CPB AAPC CH 7 COMPLETE TEST QUESTIONS 2024.

CPB AAPC CH 7 COMPLETE TEST QUESTIONS 2024. Local Coverage Determination (LCD) - correct answer Decision made by a fiscal intermediary (FI) or a Medicare carrier about the services and items that are reasonable and necessary. LCD also decides if a particular service should be covered on an intermediary-wide basis, and it makes decisions about the services that is reasonable and necessary for certain diagnoses and procedures codes. Medicare Administrative Contractor (MAC) - correct answer A company under contract with the federal government to handle claims processing for Medicare services. Medical Necessary - correct answer A decision made by a health plan as to whether a treatment, test, or procedure is necessary for a patients health or to treat a diagnosed medical condition. Medically Unlikely Edits (MUE) - correct answer Part of NCCI edits that places limits on the frequency that individual codes can be billed on a single date of service by a single provider. Modifier - correct answer A two character code that affects the meaning of another code. National Correct Coding Initiative (NCCI/CCI) - correct answer The National Correct Coding Initiative (NCCI) is a CMS program designed to prevent improper payment of procedure that should not be submitted together. National Coverage Determination (NCD) - correct answer Nationwide determination as to whether Medicare will pay for an item or service. Outpatient code Editor (OCE) - correct answer Software that edits outpatient hospital claims to detect incorrect billing data and determine if the Ambulatory Surgery Center (ASC) limit should apply to each claim, and review each HCPCS and ICD-10-CM code for validity and coverage.