AAPC Official CPC Certification Study
Guide Notes
"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...
AAPC Official CPC Certification Study
Guide Notes
"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
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