CPC Exam Questions and answers,
100% Accurate. VERIFIED.
Abstractor - -hospital employee who converts documented procedurs and diangoses into medical
codes
Abuse - -coding practices that lead to improper reimbursement by error because they do not meet
medical necessity, ex. changing diagnos...
CPC Exam Questions and answers,
100% Accurate. VERIFIED.
Abstractor - ✔✔-hospital employee who converts documented procedurs and diangoses into medical
codes
Abuse - ✔✔-coding practices that lead to improper reimbursement by error because they do not meet
medical necessity, ex. changing diagnosis to be covered by insurance
Accreditation - ✔✔-an examination process the healthcare facility goes through to evaluate the facilities
policies, procedures, and performance to meet higher standards.
Accredited - ✔✔-Having seal of approval after being evaluated and demonstrating quality standards
Act/ Law/ Statute - ✔✔-Legislation passed through Congress and signed by President or passed over his
veto
Actual Charge - ✔✔-The amount the provider charges for medical services or supplies. Not always paid
in full.
Additional Benefits - ✔✔-Health care services not covered by Medicare and are offered through the
Medicare Advantage Organization for no additional premium. The benefits must equal the ACR
(Adjusted Community Rating)
Adjudication - ✔✔-Health Insurance Claims process at the insurance company
Adjusted Average Per Capita Cost (AAPCC) - ✔✔-Estimate of how much Medicare will spend in a year for
an average beneficiary
, Administrative Code Sets - ✔✔-Non medical code sets that characterize a general business situation
rather than a medical condition.
Administrative Costs - ✔✔-Medicare, Medicaid, CMS refer to this as their expenses to have the program,
operating expenses, program management, etc.
Administrative Data - ✔✔-Health insurance information stored in automated information system about
enrollment, eligibility, claims, etc.
Administrative Law Judge (ALJ) - ✔✔-hearing officer who presides over appeal conflicts between
providers or beneficiaries, and Medicare contractors (MAC's)
Administrative Simplification - ✔✔-Part of HIPAA authorizing HHS (Health and Human Services) to 1.
adopt standards for transactions & code sets; 2. adopt standard identifiers for health plans; 3. adopt
standards to protect security & privacy of personally identifiable health information.
Administrative Simplification Act - ✔✔-Signed 12/17/01 allows HHS (Health & Human Services) to
exclude providers from Medicare for HIPAA non-compliance of electronic claims and prohibit paper
claims except in certain situations
Admission Date - ✔✔-The date the patient was admitted for inpatient care, outpatient, or start of
care.For hospice, enter effective date of election of hospice benefits.
Admitting Diagnosis - ✔✔-Diagnosis code indicating patient's diagnosis at admission
Admitting Physician - ✔✔-The doctor responsible for admitting a patient to the hospital or other
inpatient health facility
Advance Beneficiary Notification (ABN) - ✔✔-A notice from provider to patient that Medicare may deny
payment. Patient must sign before services are provider, otherwise patient is not responsible if
Medicare does not cover.
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