AAPC Official CPC Certification Study Guide definitions and questions from AAPC CPC Study Guide Medical Coding Prep Questions and
Answers latest update 100% Correct.
"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
DRG ✔️Diagnosis Related Group
Does Medicare Part B generally require a yearly deductable and copayment? ✔️yes
E/M OR E&M ✔️Evaluation and Management
EHR ✔️Electronic Health Record
Formula for Calculating Facility Payment amounts ✔️[(Work RVU * Work GPCI) + (Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)]
* CF
Formula for Non-Facility Pricing Amount ✔️[(Work RVU * Work GPCI) + (Transitioned Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] *
(CF)
GPCI ✔️Geographic Practice Cost Index
GPCI is used to ✔️realize the varying cost based on geographic location
HCPCS ✔️Healthcare Common Procedure Coding System
HHS ✔️Department of Health and Human Services
HIPAA provides federal protections for ✔️personal health information when held by covered entities.
HIPAA stands for ✔️Health Insurance Portability and Accountability Act of 1996
HITECH ✔️The Health Information Technology for Economic and Clinical Health Act
HITECH allows patients to request ✔️an audit trail showing all disclosures of their health information made through an electronic record.
HITECH requires that an individual be notified if ✔️there is an unauthorized disclosure or use of his or her health information.
HITECH was enacted as part of ✔️the American Recovery and Reinvestment Act of 2009 (ARRA)
HMO ✔️Health Maintenence Organization
Hemiplegia is a disorder caused by a defect in which anatomic system? ✔️nervous
ICD-9-CM ✔️International Classification of Disease, 9th Clinical Modification
IF:
Work RVUs = 0.48
Work GPCI = 1.000
Practice Expense CPCI = 0.943
MP GPCI = 0.572
transitioned non-facility practice RVUs = 0.70
Answers latest update 100% Correct.
"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
DRG ✔️Diagnosis Related Group
Does Medicare Part B generally require a yearly deductable and copayment? ✔️yes
E/M OR E&M ✔️Evaluation and Management
EHR ✔️Electronic Health Record
Formula for Calculating Facility Payment amounts ✔️[(Work RVU * Work GPCI) + (Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)]
* CF
Formula for Non-Facility Pricing Amount ✔️[(Work RVU * Work GPCI) + (Transitioned Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] *
(CF)
GPCI ✔️Geographic Practice Cost Index
GPCI is used to ✔️realize the varying cost based on geographic location
HCPCS ✔️Healthcare Common Procedure Coding System
HHS ✔️Department of Health and Human Services
HIPAA provides federal protections for ✔️personal health information when held by covered entities.
HIPAA stands for ✔️Health Insurance Portability and Accountability Act of 1996
HITECH ✔️The Health Information Technology for Economic and Clinical Health Act
HITECH allows patients to request ✔️an audit trail showing all disclosures of their health information made through an electronic record.
HITECH requires that an individual be notified if ✔️there is an unauthorized disclosure or use of his or her health information.
HITECH was enacted as part of ✔️the American Recovery and Reinvestment Act of 2009 (ARRA)
HMO ✔️Health Maintenence Organization
Hemiplegia is a disorder caused by a defect in which anatomic system? ✔️nervous
ICD-9-CM ✔️International Classification of Disease, 9th Clinical Modification
IF:
Work RVUs = 0.48
Work GPCI = 1.000
Practice Expense CPCI = 0.943
MP GPCI = 0.572
transitioned non-facility practice RVUs = 0.70
