CPC Exam
Abstractor - Answer-hospital employee who converts documented procedurs and diangoses into
medical codes
Abuse - Answer-coding practices that lead to improper reimbursement by error because they do not
meet medical necessity, ex. changing diagnosis to be covered by insurance
Accreditation - Answer-an examination process the healthcare facility goes through to evaluate the
facilities policies, procedures, and performance to meet higher standards.
Accredited - Answer-Having seal of approval after being evaluated and demonstrating quality standards
Act/ Law/ Statute - Answer-Legislation passed through Congress and signed by President or passed over
his veto
Actual Charge - Answer-The amount the provider charges for medical services or supplies. Not always
paid in full.
Additional Benefits - Answer-Health care services not covered by Medicare and are offered through the
Medicare Advantage Organization for no additional premium. The benefits must equal the ACR
(Adjusted Community Rating)
, Adjudication - Answer-Health Insurance Claims process at the insurance company
Adjusted Average Per Capita Cost (AAPCC) - Answer-Estimate of how much Medicare will spend in a
year for an average beneficiary
Administrative Code Sets - Answer-Non medical code sets that characterize a general business situation
rather than a medical condition.
Administrative Costs - Answer-Medicare, Medicaid, CMS refer to this as their expenses to have the
program, operating expenses, program management, etc.
Administrative Data - Answer-Health insurance information stored in automated information system
about enrollment, eligibility, claims, etc.
Administrative Law Judge (ALJ) - Answer-hearing officer who presides over appeal conflicts between
providers or beneficiaries, and Medicare contractors (MAC's)
Administrative Simplification - Answer-Part of HIPAA authorizing HHS (Health and Human Services) to 1.
adopt standards for transactions & code sets; 2. adopt standard identifiers for health plans; 3. adopt
standards to protect security & privacy of personally identifiable health information.
Administrative Simplification Act - Answer-Signed 12/17/01 allows HHS (Health & Human Services) to
exclude providers from Medicare for HIPAA non-compliance of electronic claims and prohibit paper
claims except in certain situations
Admission Date - Answer-The date the patient was admitted for inpatient care, outpatient, or start of
care.For hospice, enter effective date of election of hospice benefits.
Abstractor - Answer-hospital employee who converts documented procedurs and diangoses into
medical codes
Abuse - Answer-coding practices that lead to improper reimbursement by error because they do not
meet medical necessity, ex. changing diagnosis to be covered by insurance
Accreditation - Answer-an examination process the healthcare facility goes through to evaluate the
facilities policies, procedures, and performance to meet higher standards.
Accredited - Answer-Having seal of approval after being evaluated and demonstrating quality standards
Act/ Law/ Statute - Answer-Legislation passed through Congress and signed by President or passed over
his veto
Actual Charge - Answer-The amount the provider charges for medical services or supplies. Not always
paid in full.
Additional Benefits - Answer-Health care services not covered by Medicare and are offered through the
Medicare Advantage Organization for no additional premium. The benefits must equal the ACR
(Adjusted Community Rating)
, Adjudication - Answer-Health Insurance Claims process at the insurance company
Adjusted Average Per Capita Cost (AAPCC) - Answer-Estimate of how much Medicare will spend in a
year for an average beneficiary
Administrative Code Sets - Answer-Non medical code sets that characterize a general business situation
rather than a medical condition.
Administrative Costs - Answer-Medicare, Medicaid, CMS refer to this as their expenses to have the
program, operating expenses, program management, etc.
Administrative Data - Answer-Health insurance information stored in automated information system
about enrollment, eligibility, claims, etc.
Administrative Law Judge (ALJ) - Answer-hearing officer who presides over appeal conflicts between
providers or beneficiaries, and Medicare contractors (MAC's)
Administrative Simplification - Answer-Part of HIPAA authorizing HHS (Health and Human Services) to 1.
adopt standards for transactions & code sets; 2. adopt standard identifiers for health plans; 3. adopt
standards to protect security & privacy of personally identifiable health information.
Administrative Simplification Act - Answer-Signed 12/17/01 allows HHS (Health & Human Services) to
exclude providers from Medicare for HIPAA non-compliance of electronic claims and prohibit paper
claims except in certain situations
Admission Date - Answer-The date the patient was admitted for inpatient care, outpatient, or start of
care.For hospice, enter effective date of election of hospice benefits.
