AAPC Official CPC Certification Study Guide Notes with expert interventions
(Guaranteed Success)
"hold harmless clause" - answer * 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: - answer * 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 - answer 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 - answer only the
minimum necessary protected health information should be shared to satisfy a particular
purpose.
A medically necessary service is the - answer 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? - answer Leg
APC - answer Ambulatory Payment Classification
ARRA - answer American Recovery and Reinvestment Act (of 2009)
,ASC - answer Ambulatory Surgical Centers
Abuse consists of - answer 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 - answer 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? - answer Clearinghouse
As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of
fraud to remove the __________ requirement - answer intent
By statute, all work RVUs, must be examined no less often than - answer every 5 years
CF - answer Coversion Factor - fixed dollar amount used to translate the RVUs into fees
CMS - answer Centers for Medicare and Medicaid
CMS developed polices regarding medical necessity are based on regulations found in title XVIII,
$1862(a) of the - answer Social Security Act
CMS will accept the ____________ for either a "potentially non=covered" service or for a
statutorily excluded service - answer CMS-R-131
CMS-R-131 - answer ABN form
, or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular
service or procedure.
CPT - answer Current Procedural Terminology
CY 2013 Conversion Factor - answer $25.0008
Commercial (non-Medicare) may develop their own medical policies which do not follow
Medicare guidelines and are specified in - answer private contracts between the payer and
practice or provider
DRG - answer Diagnosis Related Group
Does Medicare Part B generally require a yearly deductable and copayment? - answer yes
E/M OR E&M - answer Evaluation and Management
EHR - answer Electronic Health Record
Formula for Calculating Facility Payment amounts - answer [(Work RVU * Work GPCI) +
(Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
Formula for Non-Facility Pricing Amount - answer [(Work RVU * Work GPCI) + (Transitioned
Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * (CF)
(Guaranteed Success)
"hold harmless clause" - answer * 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: - answer * 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 - answer 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 - answer only the
minimum necessary protected health information should be shared to satisfy a particular
purpose.
A medically necessary service is the - answer 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? - answer Leg
APC - answer Ambulatory Payment Classification
ARRA - answer American Recovery and Reinvestment Act (of 2009)
,ASC - answer Ambulatory Surgical Centers
Abuse consists of - answer 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 - answer 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? - answer Clearinghouse
As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of
fraud to remove the __________ requirement - answer intent
By statute, all work RVUs, must be examined no less often than - answer every 5 years
CF - answer Coversion Factor - fixed dollar amount used to translate the RVUs into fees
CMS - answer Centers for Medicare and Medicaid
CMS developed polices regarding medical necessity are based on regulations found in title XVIII,
$1862(a) of the - answer Social Security Act
CMS will accept the ____________ for either a "potentially non=covered" service or for a
statutorily excluded service - answer CMS-R-131
CMS-R-131 - answer ABN form
, or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular
service or procedure.
CPT - answer Current Procedural Terminology
CY 2013 Conversion Factor - answer $25.0008
Commercial (non-Medicare) may develop their own medical policies which do not follow
Medicare guidelines and are specified in - answer private contracts between the payer and
practice or provider
DRG - answer Diagnosis Related Group
Does Medicare Part B generally require a yearly deductable and copayment? - answer yes
E/M OR E&M - answer Evaluation and Management
EHR - answer Electronic Health Record
Formula for Calculating Facility Payment amounts - answer [(Work RVU * Work GPCI) +
(Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
Formula for Non-Facility Pricing Amount - answer [(Work RVU * Work GPCI) + (Transitioned
Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * (CF)
