AAPC Certified Anesthesia and Pain Management Coder (CANPC)™ certification Notes, definitions and questions from AAPC CPC Study Guide Medical Coding Prep 2025 American Academy of Professional Coders

AAPC Certified Anesthesia and Pain Management Coder (CANPC)™ certification Notes,
definitions and questions from AAPC CPC Study Guide Medical Coding Prep 2025 American
Academy of Professional Coders "hold harmless clause" - * found in some non-Medicare k8 k8 k8 k8 k8 k8 k8 k8




health plan contracts k8 k8 k8




* prohibits billingto patient foranything beyonddeductibles and co-pays.
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




A compliance plan may offer several benefits, including: - * more accuratepayment of claims
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




* fewer billing mistakes
k8 k8 k8




* improved documentation and more accurate coding
k8 k8 k8 k8 k8 k8




* less chance of violating self-referral and anti-kickback status
k8 k8 k8 k8 k8 k8 k8 k8




A healthcare clearing house is a - entitythat processes nonstandard health information they receive
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




from another entity into a standard format
k8 k8 k8 k8 k8 k8 k8




A key provision in HIPAA is the Minimum Necessary requirement. this means - only the minimum
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




necessaryprotected health information should be shared to satisfy a particular purpose.
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




A medically necessary service is the - least radical service/procedure that allows for effective
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




treatment of the patients' complaint or condition
k8 k8 k8 k8 k8 k8 k8




A patient sustaining an injury to her great saphenous vein would havesustained injury to which of
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




anatomical site? - Leg
k8 k8 k8 k8




APC - Ambulatory Payment Classification
k8 k8 k8 k8




ARRA -American RecoveryandReinvestment Act(of 2009) ASC -
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




k8 Ambulatory Surgical Centers k8 k8




Abuse consists of - payment for items or services that are billed by providers in error that
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




should not be paid for by Medicare.
k8 k8 k8 k8 k8 k8 k8




An ABN protects the provider's financial interest by - creating a paper trail that CMS requires
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




before a provider can bill the patient for payment if Medicare denies coverage for the stated
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




service or procedure.
k8 k8 k8




An entity that processesnonstandard health information they receivefrom another entity into a
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




standard format is considered what? - Clearinghouse
k8 k8 k8 k8 k8 k8 k8

, As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




to remove the
k8 k8 requirement - intent k8 k8 k8 k8




By statute, all work RVUs, must be examined no less often than - every 5 years CF -
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




Coversion Factor - fixed dollar amount used to translate the RVUs into fees CMS -
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




k8 Centers for Medicare and Medicaid k8 k8 k8 k8




CMS developed polices regarding medical necessity are based on regulations found in title XVIII,
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




$1862(a) of the - Social Security Act k8 k8 k8 k8 k8 k8




CMS will accept the k8 for either a"potentiallynon=covered"service or fora
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




statutorily excluded service - CMS-R-131
k8 k8 k8 k8 k8




CMS-R-131 - ABN form k8 k8 k8




or



Advance Beneficiary Notice which explains to the patient why Medicare may denythe
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




particular service or procedure.
k8 k8 k8 k8




CPT-CurrentProceduralTerminology CY
k8 k8 k8 k8 k8




2013 Conversion Factor - $25.0008
k8 k8 k8 k8 k8




Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




guidelines and are specified in - private contracts between the payer and practice or provider
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




DRG - Diagnosis Related Group
k8 k8 k8 k8




Does Medicare Part B generally require a yearly deductable and copayment? - yes E/M OR
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




k8 E&M - Evaluation and Management k8 k8 k8 k8




EHR - Electronic Health Record
k8 k8 k8 k8




Formula for Calculating Facility Payment amounts - [(Work RVU * Work GPCI) + (Transitioned Facility
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8




PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8 k8