AAPC CPC STUDY GUIDE QUESTIONS WITH VERIFIED DETAILED ANSWERS

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AAPC CPC STUDY GUIDE QUESTIONS WITH VERIFIED || || || || || ||




DETAILED ANSWERS
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Coding is: - ✔✔The process of translating this written or dictated medical record into a
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series of numeric and alpha numeric codes
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Proper code assignment is determined both by - ✔✔the content (documentation) in the
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medical record and by the unique rules that govern each code set in that particular instance
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Outpatient coders will focus on learning which manuals - ✔✔CPT, HCPCS Level II, and
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ICD-10-CM



Hospital inpatient coders focus on which manuals - ✔✔ICD-10-CM & ICD-10-PCS
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Risk adjustment coding focuses on which manual - ✔✔ICD-10-CM code set
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Two primary types of insurers - ✔✔commercial and government
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Commercial carriers are private pairs that may offer group and individual plans, plans very
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but may include coverage for - ✔✔Hospitalization, basic, and major medical coverage
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Medicare is - ✔✔The most significant government ensure, a federal health insurance
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program



Medicare is administered by the center for Medicare and Medicaid services (CMS)- &
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provides coverage for who - ✔✔People over the age of 65, blind or disabled, individuals, and
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people with permanent kidney failure or end stage renal disease (ESRD).
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Medicare part A covers - ✔✔Inpatient hospital, skilled nursing facilities, hospice, and home
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healthcare
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Medicare part B covers - ✔✔Medically, necessary, physicians services, outpatient care, and
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other medical services (including some preventative services) not covered under Medicare
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part a ||




Medicare part B is optional which pt.s pay a - ✔✔premium, & generally requires a yearly
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deductible and coinsurance || ||




Medicare Part C (Medicare Advantage Plans) - ✔✔Combines Medicare part A part B and
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sometimes part D. Managed by private insures approved by Medicare.
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Medicare part C plans may charge - ✔✔Different copayments, coinsurance, or deductibles
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for services
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Medicare part D is a - ✔✔Prescription drug program available to all Medicare beneficiaries.
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Private companies approved by Medicare provide coverage.
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Medicaid is - ✔✔Health insurance assistance for low income people, (especially children
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and pregnant women)
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Medicaid is administered on a - ✔✔State-by-state basis, but state programs must here to
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certain federal guidelines
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The fee schedule designed to provide national uniform payment of Medicare benefits after
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adjustment to reflect the differences in practice costs across geographic areas is called the
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______________ - ✔✔RBRVS (Resource Based Relative Value Scale) || || || || || || ||

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Resource based relative value scale costs are divided into three components - ✔✔Physicians
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work, practice expense, professional liability insurance
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Physicians work accounts for half of a procedures/services total relative value measured by -
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✔✔The time it takes to perform service, technical skill, and physical effort, required mental
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effort and judgment, stress due to potential risk to the patient
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Practice expenses account for 44% of the total relative value for each service, They are
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resource based and defer by site of service because - ✔✔The expensive providing a service
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in hospital may be different than physicians office
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The resource base professional liability insurance (PLI) account for - ✔✔4% of the total
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rally relative value for each service
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Physician fee schedule lists the component value for each CPT and HCPCS level II code
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which is published when - ✔✔Annually by CMS
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Medical necessity means - ✔✔Whether procedure service is considered appropriate in a
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given circumstance ||




CMS developed policies regarding medical necessity when a physician provides services to a
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Medicare beneficiary which is - ✔✔He/she should bill only those services that meet the
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Medicare standard of "reasonable and necessary" for the diagnosis and treatment of a
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patient



National Coverage Determination (NCD) explains - ✔✔When Medicare will pay for items
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or services
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