AAPC Official CPC Certification Study Guide Notes

AAPC Official CPC Certification Study Guide Notes "hold harmless clause" - Answer ️️ -* 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: - Answer ️️ -* 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 - Answer ️️ -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 - Answer ️️ - only the minimum necessary protected health information should be shared to satisfy a particular purpose. A medically necessary service is the - Answer ️️ -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? - Answer ️️ -Leg APC - Answer ️️ -Ambulatory Payment Classification ARRA - Answer ️️ -American Recovery and Reinvestment Act (of 2009) ASC - Answer ️️ -Ambulatory Surgical Centers Abuse consists of - Answer ️️ -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 - Answer ️️ -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? - Answer ️️ -Clearinghouse As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to remove the __________ requirement - Answer ️️ -intent By statute, all work RVUs, must be examined no less often than - Answer ️️ -every 5 years CF - Answer ️️ -Coversion Factor - fixed dollar amount used to translate the RVUs into fees CMS - Answer ️️ -Centers for Medicare and Medicaid CMS developed polices regarding medical necessity are based on regulations found in title XVIII, $1862(a) of the - Answer ️️ -Social Security Act CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily excluded service - Answer ️️ -CMS-R-131 CMS-R-131 - Answer ️️ -ABN form or Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service or procedure. CPT - Answer ️️ -Current Procedural Terminology CY 2013 Conversion Factor - Answer ️️ -$25.0008 Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare guidelines and are specified in - Answer ️️ -private contracts between the payer and practice or provider DRG - Answer ️️ -Diagnosis Related Group Does Medicare Part B generally require a yearly deductable and copayment? - Answer ️️ -yes E/M OR E&M - Answer ️️ -Evaluation and Management EHR - Answer ️️ -Electronic Health Record Formula for Calculating Facility Payment amounts - Answer ️️ -[(Work RVU * Work GPCI) + (Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF Formula for Non-Facility Pricing Amount - Answer ️️ -[(Work RVU * Work GPCI) + (Transitioned Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * (CF) GPCI - Answer ️️ -Geographic Practice Cost Index GPCI is used to - Answer ️️ -realize the varying cost based on g