AAPC Official CPC Certification Study Guide Notes

"hold harmless clause" Correct 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 benefi ...

"hold harmless clause" Correct 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: Correct 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 Correct 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 Correct Answer: only the minimum necessary protected health information should be shared to satisfy a particular purpose. A medically necessary service is the Correct 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? Correct Answer: Leg APC Correct Answer: Ambulatory Payment Classification ARRA Correct Answer: American Recovery and Reinvestment Act (of 2009) ASC Correct Answer: Ambulatory Surgical Centers Abuse consists of Correct 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 Correct 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? Correct Answer: Clearinghouse As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to remove the __________ requirement Correct Answer: intent By statute, all work RVUs, must be examined no less often than Correct Answer: every 5 years CF Correct Answer: Coversion Factor - fixed dollar amount used to translate the RVUs into fees