CPC Exam with Complete Solution

CPC Exam with Complete Solution Abstractor - hospital employee who converts documented procedurs and diangoses into medical codes Abuse - coding practices that lead to improper reimbursement by error because they do not meet medical necessity, ex. changing diagnosis to be covered by insurance Accreditation - an examination process the healthcare facility goes through to evaluate the facilities policies, procedures, and performance to meet higher standards. Accredited - Having seal of approval after being evaluated and demonstrating quality standards Act/ Law/ Statute - Legislation passed through Congress and signed by President or passed over his veto Actual Charge - The amount the provider charges for medical services or supplies. Not always paid in full. Additional Benefits - Health care services not covered by Medicare and are offered through the Medicare Advantage Organization for no additional premium. The benefits must equal the ACR (Adjusted Community Rating) Adjudication - Health Insurance Claims process at the insurance company Adjusted Average Per Capita Cost (AAPCC) - Estimate of how much Medicare will spend in a year for an average beneficiary Administrative Code Sets - Non medical code sets that characterize a general business situation rather than a medical condition. Administrative Costs - Medicare, Medicaid, CMS refer to this as their expenses to have the program, operating expenses, program management, etc. Administrative Data - Health insurance information stored in automated information system about enrollment, eligibility, claims, etc. Administrative Law Judge (ALJ) - hearing officer who presides over appeal conflicts between providers or beneficiaries, and Medicare contractors (MAC's)