Health Care > QUESTIONS & ANSWERS > AAPC Official CPC Certification Study Guide Notes (All)

AAPC Official CPC Certification Study Guide Notes

Document Content and Description Below

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

[Show More]

Last updated: 3 years ago

Preview 1 out of 23 pages

Buy Now

Instant download