CPC 2021 Exam Study Guide
Documentation (content) - ANS-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 - ANS-The role a coder may take on to verify that the documentation
supports the codes the physician has selected
Query the physician - ANS-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) - ANS-How often are codes and insurance payment policies
updated?
NPP - ANS-Non-Physician Provider (also known as mid-level providers or physician
extenders)
PA - ANS-Physician assistant
NP - ANS-Nurse practitioner
Commercial and Government - ANS-The two types of primary insurances
Commercial Carriers - ANS-Private payers that may offer both group and individual
plans
Medicare - ANS-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 - ANS-Medicare provides coverage for what kind of people?
ESRD - ANS-end-stage renal disease
Medicare Part A - ANS-Helps cover inpatient hospital care, as well as care provided in
skilled nursing facilities, hospice care, and home healthcare,
, Medicare Part B - ANS-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 - ANS-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 - ANS-A prescription drug program available to all Medicare
beneficiaries.
Medicaid - ANS-A health insurance assistance program for some low-income people
(especially children and pregnant women) sponsored by federal and state governments.
RBRVS - ANS-Resource-Based Relative Value Scale
Resource-Based Relative Value Scale (RBRVS) - ANS-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) - ANS-The three components used to determine resource cost for physician
services.
The Physician Work component - ANS-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.
Practice Expense - ANS-Accounts for 44 percent of the total relative value for each
service and differ by site of service. For example, the expense of providing services in
the hospital vs a physician's office.
PLI - ANS-Resource-Based Professional Liability Insurance
Professional Liability Insurance (PLI) - ANS-Accounts for 4 percent of the total relative
value for each service
CMS website - ANS-Where can you find Physician Fee Schedule (PFS) information?
PFS - ANS-Physician Fee Schedule
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