AAPC OFFICIAL CPC CERTIFICATION STUDY GUIDE
1. "hold harmless clause": * found in some non-Medicare health plan contracts
* prohibits billing to patient for anything beyond deductibles and co-pays.
2. 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
3. A healthcare clearing house is a: entity that processes nonstandard health information they receive
from another entity into a standard format
4. 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.
5. A medically necessary service is the: least radical service/procedure that allows for ettective
treatment of the patients' complaint or condition
6. A patient sustaining an injury to her great saphenous vein would have sus-
tained injury to which of anatomical site?: Leg
7. APC: Ambulatory Payment Classification
8. ARRA: American Recovery and Reinvestment Act (of 2009)
9. ASC: Ambulatory Surgical Centers
https://www.stuvia.com/user/MBOFFIN
, 10. Abuse consists of: payment for items or services that are billed by providers in error that should not be
paid for by Medicare.
11. 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.
12. An entity that processes nonstandard health information they receive from
another entity into a standard format is considered what?: Clearinghouse
13. As a part of Health Care Reform, the Affordable Care Act of 2010 amended
the definition of fraud to remove the requirement: intent
14. By statute, all work RVUs, must be examined no less often than: every 5 years
15. CF: Coversion Factor - fixed dollar amount used to translate the RVUs into fees
16. CMS: Centers for Medicare and Medicaid
17. CMS developed polices regarding medical necessity are based on regula-
tions found in title XVIII, $1862(a) of the: Social Security Act
https://www.stuvia.com/user/MBOFFIN
, 18. CMS will accept the for either a "potentially non=covered" service
or for a statutorily excluded service: CMS-R-131
19. CMS-R-131: ABN form
or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service or procedure.
20. CPT: Current Procedural Terminology
21. CY 2013 Conversion Factor: $25.0008
22. 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
23. DRG: Diagnosis Related Group
24. Does Medicare Part B generally require a yearly deductable and copayment?-
: yes
25. E/M OR E&M: Evaluation and Management
26. EHR: Electronic Health Record
27. Formula for Calculating Facility Payment amounts: [(Work RVU * Work GPCI) + (Transi-
tioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
https://www.stuvia.com/user/MBOFFIN
1. "hold harmless clause": * found in some non-Medicare health plan contracts
* prohibits billing to patient for anything beyond deductibles and co-pays.
2. 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
3. A healthcare clearing house is a: entity that processes nonstandard health information they receive
from another entity into a standard format
4. 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.
5. A medically necessary service is the: least radical service/procedure that allows for ettective
treatment of the patients' complaint or condition
6. A patient sustaining an injury to her great saphenous vein would have sus-
tained injury to which of anatomical site?: Leg
7. APC: Ambulatory Payment Classification
8. ARRA: American Recovery and Reinvestment Act (of 2009)
9. ASC: Ambulatory Surgical Centers
https://www.stuvia.com/user/MBOFFIN
, 10. Abuse consists of: payment for items or services that are billed by providers in error that should not be
paid for by Medicare.
11. 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.
12. An entity that processes nonstandard health information they receive from
another entity into a standard format is considered what?: Clearinghouse
13. As a part of Health Care Reform, the Affordable Care Act of 2010 amended
the definition of fraud to remove the requirement: intent
14. By statute, all work RVUs, must be examined no less often than: every 5 years
15. CF: Coversion Factor - fixed dollar amount used to translate the RVUs into fees
16. CMS: Centers for Medicare and Medicaid
17. CMS developed polices regarding medical necessity are based on regula-
tions found in title XVIII, $1862(a) of the: Social Security Act
https://www.stuvia.com/user/MBOFFIN
, 18. CMS will accept the for either a "potentially non=covered" service
or for a statutorily excluded service: CMS-R-131
19. CMS-R-131: ABN form
or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service or procedure.
20. CPT: Current Procedural Terminology
21. CY 2013 Conversion Factor: $25.0008
22. 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
23. DRG: Diagnosis Related Group
24. Does Medicare Part B generally require a yearly deductable and copayment?-
: yes
25. E/M OR E&M: Evaluation and Management
26. EHR: Electronic Health Record
27. Formula for Calculating Facility Payment amounts: [(Work RVU * Work GPCI) + (Transi-
tioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
https://www.stuvia.com/user/MBOFFIN
