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 - answerentity 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 - answeronly the minimum necessary protected health information should be shared to satisfy a particular purpose. A medically necessary service is the - answerleast 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? - answerLeg APC - answerAmbulatory Payment Classification ARRA - answerAmerican Recovery and Reinvestment Act (of 2009) ASC - answerAmbulatory Surgical Centers Abuse consists of - answerpayment 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 - answercreating 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? - answerClearinghouse As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to remove the __________ requirement - answerintent By statute, all work RVUs, must be examined no less often than - answerevery 5 years CF - answerCoversion Factor - fixed dollar amount used to translate the RVUs into fees CMS - answerCenters for Medicare and Medicaid CMS developed polices regarding medical necessity are based on regulations found in title XVIII, $1862(a) of the - answerSocial Security Act CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily excluded service - answerCMS-R-131 CMS-R-131 - answerABN form or Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service or procedure. CPT - answerCurrent 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 - answerprivate contracts between the payer and practice or provider DRG - answerDiagnosis Related Group Does Medicare Part B generally require a yearly deductable and copayment? - answeryes E/M OR E&M - answerEvaluation and Management EHR - answerElectronic 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)