CPC 2021 Exam Study Guide
Documentation (content) - Proper code assignment is determined both by _____________ in the
medical record and by the unique rules that govern each code set in that instance
An auditor - The role a coder may take on to verify that the documentation supports the codes the
physician has selected
Query the physician - If the medical record is inaccurate or incomplete, it will not translate properly
to the language of codes. What can a coder do in order for the medical record to be complete and
accurate so they can bill properly?
Quarterly (usually) - How often are codes and insurance payment policies updated?
NPP - Non-Physician Provider (also known as mid-level providers or physician extenders)
PA - Physician assistant
NP - Nurse practitioner
Commercial and Government - The two types of primary insurances
Commercial Carriers - Private payers that may offer both group and individual plans
Medicare - The most significant government insurer; a federal health insurance program
People over 65, blind or disabled individuals, and people with permanent kidney failure or end-
stage renal disease - Medicare provides coverage for what kind of people?
, ESRD - end-stage renal disease
Medicare Part A - Helps cover inpatient hospital care, as well as care provided in skilled nursing
facilities, hospice care, and home healthcare,
Medicare Part B - Covers medically necessary physicians' services, outpatient care, and other
medical services (including some preventive services) not covered under Medicare Part A. It can be
an optional benefit.
Medicare Part C - Also called Medicare Advantage, combines the benefits of Medicare Part A, Part B,
and-sometimes- Part D. The plans are managed by private insurers approved by Medicare.
Medicare Part D - A prescription drug program available to all Medicare beneficiaries.
Medicaid - A health insurance assistance program for some low-income people (especially children
and pregnant women) sponsored by federal and state governments.
RBRVS - Resource-Based Relative Value Scale
Resource-Based Relative Value Scale (RBRVS) - Medicare payments for physician services are
standardized using _____ and are divided into three components.
The physician work component, practice expense, and professional liability insurance (PLI) - The
three components used to determine resource cost for physician services.
The Physician Work component - Accounts for just over half (52 percent) of a procedure's/service's
total relative value and is measured by time it takes to perform a service, technical skill, and
physical effort.
Documentation (content) - Proper code assignment is determined both by _____________ in the
medical record and by the unique rules that govern each code set in that instance
An auditor - The role a coder may take on to verify that the documentation supports the codes the
physician has selected
Query the physician - If the medical record is inaccurate or incomplete, it will not translate properly
to the language of codes. What can a coder do in order for the medical record to be complete and
accurate so they can bill properly?
Quarterly (usually) - How often are codes and insurance payment policies updated?
NPP - Non-Physician Provider (also known as mid-level providers or physician extenders)
PA - Physician assistant
NP - Nurse practitioner
Commercial and Government - The two types of primary insurances
Commercial Carriers - Private payers that may offer both group and individual plans
Medicare - The most significant government insurer; a federal health insurance program
People over 65, blind or disabled individuals, and people with permanent kidney failure or end-
stage renal disease - Medicare provides coverage for what kind of people?
, ESRD - end-stage renal disease
Medicare Part A - Helps cover inpatient hospital care, as well as care provided in skilled nursing
facilities, hospice care, and home healthcare,
Medicare Part B - Covers medically necessary physicians' services, outpatient care, and other
medical services (including some preventive services) not covered under Medicare Part A. It can be
an optional benefit.
Medicare Part C - Also called Medicare Advantage, combines the benefits of Medicare Part A, Part B,
and-sometimes- Part D. The plans are managed by private insurers approved by Medicare.
Medicare Part D - A prescription drug program available to all Medicare beneficiaries.
Medicaid - A health insurance assistance program for some low-income people (especially children
and pregnant women) sponsored by federal and state governments.
RBRVS - Resource-Based Relative Value Scale
Resource-Based Relative Value Scale (RBRVS) - Medicare payments for physician services are
standardized using _____ and are divided into three components.
The physician work component, practice expense, and professional liability insurance (PLI) - The
three components used to determine resource cost for physician services.
The Physician Work component - Accounts for just over half (52 percent) of a procedure's/service's
total relative value and is measured by time it takes to perform a service, technical skill, and
physical effort.
