CPC 2021 Exam Study Guide Questions and Answers Graded A+

CPC 2021 Exam Study Guide Questions and Answers 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 ...

CPC 2021 Exam Study Guide Questions and Answers 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 endstage 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. Practice Expense ✔✔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 ✔✔Resource-Based Professional Liability Insurance Professional Liability Insurance (PLI) ✔✔Accounts for 4 percent of the total relative value for each service CMS website ✔✔Where can you find Physician Fee Schedule (PFS) information? PFS ✔✔Physician Fee Schedule Medical Necessity ✔✔Refers to whether a procedure or service is considered appropriate in a given circumstance NCD ✔✔National Coverage Determinations National Coverage Determinations (NCD) ✔✔Explains when Medicare will pay for items or services MAC ✔✔Medicare Administrative Contractor Medicare Administrative Contractor (MAC) ✔✔Responsible for interpreting national policies into reginal polices. Local Coverage Determinations (LCD) ✔✔Regional policies converted from national polices by a Medicare Administrative Contractor (MAC). ABN ✔✔Advance Beneficiary Notice Advanced Beneficiary Notice (ABN) ✔✔A standardized form that explains to the patient why Medicare may deny the service or procedure HIPAA ✔✔The Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA) ✔✔Provides federal protections for protected health information when held by covered entities HIPAA covered entities ✔✔A healthcare provider, a health plan, and a healthcare clearinghouse PHI ✔✔Protected Health Information Minimum Necessary requirement ✔✔A key provision of HIPPA, under which only the _______ protected health information (PHI) should be shared to satisfy a particular purpose. HITECH ✔✔Health Information Technology for Economic and Clinical Health Act Health Information Technology for Economic and Clinical Health Act (HITECH) ✔✔Allows patients to request an audit trail showing all disclosures of their health information made through an electronic record. Health Information Technology for Economic and Clinical Health Act (HITECH) ✔✔Requires that an individual be notified if there is an unauthorized disclosure or use of his or her health information. OIG ✔✔Office of Inspector General Fraud ✔✔To purposely bill for services that were never given or to bill for a service that has a high reimbursement than the services provided; The person does not have to possess knowledge of the violation for it to still be a considered offense. Abuse ✔✔Consists of payment for items or services that are billed by providers in error that should not be paid for by Medicare. Compliance Plan ✔✔A written set of instructions outlining the process for coding and submitting accurate claims, and what to do if mistakes are found. CPT ✔✔Certified Procedural Terminology ICD-10-CM ✔✔International Classification of Disease, 10th Revision Clinical Modification MP ✔✔Malpractice OCR ✔✔Office for Civil Right RVU ✔✔Relative Value Unit Part D ✔✔What part of Medicare should be billed for the pain medication by a pharmacy? Translating medical documentation into codes ✔✔What is medical coding? Workers' Compensation ✔✔Not a covered entity of HIPAA Blue Cross/Blue Shield ✔✔A commercial payer When a service is not expected to be covered by Medicare ✔✔When should an ABN be signed? $100 or 25% of cost ✔✔The amount on an ABN should be within how much of the cost to the patient? Clearinghouse ✔✔An entity that processes nonstandard health information they receive from another entity into a standard format Fraud ✔✔Intentional billing of services not provided is considered _____ OIG Work Plan ✔✔What OIG document should a provider review for potential problem areas that will receive special scrutiny in the upcoming year? The word root ✔✔The base of a medical term and can stand alone as the main portion of a medical term. Combining vowels ✔✔Attachments to a root word to link another root word or suffix and is always placed between two root words, even when the second root word begins with a vowel O and I ✔✔The most common combining vowels A Prefix ✔✔Typically attached to the beginning of a word to modify or alter its meaning; Indicates location, time, or number A Suffix ✔✔Attached to the end of a word to modify or alter its meaning; Indicates procedure, condition, disorder, or disease Anterior (ventral) ✔✔Toward the front of the body Posterior (dorsal) ✔✔Toward the back of the body Medial ✔✔Toward the midline of the body Lateral ✔✔Toward the side of the body Proximal ✔✔Nearer to the point of attachment or to a given reference point Distal ✔✔Farther from the point of attachment of from a given reference point Superior (cranial) ✔✔Above; toward the head Inferior (caudal) ✔✔Below; toward the lower end of the spine Superficial (external) ✔✔Closer to the surface of the body Deep (internal) ✔✔Closer to the center of the body Sagittal ✔✔Cuts through the midline of the body from front to back, dividing the body into the right and left sections Frontal (coronal) ✔✔Cuts at a right angle to the midline, from side to side, dividing the body into front (anterior) and back (posterior) sections Transverse (horizontal)(axial) ✔✔Cuts horizontally through the body, separating the body into upper (superior) and lower (inferior) sections The cell ✔✔Basic unit of all living things Tissue ✔✔A group of similar cells performing a specific task Organs ✔✔Two or more kinds of tissue that together perform special body functions Body Systems ✔✔Groups of organs that work together to perform complex body functions 5 cavities ✔✔How many cavities does the human body have? Cranial cavity ✔✔The space inside of the skull, or cranium, containing a brain Spinal (vertebral) cavity ✔✔The space inside the spinal column containing the spinal cord Thoracic (chest) cavity ✔✔The space containing the heart, lungs, esophagus, trachea, bronchi, and thymus Abdominal cavity ✔✔The space containing the lowest portion of the esophagus, the stomach, intestines (excluding the sigmoid colon and rectum), kidneys, liver, gallbladder, pancreas, spleen, and ureters Pelvic cavity ✔✔The space containing the urinary bladder, certain reproductive organs, part of the large intestine, and the rectum Membranes ✔✔Lines the internal space of organs and tubes that open to the outside, and line body cavities Mucous membranes ✔✔Line the interior walls of the organs and tubes that open outside of the body, such as those of the digestive, respiratory, urinary, and reproductive systems Serous membrane ✔✔Lines cavities, including the thoracic cavity and internal organs (e.g., heart) Synovial membrane ✔✔Lines the joint cavities and are composed pf connective tissue. They secrete _________ fluid into the joint cavity so that bones can move freely Meninges ✔✔Composed of three connective tissue membranes found within the dorsal cavity and serve as a protective covering of the brain and spinal cord Cutaneous membrane ✔✔A.K.A., the skin---forms the outer covering of the body Epidermis ✔✔The upper layer of the skin Dermis ✔✔The lower layer of the skin Stratum Corneum ✔✔Also called the horny layer, it is the outermost layer of the epidermis Stratum Lucidum ✔✔The clear layer of the epidermis, normally found on the palms of the hands and soles of the feet Stratum Granulosum ✔✔A layer of the epidermis that marks the transition between the deeper, metabolically active strata and the dead cells of the more superficial strata Stratum Spinosum ✔✔The layer of the epidermis that is composed of prickle cells Stratum Basale (Stratum Germinativum) ✔✔Deepest layer of the epidermis, made of basal cells Stratum Papillare ✔✔The thin superficial layer of the dermis interlocked with the epidermis Stratum Reticulare ✔✔The thick layer of dense, irregular connective tissue of the dermis Subcutaneous/Hypodermis Tissue ✔✔The layer beneath the dermis ✔✔