CPC Exam Study Guide Questions and answers, 100% Accurate. Graded A+
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 ver...
CPC Exam Study Guide Questions and
answers, 100% Accurate. Graded A+
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.
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