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