" 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 9p 9p 9p 9p 9p 9p 9p 9p
health plan contracts 9p 9p 9p
* prohibits billingto patient foranything beyond deductibles and co-pays.
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
A compliance plan may offer several benefits, including: - * more accurate payment of claims
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
* fewer billing mistakes
9p 9p 9p
* improved documentation and more accurate coding
9p 9p 9p 9p 9p 9p
* less chance of violating self-referral and anti-kickback status
9p 9p 9p 9p 9p 9p 9p 9p
A healthcare clearing house is a - entitythat processes nonstandard health information they receive
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
from another entity into a standard format
9p 9p 9p 9p 9p 9p 9p
A key provision in HIPAA is the Minimum Necessary requirement. this means - only the minimum
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
necessary protected health information should be shared to satisfy a particular purpose.
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
A medically necessary service is the - least radical service/procedure that allows for effective
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
treatment of the patients' complaint or condition
9p 9p 9p 9p 9p 9p 9p
A patient sustaining an injury to her great saphenous vein would have sustained injury to which of
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
anatomical site? - Leg
9p 9p 9p 9p
APC - Ambulatory Payment Classification
9p 9p 9p 9p
ARRA - American Recoveryand Reinvestment Act(of 2009) ASC -
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
9p Ambulatory Surgical Centers 9p 9p
Abuse consists of - payment for items or services that are billed by providers in error that
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
should not be paid for by Medicare.
9p 9p 9p 9p 9p 9p 9p
An ABN protects the provider's financial interest by - creating a paper trail that CMS requires
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
before a provider can bill the patient for payment if Medicare denies coverage for the stated
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
service or procedure.
9p 9p 9p
An entity that processes nonstandard health information they receivefrom another entity into a
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
standard format is considered what? - Clearinghouse
9p 9p 9p 9p 9p 9p 9p
, As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
to remove the
9p 9p requirement - intent 9p 9p 9p 9p
By statute, all work RVUs, must be examined no less often than - every 5 years CF -
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
Coversion Factor - fixed dollar amount used to translate the RVUs into fees CMS -
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
9p Centers for Medicare and Medicaid 9p 9p 9p 9p
CMS developed polices regarding medical necessity are based on regulations found in title XVIII,
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
$1862(a) of the - Social Security Act 9p 9p 9p 9p 9p 9p
CMS will accept the 9p for either a "potentiallynon=covered"service or for a
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
statutorily excluded service - CMS-R-131
9p 9p 9p 9p 9p
CMS-R-131 - ABN form 9p 9p 9p
or
Advance Beneficiary Notice which explains to the patient why Medicare may denythe
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
particular service or procedure.
9p 9p 9p 9p
CPT-Current ProceduralTerminology CY
9p 9p 9p 9p 9p
2013 Conversion Factor - $25.0008
9p 9p 9p 9p 9p
Commercial (non-Medicare) may develop their own medical policies which do not follow 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
Medicare guidelines and are specified in - private contracts between the payer and practice or
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
provider
9p
DRG - Diagnosis Related Group
9p 9p 9p 9p
Does Medicare Part B generally require a yearly deductable and copayment? - yes E/M OR
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
9p E&M - Evaluation and Management 9p 9p 9p 9p
EHR - Electronic Health Record
9p 9p 9p 9p
Formula for Calculating Facility Payment amounts - [(Work RVU * Work GPCI) + (Transitioned Facility
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
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 9p 9p 9p 9p 9p 9p 9p 9p
health plan contracts 9p 9p 9p
* prohibits billingto patient foranything beyond deductibles and co-pays.
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
A compliance plan may offer several benefits, including: - * more accurate payment of claims
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
* fewer billing mistakes
9p 9p 9p
* improved documentation and more accurate coding
9p 9p 9p 9p 9p 9p
* less chance of violating self-referral and anti-kickback status
9p 9p 9p 9p 9p 9p 9p 9p
A healthcare clearing house is a - entitythat processes nonstandard health information they receive
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
from another entity into a standard format
9p 9p 9p 9p 9p 9p 9p
A key provision in HIPAA is the Minimum Necessary requirement. this means - only the minimum
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
necessary protected health information should be shared to satisfy a particular purpose.
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
A medically necessary service is the - least radical service/procedure that allows for effective
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
treatment of the patients' complaint or condition
9p 9p 9p 9p 9p 9p 9p
A patient sustaining an injury to her great saphenous vein would have sustained injury to which of
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
anatomical site? - Leg
9p 9p 9p 9p
APC - Ambulatory Payment Classification
9p 9p 9p 9p
ARRA - American Recoveryand Reinvestment Act(of 2009) ASC -
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
9p Ambulatory Surgical Centers 9p 9p
Abuse consists of - payment for items or services that are billed by providers in error that
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
should not be paid for by Medicare.
9p 9p 9p 9p 9p 9p 9p
An ABN protects the provider's financial interest by - creating a paper trail that CMS requires
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
before a provider can bill the patient for payment if Medicare denies coverage for the stated
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
service or procedure.
9p 9p 9p
An entity that processes nonstandard health information they receivefrom another entity into a
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
standard format is considered what? - Clearinghouse
9p 9p 9p 9p 9p 9p 9p
, As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
to remove the
9p 9p requirement - intent 9p 9p 9p 9p
By statute, all work RVUs, must be examined no less often than - every 5 years CF -
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
Coversion Factor - fixed dollar amount used to translate the RVUs into fees CMS -
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
9p Centers for Medicare and Medicaid 9p 9p 9p 9p
CMS developed polices regarding medical necessity are based on regulations found in title XVIII,
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
$1862(a) of the - Social Security Act 9p 9p 9p 9p 9p 9p
CMS will accept the 9p for either a "potentiallynon=covered"service or for a
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
statutorily excluded service - CMS-R-131
9p 9p 9p 9p 9p
CMS-R-131 - ABN form 9p 9p 9p
or
Advance Beneficiary Notice which explains to the patient why Medicare may denythe
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
particular service or procedure.
9p 9p 9p 9p
CPT-Current ProceduralTerminology CY
9p 9p 9p 9p 9p
2013 Conversion Factor - $25.0008
9p 9p 9p 9p 9p
Commercial (non-Medicare) may develop their own medical policies which do not follow 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
Medicare guidelines and are specified in - private contracts between the payer and practice or
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
provider
9p
DRG - Diagnosis Related Group
9p 9p 9p 9p
Does Medicare Part B generally require a yearly deductable and copayment? - yes E/M OR
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
9p E&M - Evaluation and Management 9p 9p 9p 9p
EHR - Electronic Health Record
9p 9p 9p 9p
Formula for Calculating Facility Payment amounts - [(Work RVU * Work GPCI) + (Transitioned Facility
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p
