AAPC CPC Study Guide with Complete Solutions Rated A
The process of translating this written or dictated medical
Coding is:
record into a series of numeric and alpha numeric codes
the content (documentation) in the medical record and
Proper code assignment is determined both by by the unique rules that govern each code set in that
particular instance
Outpatient coders will focus on learning which manuals CPT, HCPCS Level II, and ICD-10-CM
Hospital inpatient coders focus on which manuals ICD-10-CM & ICD-10-PCS
Risk adjustment coding focuses on which manual ICD-10-CM code set
Two primary types of insurers commercial and government
Commercial carriers are private pairs that may otter group
and individual plans, plans very but may include coverage Hospitalization, basic, and major medical coverage
for
The most significant government ensure, a federal health
Medicare is
insurance program
People over the age of 65, blind or disabled, individuals,
Medicare is administered by the center for Medicare and
and people with permanent kidney failure or end stage
Medicaid services (CMS)- & provides coverage for who
renal disease (ESRD).
Inpatient hospital, skilled nursing facilities, hospice, and
Medicare part A covers
home healthcare
Medically, necessary, physicians services, outpatient care,
Medicare part B covers and other medical services (including some preventative
services) not covered under Medicare part a
premium, & generally requires a yearly deductible and
Medicare part B is optional which pt.s pay a
coinsurance
Combines Medicare part A part B and sometimes part D.
Medicare Part C (Medicare Advantage Plans)
Managed by private insures approved by Medicare.
Medicare part C plans may charge
, Ditterent copayments, coinsurance, or deductibles for ser-
vices
Prescription drug program available to all Medicare bene-
Medicare part D is a ficiaries. Private companies approved by Medicare provide
coverage.
Health insurance assistance for low income people, (es-
Medicaid is
pecially children and pregnant women)
State-by-state basis, but state programs must here to cer-
Medicaid is administered on a
tain federal guidelines
The fee schedule designed to provide national uniform
payment of Medicare benefits after adjustment to reflect
RBRVS (Resource Based Relative Value Scale)
the ditterences in practice costs across geographic areas
is called the
Resource based relative value scale costs are divided into Physicians work, practice expense, professional liability
three components insurance
The time it takes to perform service, technical skill, and
Physicians work accounts for half of a procedures/services
physical ettort, required mental ettort and judgment,
total relative value measured by
stress due to potential risk to the patient
Practice expenses account for 44% of the total relative
The expensive providing a service in hospital may be dif-
value for each service, They are resource based and defer
ferent than physicians oflce
by site of service because
The resource base professional liability insurance (PLI)
4% of the total rally relative value for each service
account for
Physician fee schedule lists the component value for each
Annually by CMS
CPT and HCPCS level II code which is published when
Whether procedure service is considered appropriate in a
Medical necessity means
given circumstance
The process of translating this written or dictated medical
Coding is:
record into a series of numeric and alpha numeric codes
the content (documentation) in the medical record and
Proper code assignment is determined both by by the unique rules that govern each code set in that
particular instance
Outpatient coders will focus on learning which manuals CPT, HCPCS Level II, and ICD-10-CM
Hospital inpatient coders focus on which manuals ICD-10-CM & ICD-10-PCS
Risk adjustment coding focuses on which manual ICD-10-CM code set
Two primary types of insurers commercial and government
Commercial carriers are private pairs that may otter group
and individual plans, plans very but may include coverage Hospitalization, basic, and major medical coverage
for
The most significant government ensure, a federal health
Medicare is
insurance program
People over the age of 65, blind or disabled, individuals,
Medicare is administered by the center for Medicare and
and people with permanent kidney failure or end stage
Medicaid services (CMS)- & provides coverage for who
renal disease (ESRD).
Inpatient hospital, skilled nursing facilities, hospice, and
Medicare part A covers
home healthcare
Medically, necessary, physicians services, outpatient care,
Medicare part B covers and other medical services (including some preventative
services) not covered under Medicare part a
premium, & generally requires a yearly deductible and
Medicare part B is optional which pt.s pay a
coinsurance
Combines Medicare part A part B and sometimes part D.
Medicare Part C (Medicare Advantage Plans)
Managed by private insures approved by Medicare.
Medicare part C plans may charge
, Ditterent copayments, coinsurance, or deductibles for ser-
vices
Prescription drug program available to all Medicare bene-
Medicare part D is a ficiaries. Private companies approved by Medicare provide
coverage.
Health insurance assistance for low income people, (es-
Medicaid is
pecially children and pregnant women)
State-by-state basis, but state programs must here to cer-
Medicaid is administered on a
tain federal guidelines
The fee schedule designed to provide national uniform
payment of Medicare benefits after adjustment to reflect
RBRVS (Resource Based Relative Value Scale)
the ditterences in practice costs across geographic areas
is called the
Resource based relative value scale costs are divided into Physicians work, practice expense, professional liability
three components insurance
The time it takes to perform service, technical skill, and
Physicians work accounts for half of a procedures/services
physical ettort, required mental ettort and judgment,
total relative value measured by
stress due to potential risk to the patient
Practice expenses account for 44% of the total relative
The expensive providing a service in hospital may be dif-
value for each service, They are resource based and defer
ferent than physicians oflce
by site of service because
The resource base professional liability insurance (PLI)
4% of the total rally relative value for each service
account for
Physician fee schedule lists the component value for each
Annually by CMS
CPT and HCPCS level II code which is published when
Whether procedure service is considered appropriate in a
Medical necessity means
given circumstance
