AAPC Official CPC Certification Study Guide Notes Already Graded A

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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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