AAPC Official CPC Certification Study Guide Notes
"hold harmless clause" - -* found in some
non-Medicare health plan contracts
* prohibits billing to patient for anything beyond ASC - -Ambulatory Surgical Centers
deductibles and co-pays.
Abuse consists of - -payment for items or
A compliance plan may offer several benefits, services that are billed by providers in error that
including: - -* more accurate payment of should not be paid for by Medicare.
claims
* fewer billing mistakes
* improved documentation and more accurate An ABN protects the provider's financial interest
coding by - -creating a paper trail that CMS
* less chance of violating self-referral and anti- requires before a provider can bill the patient for
kickback status payment if Medicare denies coverage for the
stated service or procedure.
A healthcare clearing house is a - -entity
that processes nonstandard health information An entity that processes nonstandard health
they receive from another entity into a standard information they receive from another entity into a
format standard format is considered what? - -
Clearinghouse
A key provision in HIPAA is the Minimum
Necessary requirement. this means - -only As a part of Health Care Reform, the Affordable
the minimum necessary protected health Care Act of 2010 amended the definition of fraud
information should be shared to satisfy a to remove the __________ requirement - -
particular purpose. intent
A medically necessary service is the - - By statute, all work RVUs, must be examined no
least radical service/procedure that allows for less often than - -every 5 years
effective treatment of the patients' complaint or
condition
CF - -Coversion Factor - fixed dollar
amount used to translate the RVUs into fees
A patient sustaining an injury to her great
saphenous vein would have sustained injury to
which of anatomical site? - -Leg CMS - -Centers for Medicare and Medicaid
APC - -Ambulatory Payment Classification CMS developed polices regarding medical
necessity are based on regulations found in title
XVIII, $1862(a) of the - -Social Security Act
ARRA - -American Recovery and
Reinvestment Act (of 2009)
, AAPC Official CPC Certification Study Guide Notes
CMS will accept the ____________ for either a
"potentially non=covered" service or for a
statutorily excluded service - -CMS-R-131 Formula for Non-Facility Pricing Amount - -
[(Work RVU * Work GPCI) + (Transitioned Non-
Facility PE RVU * PE GPCI) + (MP RVU * MP
CMS-R-131 - -ABN form GPCI)] * (CF)
or
GPCI - -Geographic Practice Cost Index
Advance Beneficiary Notice which explains to the
patient why Medicare may deny the particular
service or procedure. GPCI is used to - -realize the varying cost
based on geographic location
CPT - -Current Procedural Terminology
HCPCS - -Healthcare Common Procedure
Coding System
CY 2013 Conversion Factor - -$25.0008
HHS - -Department of Health and Human
Commercial (non-Medicare) may develop their Services
own medical policies which do not follow
Medicare guidelines and are specified in - -
private contracts between the payer and practice HIPAA provides federal protections for - -
or provider personal health information when held by
covered entities.
DRG - -Diagnosis Related Group
HIPAA stands for - -Health Insurance
Portability and Accountability Act of 1996
Does Medicare Part B generally require a yearly
deductable and copayment? - -yes
HITECH - -The Health Information
Technology for Economic and Clinical Health Act
E/M OR E&M - -Evaluation and
Management
HITECH allows patients to request - -an
audit trail showing all disclosures of their health
EHR - -Electronic Health Record information made through an electronic record.
Formula for Calculating Facility Payment HITECH requires that an individual be notified if -
amounts - -[(Work RVU * Work GPCI) + -there is an unauthorized disclosure or use
(Transitioned Facility PE RVU * PE GPCI) + (MP of his or her health information.
RVU * MP GPCI)] * CF
"hold harmless clause" - -* found in some
non-Medicare health plan contracts
* prohibits billing to patient for anything beyond ASC - -Ambulatory Surgical Centers
deductibles and co-pays.
Abuse consists of - -payment for items or
A compliance plan may offer several benefits, services that are billed by providers in error that
including: - -* more accurate payment of should not be paid for by Medicare.
claims
* fewer billing mistakes
* improved documentation and more accurate An ABN protects the provider's financial interest
coding by - -creating a paper trail that CMS
* less chance of violating self-referral and anti- requires before a provider can bill the patient for
kickback status payment if Medicare denies coverage for the
stated service or procedure.
A healthcare clearing house is a - -entity
that processes nonstandard health information An entity that processes nonstandard health
they receive from another entity into a standard information they receive from another entity into a
format standard format is considered what? - -
Clearinghouse
A key provision in HIPAA is the Minimum
Necessary requirement. this means - -only As a part of Health Care Reform, the Affordable
the minimum necessary protected health Care Act of 2010 amended the definition of fraud
information should be shared to satisfy a to remove the __________ requirement - -
particular purpose. intent
A medically necessary service is the - - By statute, all work RVUs, must be examined no
least radical service/procedure that allows for less often than - -every 5 years
effective treatment of the patients' complaint or
condition
CF - -Coversion Factor - fixed dollar
amount used to translate the RVUs into fees
A patient sustaining an injury to her great
saphenous vein would have sustained injury to
which of anatomical site? - -Leg CMS - -Centers for Medicare and Medicaid
APC - -Ambulatory Payment Classification CMS developed polices regarding medical
necessity are based on regulations found in title
XVIII, $1862(a) of the - -Social Security Act
ARRA - -American Recovery and
Reinvestment Act (of 2009)
, AAPC Official CPC Certification Study Guide Notes
CMS will accept the ____________ for either a
"potentially non=covered" service or for a
statutorily excluded service - -CMS-R-131 Formula for Non-Facility Pricing Amount - -
[(Work RVU * Work GPCI) + (Transitioned Non-
Facility PE RVU * PE GPCI) + (MP RVU * MP
CMS-R-131 - -ABN form GPCI)] * (CF)
or
GPCI - -Geographic Practice Cost Index
Advance Beneficiary Notice which explains to the
patient why Medicare may deny the particular
service or procedure. GPCI is used to - -realize the varying cost
based on geographic location
CPT - -Current Procedural Terminology
HCPCS - -Healthcare Common Procedure
Coding System
CY 2013 Conversion Factor - -$25.0008
HHS - -Department of Health and Human
Commercial (non-Medicare) may develop their Services
own medical policies which do not follow
Medicare guidelines and are specified in - -
private contracts between the payer and practice HIPAA provides federal protections for - -
or provider personal health information when held by
covered entities.
DRG - -Diagnosis Related Group
HIPAA stands for - -Health Insurance
Portability and Accountability Act of 1996
Does Medicare Part B generally require a yearly
deductable and copayment? - -yes
HITECH - -The Health Information
Technology for Economic and Clinical Health Act
E/M OR E&M - -Evaluation and
Management
HITECH allows patients to request - -an
audit trail showing all disclosures of their health
EHR - -Electronic Health Record information made through an electronic record.
Formula for Calculating Facility Payment HITECH requires that an individual be notified if -
amounts - -[(Work RVU * Work GPCI) + -there is an unauthorized disclosure or use
(Transitioned Facility PE RVU * PE GPCI) + (MP of his or her health information.
RVU * MP GPCI)] * CF
