AAPC Official CPC Certification Study Guide with
Verified A+ Solutions
"Hold harmless clause" - 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: - 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 - 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 - Answer only the
minimum necessary protected health information should be shared to satisfy a particular purpose.
A medically necessary service is the - 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? - Answer Leg
APC - Answer Ambulatory Payment Classification
ARRA - Answer American Recovery and Reinvestment Act (of 2009)
ASC - Answer Ambulatory Surgical Centers
Abuse consists of - 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 - 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? - Answer Clearinghouse
As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to
remove the __________ requirement - Answer intent
By statute, all work RVUs, must be examined no less often than - Answer every 5 years
CF - Answer Coversion Factor - fixed dollar amount used to translate the RVUs into fees
CMS - Answer Centers for Medicare and Medicaid
CMS developed polices regarding medical necessity are based on regulations found in title XVIII,
$1862(a) of the - Answer Social Security Act
CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily
excluded service - Answer CMS-R-131
CMS-R-131 - Answer ABN form
or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service
or procedure.
CPT - Answer Current Procedural Terminology
, CY 2013 Conversion Factor - Answer $25.0008
Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare
guidelines and are specified in - Answer private contracts between the payer and practice or provider
DRG - Answer Diagnosis Related Group
Does Medicare Part B generally require a yearly deductable and copayment? - Answer yes
E/M OR E&M - Answer Evaluation and Management
EHR - Answer Electronic Health Record
Formula for Calculating Facility Payment amounts - Answer [(Work RVU * Work GPCI) + (Transitioned
Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
Formula for Non-Facility Pricing Amount - Answer [(Work RVU * Work GPCI) + (Transitioned Non-Facility
PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * (CF)
GPCI - Answer Geographic Practice Cost Index
GPCI is used to - Answer realize the varying cost based on geographic location
HCPCS - Answer Healthcare Common Procedure Coding System
HHS - Answer Department of Health and Human Services
HIPAA provides federal protections for - Answer personal health information when held by covered
entities.
Verified A+ Solutions
"Hold harmless clause" - 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: - 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 - 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 - Answer only the
minimum necessary protected health information should be shared to satisfy a particular purpose.
A medically necessary service is the - 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? - Answer Leg
APC - Answer Ambulatory Payment Classification
ARRA - Answer American Recovery and Reinvestment Act (of 2009)
ASC - Answer Ambulatory Surgical Centers
Abuse consists of - 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 - 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? - Answer Clearinghouse
As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to
remove the __________ requirement - Answer intent
By statute, all work RVUs, must be examined no less often than - Answer every 5 years
CF - Answer Coversion Factor - fixed dollar amount used to translate the RVUs into fees
CMS - Answer Centers for Medicare and Medicaid
CMS developed polices regarding medical necessity are based on regulations found in title XVIII,
$1862(a) of the - Answer Social Security Act
CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily
excluded service - Answer CMS-R-131
CMS-R-131 - Answer ABN form
or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service
or procedure.
CPT - Answer Current Procedural Terminology
, CY 2013 Conversion Factor - Answer $25.0008
Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare
guidelines and are specified in - Answer private contracts between the payer and practice or provider
DRG - Answer Diagnosis Related Group
Does Medicare Part B generally require a yearly deductable and copayment? - Answer yes
E/M OR E&M - Answer Evaluation and Management
EHR - Answer Electronic Health Record
Formula for Calculating Facility Payment amounts - Answer [(Work RVU * Work GPCI) + (Transitioned
Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
Formula for Non-Facility Pricing Amount - Answer [(Work RVU * Work GPCI) + (Transitioned Non-Facility
PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * (CF)
GPCI - Answer Geographic Practice Cost Index
GPCI is used to - Answer realize the varying cost based on geographic location
HCPCS - Answer Healthcare Common Procedure Coding System
HHS - Answer Department of Health and Human Services
HIPAA provides federal protections for - Answer personal health information when held by covered
entities.
