A clinical medical assistant is preparing to bill a patient's insurance for a recent visit. Which of the following actions should the assistant take?
A Choose procedure codes based on the encounter form.
Upcode for greater reimbursement.
Refer to ICD-9 for diagnostic codes.
Enter all data using lowercase letters.
The Correct Answer is A
A. Choose procedure codes based on the encounter form. The encounter form, also known as a superbill, lists the procedures and services provided during the visit. The correct procedure codes (CPT codes) should be selected from this form to ensure accurate billing.
B. Upcode for greater reimbursement. Upcoding, or selecting a higher-level code than justified, is illegal and unethical as it constitutes fraud. This should never be done.
C. Refer to ICD-9 for diagnostic codes. ICD-9 codes have been replaced by ICD-10 codes, which are now the standard for diagnostic coding in the United States. Referring to ICD-9 codes would result in incorrect or outdated billing.
D. Enter all data using lowercase letters. Data entry in all lowercase letters is not a standard practice in medical billing and would not affect the accuracy of the codes. Proper case usage is typically recommended for clarity.
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Related Questions
Correct Answer is B
Explanation
A. Safety data sheet (SDS): SDS provides information on handling and disposing of hazardous materials, not specifically on infection control or disease prevention.
B. Standard precautions: Standard precautions are infection control practices used to prevent the spread of disease in healthcare settings, such as hand hygiene and using personal protective equipment.
C. CLIA: CLIA (Clinical Laboratory Improvement Amendments) regulates laboratory testing but does not specifically address disease prevention in patient interactions.
D. Exposure plan: An exposure plan is related to handling and reporting exposure to bloodborne pathogens, not general disease prevention.
Correct Answer is A
Explanation
A. Home health care: Home health care services include assistance with personal care and meal preparation for individuals who need help with daily activities but do not require 24-hour medical supervision.
B. Hospice care: Hospice care is focused on end-of-life comfort and pain management, not on routine personal care or meal preparation.
C. Assisted living facility: Assisted living facilities provide residential care and help with daily activities but are not arranged directly for home-based care.
D. Skilled nursing facility: Skilled nursing facilities provide more intensive medical care and supervision, which is beyond the level of personal care and meal preparation needed.
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