AAPC OFFICIAL CPC CERTIFICATION STUDY GUIDE NOTES 2023-2024 QUESTIONS WITH 100% CORRECT ANSWERS WITH COMPLETE VERIFIED SOLUTIONS.
"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
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