AAPC Official CPC Certification Study
Guide Notes Already Graded A
"hold harmless clause" ✔✔* found in some non-Medicare health plan contracts
* prohibits billing to patient for anything beyond deductibles and co-pays
...
AAPC Official CPC Certification Study
Guide Notes Already Graded A
"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
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