CPC Exam Prep Guide: Pass the Certified Professional
Coder Test
1. Abstractor hospital employee who converts documented procedurs and diangoses
into
medical codes
2. 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
3. Accreditation an examination process the healthcare facility goes through to
evaluate the facil- ities policies, procedures, and performance to meet
higher standards.
4. Accredited Having seal of approval after being evaluated and demonstrating quality
stan-
dards
5. Act/ Law/ Statute Legislation passed through Congress and signed by President or
passed over his veto
6. Actual Charge The amount the provider charges for medical services or supplies. Not
always paid in full.
7. Additional Health care services not covered by Medicare and are ottered through
Bene- fits
the Medicare Advantage Organization for no additional premium. The
benefits must equal the ACR (Adjusted Community Rating)
8. Adjudication Health Insurance Claims process at the insurance company
9. Adjusted Aver- Estimate of how much Medicare will spend in a year for an average
age Per
Capita Cost beneficiary
(AAPCC)
10. Administrativ
e Code Sets Non medical code sets that characterize a general business situation
11. Administrativ rather than a medical condition.
e Costs
Medicare, Medicaid, CMS refer to this as their expenses to have the
, CPC Exam Prep Guide: Pass the Certified Professional
Coder Test
program, operating expenses, program management, etc.
, CPC Exam Prep Guide: Pass the Certified Professional
Coder Test
12. Administrativ Health insurance information stored in automated information
e Data
system about enrollment, eligibility, claims, etc.
13. Administrativ
e Law Judge hearing oflcer who presides over appeal conflicts between providers or
(ALJ) benefi- ciaries, and Medicare contractors (MAC's)
14. Administrativ
e Part of HIPAA authorizing HHS (Health and Human Services) to 1. adopt
Simplification standards for transactions & code sets; 2. adopt standard identifiers for
health plans; 3. adopt standards to protect security & privacy of
personally identifiable health information.
15. Administrative
Simplification Signed 12/17/01 allows HHS (Health & Human Services) to exclude
Act providers from Medicare for HIPAA non-compliance of electronic claims
and prohibit paper claims except in certain situations
16. Admission Date The date the patient was admitted for inpatient care, outpatient, or
start of care.For hospice, enter ettective date of election of hospice
benefits.
17. Admitting Diagnosis code indicating patient's diagnosis at admission
Diag- nosis
18. Admitting
Physi- cian The doctor responsible for admitting a patient to the hospital or
other inpatient health facility
19. Advance
Benefi- ciary
Notification A notice from provider to patient that Medicare may deny payment.
(ABN) Patient must sign before services are provider, otherwise patient is not
responsible if Medicare does not cover.
20. Advanced
Direc- tive Statement written by patient on how they want medical decisions to be
made. May include a Living Will or Durable Power of Attorney for
healthcare.
21. Allowed Charge Individual charge determination by carrier for a covered service or suppl
22. Ambulatory Care All types of health services that do not require an overnight stay.
Coder Test
1. Abstractor hospital employee who converts documented procedurs and diangoses
into
medical codes
2. 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
3. Accreditation an examination process the healthcare facility goes through to
evaluate the facil- ities policies, procedures, and performance to meet
higher standards.
4. Accredited Having seal of approval after being evaluated and demonstrating quality
stan-
dards
5. Act/ Law/ Statute Legislation passed through Congress and signed by President or
passed over his veto
6. Actual Charge The amount the provider charges for medical services or supplies. Not
always paid in full.
7. Additional Health care services not covered by Medicare and are ottered through
Bene- fits
the Medicare Advantage Organization for no additional premium. The
benefits must equal the ACR (Adjusted Community Rating)
8. Adjudication Health Insurance Claims process at the insurance company
9. Adjusted Aver- Estimate of how much Medicare will spend in a year for an average
age Per
Capita Cost beneficiary
(AAPCC)
10. Administrativ
e Code Sets Non medical code sets that characterize a general business situation
11. Administrativ rather than a medical condition.
e Costs
Medicare, Medicaid, CMS refer to this as their expenses to have the
, CPC Exam Prep Guide: Pass the Certified Professional
Coder Test
program, operating expenses, program management, etc.
, CPC Exam Prep Guide: Pass the Certified Professional
Coder Test
12. Administrativ Health insurance information stored in automated information
e Data
system about enrollment, eligibility, claims, etc.
13. Administrativ
e Law Judge hearing oflcer who presides over appeal conflicts between providers or
(ALJ) benefi- ciaries, and Medicare contractors (MAC's)
14. Administrativ
e Part of HIPAA authorizing HHS (Health and Human Services) to 1. adopt
Simplification standards for transactions & code sets; 2. adopt standard identifiers for
health plans; 3. adopt standards to protect security & privacy of
personally identifiable health information.
15. Administrative
Simplification Signed 12/17/01 allows HHS (Health & Human Services) to exclude
Act providers from Medicare for HIPAA non-compliance of electronic claims
and prohibit paper claims except in certain situations
16. Admission Date The date the patient was admitted for inpatient care, outpatient, or
start of care.For hospice, enter ettective date of election of hospice
benefits.
17. Admitting Diagnosis code indicating patient's diagnosis at admission
Diag- nosis
18. Admitting
Physi- cian The doctor responsible for admitting a patient to the hospital or
other inpatient health facility
19. Advance
Benefi- ciary
Notification A notice from provider to patient that Medicare may deny payment.
(ABN) Patient must sign before services are provider, otherwise patient is not
responsible if Medicare does not cover.
20. Advanced
Direc- tive Statement written by patient on how they want medical decisions to be
made. May include a Living Will or Durable Power of Attorney for
healthcare.
21. Allowed Charge Individual charge determination by carrier for a covered service or suppl
22. Ambulatory Care All types of health services that do not require an overnight stay.
