CPC Exam Study Guide Questions And
Answers.
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.
Practice Expense -
\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.
PLI -
\Resource-Based Professional Liability Insurance
Professional Liability Insurance (PLI) -
Answers.
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.
Practice Expense -
\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.
PLI -
\Resource-Based Professional Liability Insurance
Professional Liability Insurance (PLI) -
