CPC Exam Study Guide With Complete Solution

Documentation (content) - Answer Proper code assignment is determined both by _____________ in the medical record and by the unique rules that govern each code set in that instance An auditor - Answer The role a coder may take on to verify that the documentation supports the codes the physician has selected Query the physician - Answer If the medical record is inaccurate or incomplete, it will not translate properly to the language of codes. What can a coder do in order for the medical record to be complete and accurate so they can bill properly? Quarterly (usually) - Answer How often are codes and insurance payment policies updated? NPP - Answer Non-Physician Provider (also known as mid-level providers or physician extenders) PA - Answer Physician assistant NP - Answer Nurse practitioner Commercial and Government - Answer The two types of primary insurances Commercial Carriers - Answer Private payers that may offer both group and individual plans Medicare - Answer The most significant government insurer; a federal health insurance program People over 65, blind or disabled individuals, and people with permanent kidney failure or end-stage renal disease - Answer Medicare provides coverage for what kind of people? ESRD - Answer end-stage renal disease Medicare Part A - Answer Helps cover inpatient hospital care, as well as care provided in skilled nursing facilities, hospice care, and home healthcare, Medicare Part B - Answer Covers medically necessary physicians' services, outpatient care, and other medical services (including some preventive services) not covered under Medicare Part A. It can be an optional benefit. Medicare Part C - Answer Also called Medicare Advantage, combines the benefits of Medicare Part A, Part B, and-sometimes- Part D. The plans are managed by private insurers approved by Medicare. Medicare Part D - Answer A prescription drug program available to all Medicare beneficiaries. Medicaid - Answer A health insurance assistance program for some low-income people (especially children and pregnant women) sponsored by federal and state governments. RBRVS - Answer Resource-Based Relative Value Scale Resource-Based Relative Value Scale (RBRVS) - Answer Medicare payments for physician services are standardized using _____ and are divided into three components.