AAPC Official CPC Certification Study Guide Notes
"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 p...
AAPC Official CPC Certification Study
Guide Notes
"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)
GPCI - Answer Geographic Practice Cost Index
GPCI is used to - Answer realize the varying cost based on geographic location
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