Processing Payments/ Preparation and Transmittal of Patient Statements/ Collections and Finalizing Payments/ Denials, Appeals & Refunds Coding analysis - correct answer involves analyzing the financial impact of proper vs. improper coding procedures in practice What type of codes reflect th...

NR511 Final Exam Questions with Correct Answers Define diagnostic reasoning - Answer--A type of critical thinking -Includes systematic way of thinking that evaluates each new piece of data to support some hypothesis and reduce others -Evaluates if all the avenues have been explored and that the conclusion is based on evidence -To solve problems, promote health, screen for dz/illness: all require sensitivity to complex stories, contextual factors, sense of probability/uncertainty Discus...

according to CPT, a repair of a laceration that includes retention sutures would be considered what type of closure? complex closure identify the 2 digit modifier that may be reported to indicate a doctor performed the postoperative management of a patient, but ANOTHER doctor performed the surgical procedure: -55 according to the QHDDS, what is the definition of "other diagnoses"? "other diagnoses" is interpreted as additional conditions that affect patient care in terms of ...

NR511 Midterm Exam (2024) || Questions & Answers (Rated A+) NR511 Midterm Exam (2024) || Questions & Answers (Rated A+) 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 t...

Abstractor Correct Answer: hospital employee who converts documented procedurs and diangoses into medical codes Abuse Correct Answer: 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 Answer: an examination process the healthcare facility goes through to evaluate the facilities policies, procedures, and performance to meet higher standards. Accredited Correc...