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

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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

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

Previous specialist feels the impacts of his terrible drug

A previous Sevier County restorative specialist, who attempted to charge Morristown regional government more than $ 200,000 for undesirable hypersensitivity medications and misled Grainger County Tomato Festival-goers, is getting tropical storm to compel blowback with an end goal to limit his job in a multi-million-dollar protection trick, as indicated by court records.

Read The Full Story Here!

The post Previous specialist feels the impacts of his terrible drug appeared first on The Coding Network.

The Coding Network

Molly Staley CPB/REVENUE CYCLE SPECIALIST

MOLLY R. STALEY
MEDICAL OFFICE REVENUE CYCLE SPECIALIST
Dedicated Health Care Professional Who Is Service-Focused, Results-Driven & Experienced
Seeking a service-focused position related to front-end revenue cycle and/or clerical. Proven success in billing, coding & front desk operations in outpatient clinic environments, dedicated to providing a patient-focused experience.
Phone: 313-282-2674 Address: 24579 Orangelawn Redford,Mi.48239 Email: [email protected]
 Use of multiple EMR
platforms. 
 Insurance Verification. 
  
Expertise
 Patient registration in multi- specialty, high volume clinics.
 
Charge entry.
Executing standards of Patient Centered Medical Home (PCMH).
Insurance coding: ICD10, CPT
HEDIS quality follow-up & patient outreach. 
Professional Experience
Resubmissions/AR follow-up. Patient scheduling.
Proficient in all Microsoft Suite programs, including Excel. Knowledge of commercial & government payer requirements
ASCENSION TELEHEALTH-Southfield, MIRevenue specialist/Biller2017-Present Revenue Cycle Specialist/Biller Telehealth
Responsible for maintaining insurance authorizations, billing claims, and tracking the status of claims revenue. Key Contributions:
 Trained multiple clinics billing cycle of Telehealth  Assisted in EMR clinical documentation
WAYNE STATE UNIVERSITY PHYSICIAN GROUP — Troy, MI  Medical Office Assistant 2015-2017 Front desk operations, coding & billing in multiple clinics
Responsible for registering patients while maintaining a high level of customer service. Scheduling of patient appointments. Collecting accurate demographics & insurance information. Obtaining patient referrals to specialty care & insurance authorizations. Completion of initial charge entry & coding. Communication with clinicians regarding coding & follow-up to charges submitted. Key Contributions:
 Facilitated office operations in adherence to PCMH standards of care.
 Assisted in development of office processed for front end operations.
 Developed expertise in initial coding & charge entry in multiple specialties.
ST. JOHN PROVIDENCE CANCER CENTER— Southfield, MI Medical Practice Business Assistant
Business Office Assistant in an Oncology Center.
2010-2015
Responsible for multiple revenue cycle functions. Primary daily tasks included: maintaining insurance authorizations, completing verification of insurance benefits, release of patient records. Responsible for administrative duties such as: scheduling appointments, maintaining medical records, answering phones. Key Contributions:
 Gained expertise in back-office billing functions.
 Gained expertise in both government & commercial insurance payer requirements for service.
 Assisted in the on-site training of new employees.
 Loyal employee with >15 years of service to the Organization.

MICHIGAN EAR INSTITUTE- ST. JOHN HEALTH SYSTEM — Farmington, MI  Medical Practice Business Assistant/Coder 2003-2010
Dual role as Business Assistant/Insurance Coder in an Audiology Practice.
Successfully managed dual role as a front office associate and a coder. Advanced in role to take on additional responsibility & tasks. Duties included: registering patients, billing intake, scheduling appointments, insurance verification, generalized receptionist duties. Key contributions:
 Responsible for specialized coding.
 Took on additional tasks to expand billing knowledge base.
ST JOHN PROVIDENCE HOSPITAL- SOUTHFIELD, MI  FILE CLERK 2000-2003
Organize & Maintain clinic records in a Radiology office.
Responsible for obtaining patient results and coordinating physician-to-physician communication in an efficient fashion. Maintaining organized patient health information & preparation of patient charts prior to physician care. Key contributions:
 Ensured that physicians received diagnostic testing results.
 Gained advanced working knowledge in protection of Patient Health Information (PHI).
Education and Awards
DAVENPORT UNIVERSITY — Livonia, MI MEDICAL BILLING DIPLOMA DAVID MACKENZIE HIGH SCHOOL — Detroit, MI HIGH SCHOOL DIPLOMA
Awards and recognitions: Completed Medical Billing Diploma training with a 3.0 GPA,
Advanced training: In-depth on implementation of Patient Centered Medical Home (PCMH), advanced training in resolution of patient grievances, HIPPA training.

Medical Billing and Coding Forum

Proper coding for patients seen by a specialist during their observation stay

I just wanted to confirm with the panel the correct way to bill for an exhisting pateint who was seen in the hospital during the observation stay portion prior to being formally admitted as an inpatient. We are an oncology practice and one of our oncologist was asked to consult on a patient for Hematology reasons, while the patient was still registered as being in observation. The physician obliged and saw the patient, but marked teh encounter as an initial inpatient visit (99221-99223).

Per CMS guidelines (PUB 100-04 Claim Processing Manual, Transmittal 2282, section 30.6.8 Payment fo Hosptial Observation Services and Observation of Inpateint Care Services (including admission and discharge), "Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient’s observation services began. All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes."

Unfortunately, it does not go into detail on how to code if the patient being seen was already and exhisting patient of the consulting physician. Since we are told to use the appropriate outpatient codes (99211-99215, 99201-99205), the question was asked which would be the more appropriate code type of code, exhisting or new patient? I think an argument could be made for both code types, but my gut feeling is that we are bound by the 3yr rule when using the outpatient codes. Is this the more prudent way to approach these scenarios?

Greg Quinn, CPC, CPPM, CHONC

Medical Billing and Coding Forum

Clinic / Specialist / Hospital / Confused….

A Cancer specialty clinic sees patients for care/treatment for Cancer at their clinic.
These same patients often have other comorbidities where they are treated in the ER and or Inpatient stays at the hospital located on the same campus.
Scenario:
-The Clinic Physician, who is not a hospitalist, treats a cancer patient at their (outpatient) clinic.
-The same patient ends up being admitted to the hospital for an unrelated condition.
-Because of the Cancer/Diagnosis the pt. has, the hospital staff physicians are not specialized to treat these patients.
-Due to this, our Clinic Physician will be called to manage the patient’s cancer while they are inpatient at the hospital.
-Our Clinic Physician will dictate progress notes and sometimes a Discharge summary for the patient.
-Our Clinic Physician’s progress note(s)/discharge summary will sometimes be directed at care of the pt’s cancer. Other times, the Clinic Physician will treat the (non cancer related) current condition(s) the pt. has.
I’ve looked at the guidelines but I’m a bit confused on this.
Anyone care to comment?
Thank you!

Medical Billing and Coding Forum

Behavioral Health Job Openings – Compliance Specialist and Payment Integrity Manager

Large Behavioral Health Payer looking for experienced candidates (at least 2-3 years) with excellent analytical skills and experience dealing with large data files, behavioral health coding/billing compliance experience for all lines of business (Medicare, Medicaid, Commercial).
Advanced Excel skills required. Coding credentials required.
Ability to audit, develop P&Ps, provide education and guidance to providers/plans a big plus.

Please send resume to [email protected] if interested.
Location preference for Latham, NY; Woburn, MA, or Remote

Medical Billing and Coding Forum

Billing for Provider who is PCP and Specialist

I am curious if anyone has this issue. I have a physician who joined our group recently, he is a PCP to half of his patients, the other half he sees as specialty. We are a specialty group. One insurance wants us to get a separate NPI so that this provider can be listed as both. We are trying to also figure out with our software about using the taxonomy codes for the different needs. If anyone has any advice on how they have handled this situation, I would greatly appreciate it.

Medical Billing and Coding Forum

Medical Coding Specialist Needed – Hoboken NJ

Billing and Coding Specialist is needed for a multidisciplinary practice including Orthopedic Spine, Pain management, Physical Therapy, Chiropractic and Acupuncture. Candidate must be professional and able to multi-task effectively. We are seeking an energetic and organized individual who is looking for a career in medical billing, coding and collections. We offer a warm yet professional work environment with room to advance through the company.

Daily Duties:

Coding Medical Documentation for Pain Management Providers (4 Providers).
Coding Medical Documentation for Chiropractic Services
Identify billing errors for corrections and resubmit claims to insurance carriers
Follow up on payment errors, low reimbursement and denial
Review insurance EOB’s and initiate appeals as necessary
Updating system errors, noting system, researching insurance guidelines
This position requires someone with knowledge of ICD-10 coding, accurate typing skills, computer knowledge, prior utilization of an Electronic Medical Record system, knowledge of medical terminology and the ability to communicate effectively with physicians, co-workers and insurance plan representatives.

The Ideal Candidate:

Detail-oriented
Reliable
Team Member
Strong work ethic
Friendly
Pleasant
Minimum 5 years experience
The Perks:

A work-life balance with generous levels of time off
Competitive compensation
401K Plan
Health Insurance
Position is Full Time – Hours 8:30-5:00 or 9:00-5:30

Job Type: Full-time

Medical Billing and Coding Forum

Seeking full-time employment as a medical coding specialist

Vino C. Mody Jr., M.D., Ph.D. (Lic.)
3353 Dunbar Lane, Suwanee, GA 30024
678-427-6511, 915-642-4269, 281-899-0543,
915-779-9912 eFax, 915-307-5405 Fax
[email protected], [email protected], [email protected]
medpracticeprocess.com; http://sites.99mall.in/sites/vinumod…ications.html; http://sites.99mall.in/sites/modynew/

Dear Hiring Manager,

As a medical researcher and medical coder with 15 years of experience in the medical training field, I am always on the lookout for companies who are involved in innovative and engaging work. I have been a great admirer of Baylor Scott & White Health since 1997, and I am thrilled to apply for the medical coder, medical researcher, and medical training position at your company.

Since 1992, I have been at the forefront of medical science, helping to shape design of innovative medical research products and medical coding of charts. In the last 20 years, I have led medically trained staff in an immediate increase in production. Running a department has taught me to be disciplined, organized and a self-starter when it comes to designing projects and meeting deadlines. At Karolinksa Institutet, I was a medical researcher that always met deadlines and accomplished goals including the development of a method to measure lens ascorbate concentration utilizing ultrafiltration and high pressure liquid chromatography with ultraviolet detection. At Mesa Hills Specialty Hospital, I was a medical coder who worked efficiently and successfully on charts and quality data analysis and met deadlines on time.

Your recent medical training articles, Baylor Scott & White Health, was the impetus for my exploration of medical genetics testing. I have researched inherited eye disorders extensively and implemented the results into medical science as a result of medical genetics testing’s feature. I believe that my experience and proven track record in innovative solutions make me the perfect fit for this position.

Thank you for your time and consideration.

Sincerely,

Vino C. Mody Jr., M.D., Ph.D. (Lic.)
——————————————————————————————-
Vino C. Mody Jr.
6154 Black Mallard Place, El Paso, TX 79932
678-427-6511 cell; 915-642-4269 home; [email protected]
Objective
Medical administration including coding, billing, audit, compliance, analysis, and training and pharmaceutical research
Professional Achievements
Medical coding and medical research
 Expertise in medical coding, billing, auditing, compliance and medical records administration with 4 years of experience as a CPC, CANPC, CCVTC, CEDC
 2 years of experience as a CANPC anesthesia and pain management coder
 3 years of in-patient hospital experience in medical care
 20 years of experience in medical research
 CPC® Certified Professional coder from American Academy of Professional Coders (AAPC), passed CPC® exam, AAPC, 10/2013
 COCTM Certified outpatient coder from American Academy of Professional Coders (AAPC), passed COCTM exam, AAPC, 6/2015
 CCS-P Certified coding specialist-physician based from American Health Information Management Association (AHIMA), passed CCS-P exam, AHIMA, 5/2015
 CANPCTM Certified anesthesia and pain management coder from AAPC, passed CANPCTM exam, AAPC, 8/2015
 CCVTCTM Certified cardiovascular and thoracic surgery coder from AAPC, passed CCVTCTM exam, AAPC, 3/2017
 CEDCTM Certified emergency department coder from AAPC, passed CEDCTM exam, AAPC, 6/2018
 4Med CICP ICD-10-CM certification from 4Med Plus, 10/2017
 Certificate of ICD-10-CM Coding Proficiency (4Med CICP) certification (86% final score), ICD-10-CM Coding Professional, 4Med Plus, Chicago, IL, and Libman Education, Bedford, MA, 10/2017
 Certificate of ICD-10-CM proficiency from AAPC in 1/2014 and certificate of passing an ICD-10-CM and ICD-10-PCS proficiency post-training e-assessment (100 questions; 78% score) from AHIMA Academy in 7/2015
 Certificate of ICD-10-PCS proficiency from AAPC, 11/2015
 Certificate of completion, Professional Coding Practice course (final score=91.42%) for 60 CEUs, AHIMA, Chicago, IL, 4/2018
 Certificate of completion earning 45.00 CEUs in the ICD-10-CM coding field, Basic ICD Coding Part 1 course (final score=92%), AHIMA, Chicago, IL, 4/2018
 CCS-P Badge, AHIMA, Chicago, IL, 1/2018
 Certificate, ICD-10-CM hematology and oncology specialty code set training, AAPC, 12/2017
 Certificate of Approval, ICD-10-CM Coding Workbook for Cardiology, passed 203: Cardiology ICD-10-CM certification exam 1 (2017), Optum 360, 2/2018
 Certificate of Approval, ICD-10-CM Coding Workbook for Cardiology, passed 204: Cardiology ICD-10-CM certification exam 2 (2017), Optum 360, 2/2018
 Certificate of Approval, ICD-10-CM Coding Workbook for General Surgery, passed 207: General Surgery ICD-10-CM certification exam 1, Optum 360, USA, 10/2017
 Certificate of Approval, ICD-10-CM Coding Workbook for General Surgery, passed 208: General Surgery ICD-10-CM certification exam 2, Optum 360, USA, 10/2017
 Certificate, ICD-10-CM specialty cardiology code set training, American Academy of Professional Coders, Salt Lake City, UT, 9/2016
 Certificate, CPC-A Practicum with CEUs badge, AAPC, 11/2014
 Certificate, Practicode Professional Fee (ICD-9), AAPC, 10/2016
 Certified Medical Administrative Assistant (CMAA), National Health Career Associates (NHA), passed CMAA exam, November, 2014
 Certified Billing and Coding Specialist (CBCS), passed CBCS exam, NHA, November, 2014
 Expecting certification in Texas Medical Jurisprudence
 CANPC/CCVTC lecturer for AAPC, Southwest University, and TXHIMA
 Certificate, COC Accelerated Facility Outpatient Coding course, AAPC, 9/2018
 Certificate of CPMA Medical Auditing, course, AAPC, December, 2015
 Certificate of CPPM Practice Management, course, AAPC, January, 2016
 ICD-10-PCS Code set training (16 hours) from completion of a course, AAPC 1/2015
 ICD-10-CM General code set training (16 hours) from completion of a course, AAPC, 1/2014
 Graduate of NAPSRX’s Pharmacology/Pharmaceutical Sales Training Program, CNPR Number 608042014, Member of NAPSRx, National Association of Pharmaceutical Sales Representatives (NAPSRX), Washington, D.C., 3/2014
 Certified risk management consultant (CRMC), Confidential Texas corporation
 In-patient hospital rounds including ICU and CCU at Emory University and Brown University Hospitals, 1995-1999
 Prepared health administration flowchart, Emory Healthcare, 6/2016
 Training in medical coding from Optum and United Health Group, 4/2018
 Freelance medical researcher in phytochemicals and Horizon 2020, 10/2011-
 Marquis Who’s Who in Medicine and Healthcare 2006-2007
 Vanderbilt University School of Medicine early admissions winner, 1992
Skills
 Medical coding (ICD-9-CM, CPT, HCPCS II) with proficiency in ICD-10-CM and ICD-10-PCS
 Deep knowledge of anatomy, physiology, disease management
 Expertise in use of medical coding software, professional conduct HIPAA and joint commission, medical records and analysis, RHIA training, HCC training, Epic-like experience, DRG analysis, case management, medical transcription, quality data care set analysis, coding and clinical documentation improvement (CDI) for Long-Term Care Hospital (LTCH), and insurance dispute resolution
 Extensive clinical research experience and training in medicine
 Well-versed in correct grammar and spelling, strong work ethics, leadership, and self-management discipline
Work History
Medical coding trainee, COC-A ICD-10 Practicum American Academy of Professional Coders Salt Lake City, UT 06/2018-present
HIM Coder Mesa Hills Specialty Hospital El Paso, TX USA 5/2017 to 1/2018
Remote Medical Coder and auditor Signature Staff Resources Miami Lakes, FL, USA 1/2016 to 4/2017
Volunteer E&M medical coding trainee McKesson Atlanta, GA 12/2015 to 1/2016
Remote medical coder HGS USA, LLC Peoria, IL 9/2015 to 2/2016
Medical coding trainee CPC-A ICD-10 Practicum American Academy of Professional Coders Salt Lake City, UT 11/2015-7/2016
Medical coding trainee COC-A Practicum American Academy of Professional Coders 05/2015-11/2015
Medical coding trainee CPC-A Practicum American Academy of Professional Coders Salt Lake City, UT 6/2014-11/2014
Medical Researcher Karolinska Institutet Stockholm, Sweden 10/2/2000 to 6/5/2008
Proctor National Board of Examiners in Optometry (NBEO) Stockholm, Sweden 3/2003 to 5/2005
Preliminary internal medicine intern and medical trainee, Brown University/Lifespan, Providence, RI 6/1998 to 12/1999
Preliminary internal medicine intern, Yale-New Haven Hospital (Waterbury, CT), New Haven, CT 6/1997-7/1997
Education
2018 COC Accelerated Outpatient Facility Outpatient Coding course (93.00% A average; GPA 4.00) American Academy of Professional Coders Salt Lake City, UT 8/2018
Certificate of Cardiology coding and Certificate of General Surgery and Anesthesia coding Greenville Tech Greenville, SC 2/2016
MOOC certificate of attendance Health Data Analytics with MS Excel St. Scholastica, MN December, 2015
Certificate of Achievement Coding-Baseline-ICD-10 Inpatient Diagnostic Precyse University, USA December 4, 2015
Certificate Explore a career in medical coding (A average; GPA 4.00) (360 hours) El Paso Community College El Paso, TX 7/2018
Triple Certificate in administrative medical specialist (GPA 4.00), medical coding and billing (97% A average; GPA 4.00), +medical terminology (98% A average; GPA 4.00) (360 Hours) University of Georgia Athens, GA 3/2015
Graduate from a Certificate of ICD-10-CM Coding Proficiency (CICP) course (scored 86% on final exam) 4Med Plus Chicago, IL 10/2017
School worth educational hours (322.75 hours up to 4/2018) American Academy of Professional Coders Salt Lake City UT 10/2013 to present
Graduate Certificate Medical Coding Specialist course (87% B average; GPA 3.00) (600 Hours) U.S. Career Institute Fort Collins, CO 2012-2013
Licentiate (comparable to M.S.) degree in clinical science for ophthalmology Department of Clinical Neuroscience Karolinska Institutet Stockholm, Sweden October, 2006
B.S. in Molecular Biology (GPA 3.95) summa cum laude high honors in molecular biology Vanderbilt University Nashville, TN 1993
\References
References are available on request.

Medical Billing and Coding Forum

Seeking full-time employment as a medical coding specialist

I am currently a member of AAPC and obtained certification as a professional medical coder in September 2018. I recently graduated with an AAS degree from Minnesota State College Southeast in medical coding, earning a 4.0 GPA. I have a background in healthcare, teaching, and public health. Please see my attached resume for consideration of full-time employment as a medical coding specialist.
Attached Files

Medical Billing and Coding Forum