AAPC Official CPC Certification Study Guide Notes

AAPC Official CPC Certification Study Guide Notes
i i i i i i




"holdiharmlessiclause"i-i

i ✅*ifoundiinisomeinon-Medicareihealthiplanicontracts

*iprohibitsibillingitoipatientiforianythingibeyondideductiblesiandico-pays.



Aicomplianceiplanimayiofferiseveralibenefits,iincluding:i-i

i ✅*imoreiaccurateipaymentioficlaims

*ifeweribillingimistakes

*iimprovedidocumentationiandimoreiaccurateicoding

*ilessichanceiofiviolatingiself-referraliandianti-kickbackistatus



Aihealthcareiclearingihouseiisiai-i

✅entityithatiprocessesinonstandardihealthiinformationitheyireceiveifromianotherientityiintoiaistandar
i

diformat



AikeyiprovisioniiniHIPAAiisitheiMinimumiNecessaryirequirement.ithisimeansi-i

✅onlyitheiminimuminecessaryiprotectedihealthiinformationishouldibeishareditoisatisfyiaiparticularipu
i

rpose.



Aimedicallyinecessaryiserviceiisithei-i

✅leastiradicaliservice/procedureithatiallowsiforieffectiveitreatmentiofitheipatients'icomplaintioricondi
i

tion



Aipatientisustainingianiinjuryitoiherigreatisaphenousiveiniwouldihaveisustainediinjuryitoiwhichiofianato
micalisite?i-i

i ✅Leg



APCi-i

i ✅AmbulatoryiPaymentiClassification




1i|iP a g e

,ARRAi-i

i ✅AmericaniRecoveryiandiReinvestmentiActi(ofi2009)



ASCi-i

i ✅AmbulatoryiSurgicaliCenters



Abuseiconsistsiofi-i

✅paymentiforiitemsioriservicesithatiareibilledibyiprovidersiinierrorithatishouldinotibeipaidiforibyiMedic
i

are.



AniABNiprotectsitheiprovider'sifinancialiinterestibyi-i

✅creatingiaipaperitrailithatiCMSirequiresibeforeiaiprovidericanibillitheipatientiforipaymentiifiMedicarei
i

deniesicoverageiforitheistatediserviceioriprocedure.



Anientityithatiprocessesinonstandardihealthiinformationitheyireceiveifromianotherientityiintoiaistandar
diformatiisiconsiderediwhat?i-i

i ✅Clearinghouse



AsiaipartiofiHealthiCareiReform,itheiAffordableiCareiActiofi2010iamendeditheidefinitioniofifrauditoiremo
veithei__________irequirementi-i

i ✅intent



Byistatute,ialliworkiRVUs,imustibeiexaminedinoilessioftenithani-i

i ✅everyi5iyears



CFi-i

i ✅CoversioniFactori-ifixedidollariamountiuseditoitranslateitheiRVUsiintoifees



CMSi-i

i ✅CentersiforiMedicareiandiMedicaid




2i|iP a g e

, CMSidevelopedipolicesiregardingimedicalinecessityiareibasedioniregulationsifoundiinititleiXVIII,i$1862(a
)iofithei-i

i ✅SocialiSecurityiAct



CMSiwilliacceptithei____________iforieitheriai"potentiallyinon=covered"iserviceioriforiaistatutorilyiexcl
udediservicei-i

i ✅CMS-R-131



CMS-R-131i-i

i ✅ABNiformi



or



AdvanceiBeneficiaryiNoticeiwhichiexplainsitoitheipatientiwhyiMedicareimayidenyitheiparticulariservicei
oriprocedure.



CPTi-i

i ✅CurrentiProceduraliTerminology



CYi2013iConversioniFactori-i

i ✅$25.0008



Commerciali(non-
Medicare)imayidevelopitheiriownimedicalipoliciesiwhichidoinotifollowiMedicareiguidelinesiandiareispeci
fiediini-i

i ✅privateicontractsibetweenitheipayeriandipracticeioriprovider



DRGi-i

i ✅DiagnosisiRelatediGroup



DoesiMedicareiPartiBigenerallyirequireiaiyearlyideductableiandicopayment?i-i

i ✅yes


3i|iP a g e