AAPC Official CPC Certification Study
Guide Notes Questions And Answers.
"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
or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the
particular service or procedure.
CPT -
\Current Procedural Terminology
CY 2013 Conversion Factor -
\$25.0008
Commercial (non-Medicare) may develop their own medical policies which do not follow
Medicare guidelines and are specified in -
\private contracts between the payer and practice or provider
Guide Notes Questions And Answers.
"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
or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the
particular service or procedure.
CPT -
\Current Procedural Terminology
CY 2013 Conversion Factor -
\$25.0008
Commercial (non-Medicare) may develop their own medical policies which do not follow
Medicare guidelines and are specified in -
\private contracts between the payer and practice or provider
