AAPC OFFICIAL CPC CERTIFICATION
STUDY GUIDE NOTES WITH
COMPLETE SOLUTIONS
"hold bharmless bclause" b- b bcorrect banswer- b* bfound bin bsome bnon-Medicare
bhealth bplan bcontracts
* bprohibits bbilling bto bpatient bfor banything bbeyond bdeductibles band bco-pays.
A bcompliance bplan bmay boffer bseveral bbenefits, bincluding: b- b bcorrect banswer- b*
bmore baccurate bpayment bof bclaims
* bfewer bbilling bmistakes
* bimproved bdocumentation band bmore baccurate bcoding
* bless bchance bof bviolating bself-referral band banti-kickback bstatus
A bhealthcare bclearing bhouse bis ba b- b bcorrect banswer- bentity bthat bprocesses
bnonstandard bhealth binformation bthey breceive bfrom banother bentity binto ba
bstandard bformat
A bkey bprovision bin bHIPAA bis bthe bMinimum bNecessary brequirement. bthis bmeans
b- b bcorrect banswer- bonly bthe bminimum bnecessary bprotected bhealth binformation
bshould bbe bshared bto bsatisfy ba bparticular bpurpose.
A bmedically bnecessary bservice bis bthe b- b bcorrect banswer- bleast bradical
bservice/procedure bthat ballows bfor beffective btreatment bof bthe bpatients' bcomplaint
bor bcondition
A bpatient bsustaining ban binjury bto bher bgreat bsaphenous bvein bwould bhave
bsustained binjury bto bwhich bof banatomical bsite? b- b bcorrect banswer- bLeg
, APC b- b bcorrect banswer- bAmbulatory bPayment bClassification
ARRA b- b bcorrect banswer- bAmerican bRecovery band bReinvestment bAct b(of b2009)
ASC b- b bcorrect banswer- bAmbulatory bSurgical bCenters
Abuse bconsists bof b- b bcorrect banswer- bpayment bfor bitems bor bservices bthat bare
bbilled bby bproviders bin berror bthat bshould bnot bbe bpaid bfor bby bMedicare.
An bABN bprotects bthe bprovider's bfinancial binterest bby b- b bcorrect banswer-
bcreating ba bpaper btrail bthat bCMS brequires bbefore ba bprovider bcan bbill bthe
bpatient bfor bpayment bif bMedicare bdenies bcoverage bfor bthe bstated bservice bor
bprocedure.
An bentity bthat bprocesses bnonstandard bhealth binformation bthey breceive bfrom
banother bentity binto ba bstandard bformat bis bconsidered bwhat? b- b bcorrect banswer-
bClearinghouse
As ba bpart bof bHealth bCare bReform, bthe bAffordable bCare bAct bof b2010 bamended
bthe bdefinition bof bfraud bto bremove bthe b__________ brequirement b- b bcorrect
banswer- bintent
By bstatute, ball bwork bRVUs, bmust bbe bexamined bno bless boften bthan b- b bcorrect
banswer- bevery b5 byears
CF b- b bcorrect banswer- bCoversion bFactor b- bfixed bdollar bamount bused bto
btranslate bthe bRVUs binto bfees
CMS b- b bcorrect banswer- bCenters bfor bMedicare band bMedicaid
CMS bdeveloped bpolices bregarding bmedical bnecessity bare bbased bon bregulations
bfound bin btitle bXVIII, b$1862(a) bof bthe b- b bcorrect banswer- bSocial bSecurity bAct
CMS bwill baccept bthe b____________ bfor beither ba b"potentially bnon=covered"
bservice bor bfor ba bstatutorily bexcluded bservice b- b bcorrect banswer- bCMS-R-131
CMS-R-131 b- b bcorrect banswer- bABN bform b
or
Advance bBeneficiary bNotice bwhich bexplains bto bthe bpatient bwhy bMedicare bmay
bdeny bthe bparticular bservice bor bprocedure.
CPT b- b bcorrect banswer- bCurrent bProcedural bTerminology
CY b2013 bConversion bFactor b- b bcorrect banswer- b$25.0008
Commercial b(non-Medicare) bmay bdevelop btheir bown bmedical bpolicies bwhich bdo
bnot bfollow bMedicare bguidelines band bare bspecified bin b- b bcorrect banswer- bprivate
bcontracts bbetween bthe bpayer band bpractice bor bprovider
STUDY GUIDE NOTES WITH
COMPLETE SOLUTIONS
"hold bharmless bclause" b- b bcorrect banswer- b* bfound bin bsome bnon-Medicare
bhealth bplan bcontracts
* bprohibits bbilling bto bpatient bfor banything bbeyond bdeductibles band bco-pays.
A bcompliance bplan bmay boffer bseveral bbenefits, bincluding: b- b bcorrect banswer- b*
bmore baccurate bpayment bof bclaims
* bfewer bbilling bmistakes
* bimproved bdocumentation band bmore baccurate bcoding
* bless bchance bof bviolating bself-referral band banti-kickback bstatus
A bhealthcare bclearing bhouse bis ba b- b bcorrect banswer- bentity bthat bprocesses
bnonstandard bhealth binformation bthey breceive bfrom banother bentity binto ba
bstandard bformat
A bkey bprovision bin bHIPAA bis bthe bMinimum bNecessary brequirement. bthis bmeans
b- b bcorrect banswer- bonly bthe bminimum bnecessary bprotected bhealth binformation
bshould bbe bshared bto bsatisfy ba bparticular bpurpose.
A bmedically bnecessary bservice bis bthe b- b bcorrect banswer- bleast bradical
bservice/procedure bthat ballows bfor beffective btreatment bof bthe bpatients' bcomplaint
bor bcondition
A bpatient bsustaining ban binjury bto bher bgreat bsaphenous bvein bwould bhave
bsustained binjury bto bwhich bof banatomical bsite? b- b bcorrect banswer- bLeg
, APC b- b bcorrect banswer- bAmbulatory bPayment bClassification
ARRA b- b bcorrect banswer- bAmerican bRecovery band bReinvestment bAct b(of b2009)
ASC b- b bcorrect banswer- bAmbulatory bSurgical bCenters
Abuse bconsists bof b- b bcorrect banswer- bpayment bfor bitems bor bservices bthat bare
bbilled bby bproviders bin berror bthat bshould bnot bbe bpaid bfor bby bMedicare.
An bABN bprotects bthe bprovider's bfinancial binterest bby b- b bcorrect banswer-
bcreating ba bpaper btrail bthat bCMS brequires bbefore ba bprovider bcan bbill bthe
bpatient bfor bpayment bif bMedicare bdenies bcoverage bfor bthe bstated bservice bor
bprocedure.
An bentity bthat bprocesses bnonstandard bhealth binformation bthey breceive bfrom
banother bentity binto ba bstandard bformat bis bconsidered bwhat? b- b bcorrect banswer-
bClearinghouse
As ba bpart bof bHealth bCare bReform, bthe bAffordable bCare bAct bof b2010 bamended
bthe bdefinition bof bfraud bto bremove bthe b__________ brequirement b- b bcorrect
banswer- bintent
By bstatute, ball bwork bRVUs, bmust bbe bexamined bno bless boften bthan b- b bcorrect
banswer- bevery b5 byears
CF b- b bcorrect banswer- bCoversion bFactor b- bfixed bdollar bamount bused bto
btranslate bthe bRVUs binto bfees
CMS b- b bcorrect banswer- bCenters bfor bMedicare band bMedicaid
CMS bdeveloped bpolices bregarding bmedical bnecessity bare bbased bon bregulations
bfound bin btitle bXVIII, b$1862(a) bof bthe b- b bcorrect banswer- bSocial bSecurity bAct
CMS bwill baccept bthe b____________ bfor beither ba b"potentially bnon=covered"
bservice bor bfor ba bstatutorily bexcluded bservice b- b bcorrect banswer- bCMS-R-131
CMS-R-131 b- b bcorrect banswer- bABN bform b
or
Advance bBeneficiary bNotice bwhich bexplains bto bthe bpatient bwhy bMedicare bmay
bdeny bthe bparticular bservice bor bprocedure.
CPT b- b bcorrect banswer- bCurrent bProcedural bTerminology
CY b2013 bConversion bFactor b- b bcorrect banswer- b$25.0008
Commercial b(non-Medicare) bmay bdevelop btheir bown bmedical bpolicies bwhich bdo
bnot bfollow bMedicare bguidelines band bare bspecified bin b- b bcorrect banswer- bprivate
bcontracts bbetween bthe bpayer band bpractice bor bprovider
