CPC Certification 1 exam with 100% correct answer 2024.

Which part of Medicare should be billed for medication filled in a pharmacy? - ANSWER-Part D What is Medical Coding? - ANSWER-Translating medical documentation into codes. ABN - ANSWER-Advanced Beneficiary Notice AMA - ANSWER-American Medical Association APC - ANSWER-Ambulatory Payment Classification ARRA - ANSWER-American Recovery and Reinvestment Act of 2009 ASC - ANSWER-Ambulatory Surgical Centers CF - ANSWER-Conversion Factor CMS - ANSWER-Centers for Medicare and Medicaid Services CPC - ANSWER-Certified Professional Coder CPT - ANSWER-Current Procedural Terminology DRG - ANSWER-Diagnosis Related Group EHR - ANSWER-Electronic Health Record E/M or E&M - ANSWER-Evaluation & Management GPCI - ANSWER-Geographic Practice Cost Index HCPCS - ANSWER-Health Care Procedure Coding System HHS - ANSWER-Department of Health & Human Services HIPAA - ANSWER-Health Insurance Portability & Accountability Act of 1996 HITECH - ANSWER-Health Information Technology for Economic and Clinical Health Act HMO - ANSWER-Health Maintenance Organization ICD-9-CM - ANSWER-International Classification of Disease, 9th Clinical Modification LCD - ANSWER-Local Coverage Determination MAC - ANSWER-Medicare Administrative Contractor MP - ANSWER-Malpractice MS-DRG - ANSWER-Medicare Severity- Diagnosis Related Group NCD - ANSWER-National Coverage Determination NP - ANSWER-Nurse Practitioner OCR - ANSWER-Office for Civil Rights OIG - ANSWER-Office of Inspector General PA - ANSWER-Physician Assistant PE - ANSWER-Physician Expense PFS - ANSWER-Physician Fee Schedule PHI - ANSWER-Protected Health Information PLI - ANSWER-Professional Liability Insurance RUC - ANSWER-Relative Value Update Committee RVU - ANSWER-Relative Value Unit RBRVS - ANSWER-Resource Based Relative Value System What is an NDC interpreted at the MAC level considered? - ANSWER-LCD Rationale: NCDs explain when Medicare will pay for items or services. Each MAC is responsible for interpreting national policies into regional policies, called LCDs. When should an ABN be signed? - ANSWER-When a service is not expected to be covered by Medicare. The amount of an ABN should be within how much of the cost to the patient? - ANSWER-$100 or 25% of cost. Rationale: CMS instructions stipulate, "Notifiers must make a good faith effort to insert a reasonable estimate... the estimate should be within $100 or 25% of the actual costs, whichever is greater. An entity that processes nonstandard health information they receive from another entity into a standard format is considered what? - ANSWER-Clearinghouse. Rationale: A Health Care Clearinghouse is an entity that processes nonstandard health information they receive from another entity into a standard (such as standard electronic format, or data content), or vice versa. Intentional billing of services not provided is considered ___________________? - ANSWER-Fraud What OIG document should a provider review for potential problem areas that will receive special scrutiny in the upcoming year? - ANSWER-OIG Work Plan. Rationale: Each year in October, the OIG releases a Work Plan outlining its priorities for the fiscal year ahead. Which part of Medicare should be billed to cover inpatient hospital care, as well as care provided in skilled nursing facilities, hospice care, and home health care? - ANSWER-Part A Which part of Medicare covers medically necessary physicians' services, outpatient care, and other medical services (including some preventative services) not covered under Medicare Part A? - ANSWER-Part B What is Medicare Part C? (Also known as Medicare Advantage) - ANSWER-It combines the benefits of Medicare Part A, Part B, and- sometimes -Part D. The plans are managed by private insurers approved by Medicare. The plans may charge different co-payments, coinsurance, or deductibles for services. What is Medicaid? - ANSWER-A health insurance assistance program for some low-income people (especially children and pregnant women) sponsored by federal and state governments. It is administered on a state-by-state basis, but state programs must adhere to certain federal guidelines. Name some state funded insurance programs that provide coverage for children up to age 21. - ANSWER-Crippled Children's Services, Children's Medical Services, Children's Indigent Disability Services, and Children with Special Health Care Needs. How are RBRVS costs divided? - ANSWER-Physician work, Practice expense, and Professional liability insurance. How is physician work measured? - ANSWER-The time it takes to perform the service; the technical skill and physical effort; the required mental effort and judgement; and stress due to the potential risk to patient.