Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Practice Exam

CPC Practice Exam and Study Guide Package

Practice Exam

What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

CPC Exam Review Video

Laureen shows you her proprietary “Bubbling and Highlighting Technique”

Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page

Practice Exam

2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Advanced Care Planning and minimum amount of time needed

Question: How long does a provider have to spend with a patient in Advanced Care Planning, such as DNR, living will, feeding tubes etc in order to bill?
I know CPT says 30 minutes, but I thought I saw on a Webinar that it’s the better part of half an hour, or 16 minutes.
Please Help.
Thanks

Medical Billing and Coding Forum

10 things you should know to ensure successful discharge planning

10 things you should know to ensure successful discharge planning

Learning objective

At the completion of this educational activity, the learner will be able to:

  • Identify strategies to comply with proposed Medicare changes to the discharge process

 

One of the more challenging aspects of a case manager’s job is helping to ensure a patient successfully transfers from the hospital to the next level of care. Under a set of proposed revisions to Medicare’s Conditions of Participation (CoP) announced in November 2015. This job may get even harder, more specific, and apply to more patients. The changes, among other things, will require hospitals, including critical access hospitals, to create discharge plans for more patients. Case managers will need a more direct plan to include patients and their caregivers in the discharge planning process, in particular taking into account their individual "goals and preferences." This discharge planning process will also need to start sooner?within 24 hours of admission instead.

So what can you do to ensure your organization is up for the challenge? In an April webinar titled "Discharge Planning: Realignment of Standards and Workflow," speaker Jackie Birmingham, RN, BSN, MS, CMAC, vice president emerita of clinical leadership for Curaspan Health Group in Newton, Massachusetts, and Janet L. Blondo, MSW, LCSW-C, LICSW, CMAC, ACM, CCM, the manager of case management at Washington Adventist Hospital in Takoma Park, Maryland, offered up some compliance tips that you can use to ensure your hospital is ready:

1.Assess your current discharge process. Under the proposed changes, the discharge planning process needs to start in the first 24 hours after the patient arrives at the facility. You’ll need to identify how your current processes work in order to make sure they comply with this timeline. Identify your current workflow?specifically, who does what, why they do it, and how it’s done. Ask the following questions:

  • What is your current case management model?
  • Who’s on your team?
  • What’s their role?
  • Who does the screening right now in the current
  • Who does the patient assessment?
  • Who makes referrals when you need to refer patients for services?
  • In your current model, do the nurses perform the assessment for patients who go home while the social workers do the placements? Or do you have nurses and social workers assess everyone? "If you’re having all your patients assessed right now, well, you’re ahead of the game already, because that’s the new proposal," said Blondo.

 

Also think about why your processes were designed the way they are. "If you have it on one unit a certain way and not on another, think about what you need to do to change your practice so that perhaps every unit you can do assessment on every patient," said Blondo. "If your model is something that doesn’t seem to make sense with the proposal, what can you do to change it?"

Changes to bring the model in line could include adding technology (e.g., laptops, tablets) to speed up the process, adding staff members, or reassigning current staff members. "Perhaps some of your social workers can do UR," said Blondo. Alternatively, maybe a staff nurse can do an initial assessment instead of a case manager, or perhaps a nonclinical staff member can take over certain tasks. Taking the time to examine your current processes and think about how they can be switched up to meet the new requirements will give you the foundation for a new plan.

2.Drill documentation. Hold physicians accountable for following through and documenting discharge plans and dates. "If they’re documenting in the chart the discharge date and plan, that makes your job a little easier, because you have that in the chart already and can discuss that with the patient and their family," said Blondo. Take advantage of pre-procedure assessments by ensuring they are included in the chart, then making sure staff members follow through on that plan. "You don’t want Joint Commission or the state coming to do their survey and then you find out the assessment is not getting done because your staff has decided they want to do something different. So make sure everyone is doing the same," said Blondo.

3.Focus on delays. Use these potential discharge changes in the CoPs as an opportunity for process improvement. Look at what’s causing delays in your current process?use this information to improve systems and boost patient satisfaction. "You’re going to improve, perhaps, length of stay with this increased attention with discharge planning," said Blondo.

4.Make rounds count. If you are currently using rounds, examine what they’re being used for and how they’re working. Blondo says it’s important to ask:

  • Are rounds being used for discharge planning?
  • Are they used for the patient experience to improve your scores?
  • Are they used for throughput or for some other reason?

 

After thinking about the current purpose your rounds serve, consider how they can be modified to fit your new objectives. "Many people just do one type of rounds per day, but you could actually be creative with these. There are some hospitals that I know of that divide rounds into different parts of the day," said Blondo. "For instance, you might want to think about doing rounds early in the morning for those patients that will be discharged [later] that day." The discussion could center on determining whether those patients are prepared to leave and have the right resources. Another idea is to add rounds to the short-stay area or outpatient area for procedures done late in the day. "And if you have case managers in the emergency room, you could ask them to round for those areas, catching any patients that might need something late in the day after your regular case management staff have left," said Blondo.

5.Understand patient options. This topic includes both big-picture and smaller issues. Case managers should focus on patient-based issues, which relate to talking to the patient, as well as on setting the patient’s broader goals and preferences. The organization’s systems must be set up to give patients a choice of postacute options. But keep in mind, when working with patients, you’ll always come across those who don’t like what you’re doing or who don’t agree with you and want to go another direction. "You need to have something standardized and something that you can fall back on when you’re presented with a patient and family who, in their eyes, have a reasonable goal and clinically or medically or psychosocially, they don’t," said Birmingham. Staff members must understand the concept of patient choice. "The staff must be comfortable that they are doing the right thing for the patient and the right thing for networks and the right thing for the organization."

It’s also important for staff to understand that the patient has the right to refuse the plan. "[The patient] may be in denial. They may be suffering grief," said Birmingham. The hospital should have a policy for patients leaving against medical advice (AMA), but case management must have its own discharge planning policy for those leaving AMA. In these instances, it’s not just enough to have the patient sign a paper, but rather actively assist the patient with the transition by ensuring that he or she has transportation and needed prescriptions. Even though there is an exemption for patients who signed out AMA and are readmitted the hospital, the hospital should have a plan for how to work with these patients, said Birmingham., said Birmingham.

You should also consider planning for a patient’s deficits related to loss of functioning, whether it be ADLs or IADLs. Birmingham recommended asking the following questions:

  • Is the patient medicated and therefore unable to participate in planning?
  • Does the patient need to have a conservatorship?
  • Is there conflict among the patient’s children or the patient’s siblings?
  • Does the patient have a family or responsible person?
  • Is the patient appealing the discharge?

 

A plan should be in place to address the answers to these questions.

6.Help patients achieve their goals. This is something that organizations should have been doing all along, but there is much more emphasis on it now. A problem arises when the patient’s goals and preferences don’t align with what is medically necessary or what is reasonable and necessary. In these instances, it may be wise to involve social workers. "Look at some of the things that patients might be going through?denial, grief that might affect their decision-making at the time," said Birmingham. "With the family dynamics, there might be family members trying to convince the patient to make a decision that isn’t really what the patient wants." Ultimately, the goal is to help the patient make the decision that is best for him or her, but also to think about what is medically the best option.

7.Involve the physician. Physicians are an integral part of discharge planning, so it’s important to make sure they are actively involved in the process. This communication between the patient and the physician needs to be sensitive to generational and cultural differences. "To involve perhaps some of the older patients, just have the doctor come in and say, ‘We want you to do this,’ " said Blondo. "That might not work for younger generation or baby boomers who are used to rebelling, but if you have the doctor come in and say, ‘This is what we’re recommending and this is why’ and help the patient to understand why it is recommended."

While it may be easier to foster good communication if you’re working with a hospitalist, it can be more of a challenge if the physician is community based. "How will you manage when the patient is transferred to another facility? It’s not been a problem if you’re transferring the patient to another hospital, but if that patient is being transferred to a SNF, there haven’t been that many times when the doctors have called to the doctor in that SNF to give them an update," said Blondo. Have a plan in place to ensure the communication lines are always open.

8.Work to decrease unplanned readmissions and improve patient outcomes. "Readmissions are an old problem with new incentives," said Birmingham. Readmissions can be strongly linked to location and patient access to resources, which shows that they often depend on factors other than the medical treatment the patient received. This underscores the importance of ensuring your patients have access to things like food and transportation when they leave the facility. "Is your [patient’s] area in a food desert? No car, no supermarket store within a mile?and that makes a huge difference," said Birmingham. If this is the case, your organization might want to develop or contact an existing program that delivers food to the homes of qualifying individuals. "Home health agencies could do that too for some programs to be able to provide some fresh groceries to some patients," she said.

Also find out if your patient has been readmitted in the past, a risk factor for readmissions. "You can look to see if a patient is readmitted from an acute level of care, but you’ll need to ask the patient if they’ve been in the emergency room in the past 30 days, if they were admitted from a facility SNF," said Blondo. "Often, that information is sent with them to the hospital, but you can ask them." Ask if the patient was receiving home health services prior to admission. Encourage physicians to include this type of information in the history and physical to ensure it won’t be missed.

"We’re never going to be perfect and have no readmissions, because some patients have a legitimate need to come back to the hospital within those 30 days, but look at your readmissions. Learn from who is coming back and think about what strategies you can put in place for that," said Blondo.

9.Keep the focus where it belongs. "Discharge planning is a patient-centered function," said Birmingham. "You can do utilization review without talking to the patient. You can do quality improvement without talking to the patient and family, but you can’t do discharge planning." For this reason, discharge planning can be very rewarding to clinicians who want to be involved in the patient’s care, and to be there for them when they’re at their most vulnerable.

10.Take your cues from the experts. While Medicare’s CoPs aren’t a cookbook on how to run your organization, they are a good place to start because they’re based on years of evidence. "Many of the changes in the original CoPs happen because commenters send in a comment to CMS and CMS responded and actually changed the proposed rule," said Birmingham. "Now, will they change these proposed [discharge planning] rules? I don’t think so, and I think that’s because they’ve been published as interpretive guidelines for over two years." That means these discharge changes are likely here to stay. Like all other CoPs, they should be blended into your workflow and your strategies and partnerships with other departments, said Birmingham.

HCPro.com – Case Management Monthly

Chain of command: Succession planning must be specific to leadership role, not an individual

You’re working at a hospital during an emergency (e.g., a hurricane). But the person who’s supposed to take the lead is out sick or on vacation, or is distracted from duty because a family member is in danger. Do you know who’s supposed to take that person’s place?

HCPro.com – Briefings on Accreditation and Quality

Coding for pre planning for AW exam when done with a chronic medical condition f/u

I’m wondering if there is an ICD-10 code to use for pre planning. I often see the Z00.00 used ,which I really feel is not appropriat
For example when a Provider orders preventative screening diagnostics with a routine f/u appt. Since time and and MDM is part of ordering the screening labs, mamo and dexa ,etc I’m wondering if there is a more appropriate way to code for same
I don’t feel the Z00.00 should be on the claim for say a f/u DM,HTN just because the Provider ordered the screening diagnostics at the time of the f/u
I thought it might be better to do pre planning in a separate encounter ,however Providers are not willing to do same
Appreciate any input

Medical Billing and Coding Forum

Planning a Medical Recruitment Budget

For every medical establishment, it becomes necessary to create in-house physician recruitment budget so that they have an idea about how it all works. It can turn out to be quite a daunting task for one who has minimum budgeting experience or has little experience in the field of medical recruitment.  People who specialise in the field of medical recruitment often find it challenging enough. They have either been a part of a human resource department or have worked in a hospital before and thus have experience in the recruitment of nurses, other medical staff, clerical personnel and technicians.

 

Each clinic or medical establishment has its own set of requirements and infrastructure and this obviously affects the way its recruitment budget is set. The budget model is usually divided into different categories. These include:

 

Employee Expenses: This mainly comprises the salaries of the doctors, nurses, pharmacists, lab assistants and other medical staff on board. The expenses vary depending on the size of the medical unit, the available infrastructure, its location and of course the experience and credibility of the doctors.

 

Interview Costs: A certain amount is spent in conducting interviews and selecting the right people for the job. If an overseas candidate is found to be eligible and subsequently selected, then the travel expenses are later borne by the recruiting medical establishment.

 

Relocation Expenses: If the potential candidate has decided to relocate from one place to another, then the relocation expenses are met by the medical establishment.

 

Recruitment Agency Expenses: There are a number of recruitment agencies that conduct recruitment for medical positions alone. These medical recruitment agencies have a huge database comprising medical professionals willing to work in temporary positions for a proper salary and other associated benefits.  Hospital authorities are often keen on finding out which option turns out to be a more reasonable one, when it comes to the recruitment of doctors on their own or by hiring recruitment agency that does the job for them.

 

There are some additional expenses as well that goes into the sourcing of medical candidates and creating a sort of a database for them. There are different staffing solutions that have flooded the market in recent times. These are aimed at easing out the task of the recruiter to a great extent. These solutions often require considerable investments. Recruiters also attend professional trade shows that also help them to look for potential candidates.

 

These are some of the factors that are common to more or less every medical recruitment program in most of the medical establishments. Every hospital has its own set of issues that may lower or increase particular line items that form a part of the doctor recruitment budget. The budgets may vary as well. In case of rural areas, the amount designated for travel is more than a city based hospital. Though the set up and infrastructure of each hospital is different, a broad hospital budget can be planned based on the aforementioned factors. This kind of a budget planning forms an integral part of medical recruitment.

 

 

 

Daniel Smith is a recruitment consultant and has actively worked with locums that specialise in medical jobs. He has in-depth industry knowledge which is apparent through his publications. He recommends a visit to the website http://www.globalmedics.com/ for further information.

Is End-of-life Planning an Optional Medicare IPPE Service?

Q: “End-of-life planning, on agreement of the beneficiary” is listed as a requirement for Medicare’s Initial Preventive Physical Examination (IPPE). Does this mean that end-of-life planning is optional? What documentation is necessary to substantiate the service? A: The IPPE, or “Welcome to Medicare” visit, is a once-per-lifetime benefit, which must be provided within the first 12 months […]
AAPC Knowledge Center

prostate volume echo, not for brachytherapy treatment planning

Hi,

I have a urologist who is billing out for 76873, echo, transrectal, prostate volume study for brachytherapy treatment planning, separate procedure. However, there are no orders or plan to treat these patient’s with brachytherapy. Can this cpt code still be used if they do indeed take prostate volume measurements?

Any help or guidance is appreciated.

Thanks
Kathleen

Medical Billing and Coding Forum

Advanced Care Planning and Medicare

Medicare covers advanced care planning (ACP) as a separate service when provided by physicians and other health professionals (such as nurse practitioners who bill Medicare using the physician fee schedule). Advanced care planning is a face-to-face service that, as described by the AMA (CPT Assistant, Dec. 2014), “involves learning about and considering the types of […]
AAPC Knowledge Center

I am planning to take CPB exam this November

Hi everyone,
I am planning to take the CPB exam this November. Do you guys have any tips on how to pass the exam? Like areas where to focus on? How’s the Case Analysis part? I heard a lot of news that the exam is difficult and I’m actually quite nervous about the exam.

Medical Billing and Coding Forum | AAPC