AAPC Official CPC Certification Study Guide Notes 2023

AAPC Official CPC Certification Study Guide Notes 2023 "hold harmless clause" - ANS-* found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-pays. A compliance plan may offer several benefits, including: - ANS-* more accurate payment of claims * fewer billing mistakes * improved documentation and more accurate coding * less chance of violating self-referral and anti-kickback status A healthcare clearing house is a - ANS-entity that processes nonstandard health information they receive from another entity into a standard format A key provision in HIPAA is the Minimum Necessary requirement. this means - ANSonly the minimum necessary protected health information should be shared to satisfy a particular purpose. A medically necessary service is the - ANS-least radical service/procedure that allows for effective treatment of the patients' complaint or condition A patient sustaining an injury to her great saphenous vein would have sustained injury to which of anatomical site? - ANS-Leg APC - ANS-Ambulatory Payment Classification ARRA - ANS-American Recovery and Reinvestment Act (of 2009) ASC - ANS-Ambulatory Surgical Centers Abuse consists of - ANS-payment for items or services that are billed by providers in error that should not be paid for by Medicare. An ABN protects the provider's financial interest by - ANS-creating a paper trail that CMS requires before a provider can bill the patient for payment if Medicare denies coverage for the stated service or procedure. An entity that processes nonstandard health information they receive from another entity into a standard format is considered what? - ANS-Clearinghouse As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to remove the __________ requirement - ANS-intent By statute, all work RVUs, must be examined no less often than - ANS-every 5 years CF - ANS-Coversion Factor - fixed dollar amount used to translate the RVUs into fees CMS - ANS-Centers for Medicare and Medicaid CMS developed polices regarding medical necessity are based on regulations found in title XVIII, $1862(a) of the - ANS-Social Security Act CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily excluded service - ANS-CMS-R-131 CMS-R-131 - ANS-ABN form or Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service or procedure. CPT - ANS-Current Procedural Terminology CY 2013 Conversion Factor - ANS-$25.0008 Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare guidelines and are specified in - ANS-private contracts between the payer and practice or provider DRG - ANS-Diagnosis Related Group Does Medicare Part B generally require a yearly deductable and copayment? - ANS-yes E/M OR E&M - ANS-Evaluation and Management EHR - ANS-Electronic Health Record Formula for Calculating Facility Payment amounts - ANS-[(Work RVU * Work GPCI) + (Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF Formula for Non-Facility Pricing Amount - ANS-[(Work RVU * Work GPCI) + (Transitioned Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * (CF) GPCI - ANS-Geographic Practice Cost Index GPCI is used to - ANS-realize the varying cost based on geographic location HCPCS ...