CPC 2022 Exam Study Guide| 105 questions| with complete
solutions
Proper code assignment is determined both by _____________ in the medical record and by the
unique rules that govern each code set in that instance Correct Answer: Documentation (content)
The role a coder may take on to verify that the documentation supports the codes the physician
has selected Correct Answer: An auditor
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? Correct Answer: Query the physician
How often are codes and insurance payment policies updated? Correct Answer: Quarterly
(usually)
Non-Physician Provider (also known as mid-level providers or physician extenders) Correct
Answer: NPP
Physician assistant Correct Answer: PA
Nurse practitioner Correct Answer: NP
The two types of primary insurances Correct Answer: Commercial and Government
Private payers that may offer both group and individual plans Correct Answer: Commercial
Carriers
The most significant government insurer; a federal health insurance program Correct Answer:
Medicare
Medicare provides coverage for what kind of people? Correct Answer: People over 65, blind or
disabled individuals, and people with permanent kidney failure or end-stage renal disease
end-stage renal disease Correct Answer: ESRD
Helps cover inpatient hospital care, as well as care provided in skilled nursing facilities, hospice
care, and home healthcare, Correct Answer: Medicare Part A
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. Correct Answer: Medicare Part B
, 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. Correct
Answer: Medicare Part C
A prescription drug program available to all Medicare beneficiaries. Correct Answer: Medicare
Part D
A health insurance assistance program for some low-income people (especially children and
pregnant women) sponsored by federal and state governments. Correct Answer: Medicaid
Resource-Based Relative Value Scale Correct Answer: RBRVS
Medicare payments for physician services are standardized using _____ and are divided into
three components. Correct Answer: Resource-Based Relative Value Scale (RBRVS)
The three components used to determine resource cost for physician services. Correct Answer:
The physician work component, practice expense, and professional liability insurance (PLI)
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. Correct
Answer: The Physician Work component
Accounts for 44 percent of the total relative value for each service and differ by site of service.
For example, the expense of providing services in the hospital vs a physician's office. Correct
Answer: Practice Expense
Resource-Based Professional Liability Insurance Correct Answer: PLI
Accounts for 4 percent of the total relative value for each service Correct Answer: Professional
Liability Insurance (PLI)
Where can you find Physician Fee Schedule (PFS) information? Correct Answer: CMS website
Physician Fee Schedule Correct Answer: PFS
Refers to whether a procedure or service is considered appropriate in a given circumstance
Correct Answer: Medical Necessity
National Coverage Determinations Correct Answer: NCD
Explains when Medicare will pay for items or services Correct Answer: National Coverage
Determinations (NCD)
Medicare Administrative Contractor Correct Answer: MAC
solutions
Proper code assignment is determined both by _____________ in the medical record and by the
unique rules that govern each code set in that instance Correct Answer: Documentation (content)
The role a coder may take on to verify that the documentation supports the codes the physician
has selected Correct Answer: An auditor
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? Correct Answer: Query the physician
How often are codes and insurance payment policies updated? Correct Answer: Quarterly
(usually)
Non-Physician Provider (also known as mid-level providers or physician extenders) Correct
Answer: NPP
Physician assistant Correct Answer: PA
Nurse practitioner Correct Answer: NP
The two types of primary insurances Correct Answer: Commercial and Government
Private payers that may offer both group and individual plans Correct Answer: Commercial
Carriers
The most significant government insurer; a federal health insurance program Correct Answer:
Medicare
Medicare provides coverage for what kind of people? Correct Answer: People over 65, blind or
disabled individuals, and people with permanent kidney failure or end-stage renal disease
end-stage renal disease Correct Answer: ESRD
Helps cover inpatient hospital care, as well as care provided in skilled nursing facilities, hospice
care, and home healthcare, Correct Answer: Medicare Part A
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. Correct Answer: Medicare Part B
, 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. Correct
Answer: Medicare Part C
A prescription drug program available to all Medicare beneficiaries. Correct Answer: Medicare
Part D
A health insurance assistance program for some low-income people (especially children and
pregnant women) sponsored by federal and state governments. Correct Answer: Medicaid
Resource-Based Relative Value Scale Correct Answer: RBRVS
Medicare payments for physician services are standardized using _____ and are divided into
three components. Correct Answer: Resource-Based Relative Value Scale (RBRVS)
The three components used to determine resource cost for physician services. Correct Answer:
The physician work component, practice expense, and professional liability insurance (PLI)
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. Correct
Answer: The Physician Work component
Accounts for 44 percent of the total relative value for each service and differ by site of service.
For example, the expense of providing services in the hospital vs a physician's office. Correct
Answer: Practice Expense
Resource-Based Professional Liability Insurance Correct Answer: PLI
Accounts for 4 percent of the total relative value for each service Correct Answer: Professional
Liability Insurance (PLI)
Where can you find Physician Fee Schedule (PFS) information? Correct Answer: CMS website
Physician Fee Schedule Correct Answer: PFS
Refers to whether a procedure or service is considered appropriate in a given circumstance
Correct Answer: Medical Necessity
National Coverage Determinations Correct Answer: NCD
Explains when Medicare will pay for items or services Correct Answer: National Coverage
Determinations (NCD)
Medicare Administrative Contractor Correct Answer: MAC
