CPC 2021 Exam Study Guide

Documentation (content) - Answer- Proper code assignment is determined both by _____________ in the medical record and by the unique rules that govern each code set in that instance An auditor - Answer- The role a coder may take on to verify that the documentation supports the codes the physician has selected Query the physician - Answer- If the medical record is inaccurate or incomplete, it will not translate properly to the language of codes. What can a coder do in order for the medical record to be complete and accurate so they can bill properly? Quarterly (usually) - Answer- How often are codes and insurance payment policies updated? NPP - Answer- Non-Physician Provider (also known as mid-level providers or physician extenders) PA - Answer- Physician assistant NP - Answer- Nurse practitioner Commercial and Government - Answer- The two types of primary insurances Commercial Carriers - Answer- Private payers that may offer both group and individual plans Medicare - Answer- The most significant government insurer; a federal health insurance program People over 65, blind or disabled individuals, and people with permanent kidney failure or end-stage renal disease - Answer- Medicare provides coverage for what kind of people? ESRD - Answer- end-stage renal disease Medicare Part A - Answer- Helps cover inpatient hospital care, as well as care provided in skilled nursing facilities, hospice care, and home healthcare, Medicare Part B - Answer- Covers medically necessary physicians' services, outpatient care, and other medical services (including some preventive services) not covered under Medicare Part A. It can be an optional benefit. Medicare Part C - Answer- Also called Medicare Advantage, combines the benefits of Medicare Part A, Part B, and-sometimes- Part D. The plans are managed by private insurers approved by Medicare. Medicare Part D - Answer- A prescription drug program available to all Medicare beneficiaries. Medicaid -