CPC Exam Questions and answers, 100% Accurate. VERIFIED.

CPC Exam Questions and answers, 100% Accurate. VERIFIED. Abstractor - -hospital employee who converts documented procedurs and diangoses into medical codes Abuse - -coding practices that lead to improper reimbursement by error because they do not meet medical necessity, ex. changing diagnosis to be covered by insurance Accreditation - -an examination process the healthcare facility goes through to evaluate the facilities policies, procedures, and performance to meet higher standards. Accredited - -Having seal of approval after being evaluated and demonstrating quality standards Act/ Law/ Statute - -Legislation passed through Congress and signed by President or passed over his veto Actual Charge - -The amount the provider charges for medical services or supplies. Not always paid in full. Additional Benefits - -Health care services not covered by Medicare and are offered through the Medicare Advantage Organization for no additional premium. The benefits must equal the ACR (Adjusted Community Rating) Adjudication - -Health Insurance Claims process at the insurance company Adjusted Average Per Capita Cost (AAPCC) - -Estimate of how much Medicare will spend in a year for an average beneficiary Administrative Code Sets - -Non medical code sets that characterize a general business situation rather than a medical condition. Administrative Costs - -Medicare, Medicaid, CMS refer to this as their expenses to have the program, operating expenses, program management, etc. Administrative Data - -Health insurance information stored in automated information system about enrollment, eligibility, claims, etc. Administrative Law Judge (ALJ) - -hearing officer who presides over appeal conflicts between providers or beneficiaries, and Medicare contractors (MAC's) Administrative Simplification - -Part of HIPAA authorizing HHS (Health and Human Services) to 1. adopt standards for transactions & code sets; 2. adopt standard identifiers for health plans; 3. adopt standards to protect security & privacy of personally identifiable health information. Administrative Simplification Act - -Signed 12/17/01 allows HHS (Health & Human Services) to exclude providers from Medicare for HIPAA non-compliance of electronic claims and prohibit paper claims except in certain situations Admission Date - -The date the patient was admitted for inpatient care, outpatient, or start of care.For hospice, enter effective date of election of hospice benefits. Admitting Diagnosis - -Diagnosis code indicating patient's diagnosis at admission Admitting Physician - -The doctor responsible for admitting a patient to the hospital or other inpatient health facility Advance Beneficiary Notification (ABN) - -A notice from provider to patient that Medicare may deny payment. Patient must sign before services are provider, otherwise patient is not responsible if Medicare does not cover. Advanced Directive - -Statement written by patient on how they want medical decisions to be made. May include a Living Will or Durable Power of Attorney for healthcare. Allowed Charge - -Individual charge determination by carrier for a covered service or supply. Ambulatory Care - -All types of health services that do not require an overnight stay. Ambulatory Care Sensitive Conditions (ACSC) - -Medical condtions that if treated immediatly and managed properly should not require hospitalization. Ambulatory Payment Classification (APC) - -Medicare's outpatient prospective payment system in which services are grouped based on the resources needed and payment is fixed within each group Ambulatory Surgery Center (ASC) - -Outpatient surgery center not located in the hospital. Patient's may stay a few hours up to 1 night.