AAPC Official CPC Certification Study
Guide Notes Already Graded A
"hold harmless clause" ✔✔* found in some non-Medicare health plan contracts
* prohibits billing to patient for anything beyond deductibles and co-pays.
A compliance plan may offer several benefits, including: ✔✔* more accurate payment of claims
* fewer billing mistakes
* improved documentation and more accurate coding
* less chance of violating self-referral and anti-kickback status
A healthcare clearing house is a ✔✔entity that processes nonstandard health information they
receive from another entity into a standard format
A key provision in HIPAA is the Minimum Necessary requirement. this means ✔✔only the
minimum necessary protected health information should be shared to satisfy a particular purpose.
A medically necessary service is the ✔✔least radical service/procedure that allows for effective
treatment of the patients' complaint or condition
,A patient sustaining an injury to her great saphenous vein would have sustained injury to which
of anatomical site? ✔✔Leg
APC ✔✔Ambulatory Payment Classification
ARRA ✔✔American Recovery and Reinvestment Act (of 2009)
ASC ✔✔Ambulatory Surgical Centers
Abuse consists of ✔✔payment for items or services that are billed by providers in error that
should not be paid for by Medicare.
An ABN protects the provider's financial interest by ✔✔creating a paper trail that CMS requires
before a provider can bill the patient for payment if Medicare denies coverage for the stated
service or procedure.
An entity that processes nonstandard health information they receive from another entity into a
standard format is considered what? ✔✔Clearinghouse
, As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of
fraud to remove the __________ requirement ✔✔intent
By statute, all work RVUs, must be examined no less often than ✔✔every 5 years
CF ✔✔Coversion Factor - fixed dollar amount used to translate the RVUs into fees
CMS ✔✔Centers for Medicare and Medicaid
CMS developed polices regarding medical necessity are based on regulations found in title
XVIII, $1862(a) of the ✔✔Social Security Act
CMS will accept the ____________ for either a "potentially non=covered" service or for a
statutorily excluded service ✔✔CMS-R-131
CMS-R-131 ✔✔ABN form
Guide Notes Already Graded A
"hold harmless clause" ✔✔* found in some non-Medicare health plan contracts
* prohibits billing to patient for anything beyond deductibles and co-pays.
A compliance plan may offer several benefits, including: ✔✔* more accurate payment of claims
* fewer billing mistakes
* improved documentation and more accurate coding
* less chance of violating self-referral and anti-kickback status
A healthcare clearing house is a ✔✔entity that processes nonstandard health information they
receive from another entity into a standard format
A key provision in HIPAA is the Minimum Necessary requirement. this means ✔✔only the
minimum necessary protected health information should be shared to satisfy a particular purpose.
A medically necessary service is the ✔✔least radical service/procedure that allows for effective
treatment of the patients' complaint or condition
,A patient sustaining an injury to her great saphenous vein would have sustained injury to which
of anatomical site? ✔✔Leg
APC ✔✔Ambulatory Payment Classification
ARRA ✔✔American Recovery and Reinvestment Act (of 2009)
ASC ✔✔Ambulatory Surgical Centers
Abuse consists of ✔✔payment for items or services that are billed by providers in error that
should not be paid for by Medicare.
An ABN protects the provider's financial interest by ✔✔creating a paper trail that CMS requires
before a provider can bill the patient for payment if Medicare denies coverage for the stated
service or procedure.
An entity that processes nonstandard health information they receive from another entity into a
standard format is considered what? ✔✔Clearinghouse
, As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of
fraud to remove the __________ requirement ✔✔intent
By statute, all work RVUs, must be examined no less often than ✔✔every 5 years
CF ✔✔Coversion Factor - fixed dollar amount used to translate the RVUs into fees
CMS ✔✔Centers for Medicare and Medicaid
CMS developed polices regarding medical necessity are based on regulations found in title
XVIII, $1862(a) of the ✔✔Social Security Act
CMS will accept the ____________ for either a "potentially non=covered" service or for a
statutorily excluded service ✔✔CMS-R-131
CMS-R-131 ✔✔ABN form
