AAPC Official CPC Certification
complete Study Questions and
simplified correct Answers
"hold harmless clause" - correct 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: - correct 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 - correct 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 - correct answer-only the
minimum necessary protected health information should be shared to satisfy a particular purpose.
A medically necessary service is the - correct 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? - correct answer-Leg
APC - correct answer-Ambulatory Payment Classification
ARRA - correct answer-American Recovery and Reinvestment Act (of 2009)
ASC - correct answer-Ambulatory Surgical Centers
Abuse consists of - correct 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 - correct 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? - correct answer-Clearinghouse
As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to
remove the __________ requirement - correct answer-intent
By statute, all work RVUs, must be examined no less often than - correct answer-every 5 years
CF - correct answer-Coversion Factor - fixed dollar amount used to translate the RVUs into fees
, CMS - correct answer-Centers for Medicare and Medicaid
CMS developed polices regarding medical necessity are based on regulations found in title XVIII,
$1862(a) of the - correct answer-Social Security Act
CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily
excluded service - correct answer-CMS-R-131
CMS-R-131 - correct answer-ABN form
or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service
or procedure.
CPT - correct answer-Current Procedural Terminology
CY 2013 Conversion Factor - correct answer-$25.0008
Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare
guidelines and are specified in - correct answer-private contracts between the payer and practice or
provider
DRG - correct answer-Diagnosis Related Group
Does Medicare Part B generally require a yearly deductable and copayment? - correct answer-yes
E/M OR E&M - correct answer-Evaluation and Management
EHR - correct answer-Electronic Health Record
Formula for Calculating Facility Payment amounts - correct answer-[(Work RVU * Work GPCI) +
(Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
Formula for Non-Facility Pricing Amount - correct answer-[(Work RVU * Work GPCI) + (Transitioned Non-
Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * (CF)
GPCI - correct answer-Geographic Practice Cost Index
GPCI is used to - correct answer-realize the varying cost based on geographic location
HCPCS - correct answer-Healthcare Common Procedure Coding System
HHS - correct answer-Department of Health and Human Services
HIPAA provides federal protections for - correct answer-personal health information when held by
covered entities.
HIPAA stands for - correct answer-Health Insurance Portability and Accountability Act of 1996
HITECH - correct answer-The Health Information Technology for Economic and Clinical Health Act
complete Study Questions and
simplified correct Answers
"hold harmless clause" - correct 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: - correct 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 - correct 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 - correct answer-only the
minimum necessary protected health information should be shared to satisfy a particular purpose.
A medically necessary service is the - correct 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? - correct answer-Leg
APC - correct answer-Ambulatory Payment Classification
ARRA - correct answer-American Recovery and Reinvestment Act (of 2009)
ASC - correct answer-Ambulatory Surgical Centers
Abuse consists of - correct 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 - correct 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? - correct answer-Clearinghouse
As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to
remove the __________ requirement - correct answer-intent
By statute, all work RVUs, must be examined no less often than - correct answer-every 5 years
CF - correct answer-Coversion Factor - fixed dollar amount used to translate the RVUs into fees
, CMS - correct answer-Centers for Medicare and Medicaid
CMS developed polices regarding medical necessity are based on regulations found in title XVIII,
$1862(a) of the - correct answer-Social Security Act
CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily
excluded service - correct answer-CMS-R-131
CMS-R-131 - correct answer-ABN form
or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service
or procedure.
CPT - correct answer-Current Procedural Terminology
CY 2013 Conversion Factor - correct answer-$25.0008
Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare
guidelines and are specified in - correct answer-private contracts between the payer and practice or
provider
DRG - correct answer-Diagnosis Related Group
Does Medicare Part B generally require a yearly deductable and copayment? - correct answer-yes
E/M OR E&M - correct answer-Evaluation and Management
EHR - correct answer-Electronic Health Record
Formula for Calculating Facility Payment amounts - correct answer-[(Work RVU * Work GPCI) +
(Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
Formula for Non-Facility Pricing Amount - correct answer-[(Work RVU * Work GPCI) + (Transitioned Non-
Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * (CF)
GPCI - correct answer-Geographic Practice Cost Index
GPCI is used to - correct answer-realize the varying cost based on geographic location
HCPCS - correct answer-Healthcare Common Procedure Coding System
HHS - correct answer-Department of Health and Human Services
HIPAA provides federal protections for - correct answer-personal health information when held by
covered entities.
HIPAA stands for - correct answer-Health Insurance Portability and Accountability Act of 1996
HITECH - correct answer-The Health Information Technology for Economic and Clinical Health Act
