CPC 2025 ACTUAL EXAM TEST QUESTIONS WITH ACCURATE SOLUTIONS
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)
ASHIM
American Society of Health Informatics Managers, Inc. is a non-profit group of computer
professionals that specialize in health information technology (HIT). They are certified
through Certified Health Informatics System Professionals (CHISP)
Ancillary Services
Professional services by a hospital or inpatient facility. Xrays, drugs, labs, etc.
Appeal
Complaint by hospital or patient about a health care payment
Approved Amount
The fee Medicare sets as reasonable and pays to the provider.
Assigned Claim
Claim submittted by a provider who accepts Medicare
,Assignment
Agreeing to acccept Medicare fees as payment in full
Attending Physician
Licensed physician who certifies the patient services via medical necessity and is primarily
responsible for the patient's medical care and treatment.
Automated Claim Review
Claim review and etermination via system edits and don't require human intervention
Basic Benefit
Includes Medicare covered benefits (except hospice) and additional benefits
Beneficiary
The name of a person who has health care insurance through the insurance program
Benefit Payment
Amount paid by insurance after the deductible and coinsurance have been deducted
, Benefit Period
Episode of care within hospitals & skilled nursing facilities (SNF). Begins on admission and
ends 60 days after care has ended
Benefits
The money or services provided through an insurance policy
Board Certified
Doctor specializing in certain area of medicine and who passes an advanced exam.
Primary care and specialists can both be board certified
Business Associate
Someone performs a function on behalf of a covered entity but is not part of the covered
entity's workforce, outside business manager.
Capitation
Specified amount of money is paid to a health plan or doctor regardless of the services
rendered in that period. One lump sum.
Care Plan
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)
ASHIM
American Society of Health Informatics Managers, Inc. is a non-profit group of computer
professionals that specialize in health information technology (HIT). They are certified
through Certified Health Informatics System Professionals (CHISP)
Ancillary Services
Professional services by a hospital or inpatient facility. Xrays, drugs, labs, etc.
Appeal
Complaint by hospital or patient about a health care payment
Approved Amount
The fee Medicare sets as reasonable and pays to the provider.
Assigned Claim
Claim submittted by a provider who accepts Medicare
,Assignment
Agreeing to acccept Medicare fees as payment in full
Attending Physician
Licensed physician who certifies the patient services via medical necessity and is primarily
responsible for the patient's medical care and treatment.
Automated Claim Review
Claim review and etermination via system edits and don't require human intervention
Basic Benefit
Includes Medicare covered benefits (except hospice) and additional benefits
Beneficiary
The name of a person who has health care insurance through the insurance program
Benefit Payment
Amount paid by insurance after the deductible and coinsurance have been deducted
, Benefit Period
Episode of care within hospitals & skilled nursing facilities (SNF). Begins on admission and
ends 60 days after care has ended
Benefits
The money or services provided through an insurance policy
Board Certified
Doctor specializing in certain area of medicine and who passes an advanced exam.
Primary care and specialists can both be board certified
Business Associate
Someone performs a function on behalf of a covered entity but is not part of the covered
entity's workforce, outside business manager.
Capitation
Specified amount of money is paid to a health plan or doctor regardless of the services
rendered in that period. One lump sum.
Care Plan
