AAPC Official CPC Certification Study Guide Notes
"hold harmless clause" - -* found in some non-
Medicare health plan contracts An ABN protects the provider's financial interest by -
* prohibits billing to patient for anything beyond -creating a paper trail that CMS requires before
deductibles and co-pays. a provider can bill the patient for payment if Medicare
denies coverage for the stated service or procedure.
A compliance plan may offer several benefits,
including: - -* more accurate payment of claims An entity that processes nonstandard health
* fewer billing mistakes information they receive from another entity into a
* improved documentation and more accurate coding standard format is considered what? - -
* less chance of violating self-referral and anti- Clearinghouse
kickback status
As a part of Health Care Reform, the Affordable Care
A healthcare clearing house is a - -entity that Act of 2010 amended the definition of fraud to
processes nonstandard health information they remove the __________ requirement - -intent
receive from another entity into a standard format
By statute, all work RVUs, must be examined no less
A key provision in HIPAA is the Minimum Necessary often than - -every 5 years
requirement. this means - -only the minimum
necessary protected health information should be
shared to satisfy a particular purpose. CF - -Coversion Factor - fixed dollar amount
used to translate the RVUs into fees
A medically necessary service is the - -least
radical service/procedure that allows for effective CMS - -Centers for Medicare and Medicaid
treatment of the patients' complaint or condition
CMS developed polices regarding medical necessity
A patient sustaining an injury to her great saphenous are based on regulations found in title XVIII, $1862(a)
vein would have sustained injury to which of of the - -Social Security Act
anatomical site? - -Leg
CMS will accept the ____________ for either a
APC - -Ambulatory Payment Classification "potentially non=covered" service or for a statutorily
excluded service - -CMS-R-131
ARRA - -American Recovery and
Reinvestment Act (of 2009) CMS-R-131 - -ABN form
or
ASC - -Ambulatory Surgical Centers
Advance Beneficiary Notice which explains to the
patient why Medicare may deny the particular service
Abuse consists of - -payment for items or or procedure.
services that are billed by providers in error that
should not be paid for by Medicare.
CPT - -Current Procedural Terminology
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, AAPC Official CPC Certification Study Guide Notes
Services
CY 2013 Conversion Factor - -$25.0008
HIPAA provides federal protections for - -
personal health information when held by covered
Commercial (non-Medicare) may develop their own entities.
medical policies which do not follow Medicare
guidelines and are specified in - -private
contracts between the payer and practice or provider HIPAA stands for - -Health Insurance
Portability and Accountability Act of 1996
DRG - -Diagnosis Related Group
HITECH - -The Health Information Technology
for Economic and Clinical Health Act
Does Medicare Part B generally require a yearly
deductable and copayment? - -yes
HITECH allows patients to request - -an audit
trail showing all disclosures of their health information
E/M OR E&M - -Evaluation and Management made through an electronic record.
EHR - -Electronic Health Record HITECH requires that an individual be notified if -
-there is an unauthorized disclosure or use of
his or her health information.
Formula for Calculating Facility Payment amounts -
-[(Work RVU * Work GPCI) + (Transitioned
Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] HITECH was enacted as part of - -the
* CF American Recovery and Reinvestment Act of 2009
(ARRA)
Formula for Non-Facility Pricing Amount - -
[(Work RVU * Work GPCI) + (Transitioned Non- HMO - -Health Maintenence Organization
Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)]
* (CF)
Hemiplegia is a disorder caused by a defect in which
anatomic system? - -nervous
GPCI - -Geographic Practice Cost Index
ICD-9-CM - -International Classification of
GPCI is used to - -realize the varying cost Disease, 9th Clinical Modification
based on geographic location
IF:
HCPCS - -Healthcare Common Procedure
Coding System Work RVUs = 0.48
Work GPCI = 1.000
HHS - -Department of Health and Human
Practice Expense CPCI = 0.943
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"hold harmless clause" - -* found in some non-
Medicare health plan contracts An ABN protects the provider's financial interest by -
* prohibits billing to patient for anything beyond -creating a paper trail that CMS requires before
deductibles and co-pays. a provider can bill the patient for payment if Medicare
denies coverage for the stated service or procedure.
A compliance plan may offer several benefits,
including: - -* more accurate payment of claims An entity that processes nonstandard health
* fewer billing mistakes information they receive from another entity into a
* improved documentation and more accurate coding standard format is considered what? - -
* less chance of violating self-referral and anti- Clearinghouse
kickback status
As a part of Health Care Reform, the Affordable Care
A healthcare clearing house is a - -entity that Act of 2010 amended the definition of fraud to
processes nonstandard health information they remove the __________ requirement - -intent
receive from another entity into a standard format
By statute, all work RVUs, must be examined no less
A key provision in HIPAA is the Minimum Necessary often than - -every 5 years
requirement. this means - -only the minimum
necessary protected health information should be
shared to satisfy a particular purpose. CF - -Coversion Factor - fixed dollar amount
used to translate the RVUs into fees
A medically necessary service is the - -least
radical service/procedure that allows for effective CMS - -Centers for Medicare and Medicaid
treatment of the patients' complaint or condition
CMS developed polices regarding medical necessity
A patient sustaining an injury to her great saphenous are based on regulations found in title XVIII, $1862(a)
vein would have sustained injury to which of of the - -Social Security Act
anatomical site? - -Leg
CMS will accept the ____________ for either a
APC - -Ambulatory Payment Classification "potentially non=covered" service or for a statutorily
excluded service - -CMS-R-131
ARRA - -American Recovery and
Reinvestment Act (of 2009) CMS-R-131 - -ABN form
or
ASC - -Ambulatory Surgical Centers
Advance Beneficiary Notice which explains to the
patient why Medicare may deny the particular service
Abuse consists of - -payment for items or or procedure.
services that are billed by providers in error that
should not be paid for by Medicare.
CPT - -Current Procedural Terminology
1/9
, AAPC Official CPC Certification Study Guide Notes
Services
CY 2013 Conversion Factor - -$25.0008
HIPAA provides federal protections for - -
personal health information when held by covered
Commercial (non-Medicare) may develop their own entities.
medical policies which do not follow Medicare
guidelines and are specified in - -private
contracts between the payer and practice or provider HIPAA stands for - -Health Insurance
Portability and Accountability Act of 1996
DRG - -Diagnosis Related Group
HITECH - -The Health Information Technology
for Economic and Clinical Health Act
Does Medicare Part B generally require a yearly
deductable and copayment? - -yes
HITECH allows patients to request - -an audit
trail showing all disclosures of their health information
E/M OR E&M - -Evaluation and Management made through an electronic record.
EHR - -Electronic Health Record HITECH requires that an individual be notified if -
-there is an unauthorized disclosure or use of
his or her health information.
Formula for Calculating Facility Payment amounts -
-[(Work RVU * Work GPCI) + (Transitioned
Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] HITECH was enacted as part of - -the
* CF American Recovery and Reinvestment Act of 2009
(ARRA)
Formula for Non-Facility Pricing Amount - -
[(Work RVU * Work GPCI) + (Transitioned Non- HMO - -Health Maintenence Organization
Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)]
* (CF)
Hemiplegia is a disorder caused by a defect in which
anatomic system? - -nervous
GPCI - -Geographic Practice Cost Index
ICD-9-CM - -International Classification of
GPCI is used to - -realize the varying cost Disease, 9th Clinical Modification
based on geographic location
IF:
HCPCS - -Healthcare Common Procedure
Coding System Work RVUs = 0.48
Work GPCI = 1.000
HHS - -Department of Health and Human
Practice Expense CPCI = 0.943
2/9
