CPC 2021 Exam Study Guide Latest
Update Of 2026/2027
Documentation (content) - Answer--Proper code assignment is determined both by
_____________ in the medical record and by the unique rules that govern each
code set in that instance
An auditor - Answer--The role a coder may take on to verify that the documentation
supports the codes the physician has selected
Query the physician - Answer--If the medical record is inaccurate or incomplete, it
will not translate properly to the language of codes. What can a coder do in order for
the medical record to be complete and accurate so they can bill properly?
Quarterly (usually) - Answer--How often are codes and insurance payment policies
updated?
NPP - Answer--Non-Physician Provider (also known as mid-level providers or
physician extenders)
PA - Answer--Physician assistant
NP - Answer--Nurse practitioner
Commercial and Government - Answer--The two types of primary insurances
Commercial Carriers - Answer--Private payers that may offer both group and
individual plans
Medicare - Answer--The most significant government insurer; a federal health
insurance program
People over 65, blind or disabled individuals, and people with permanent kidney
failure or end-stage renal disease - Answer--Medicare provides coverage for what
kind of people?
ESRD - Answer--end-stage renal disease
, Medicare Part A - Answer--Helps cover inpatient hospital care, as well as care
provided in skilled nursing facilities, hospice care, and home healthcare,
Medicare Part B - Answer--Covers medically necessary physicians' services,
outpatient care, and other medical services (including some preventive services) not
covered under Medicare Part A. It can be an optional benefit.
Medicare Part C - Answer--Also called Medicare Advantage, combines the benefits
of Medicare Part A, Part B, and-sometimes- Part D. The plans are managed by
private insurers approved by Medicare.
Medicare Part D - Answer--A prescription drug program available to all Medicare
beneficiaries.
Medicaid - Answer--A health insurance assistance program for some low-income
people (especially children and pregnant women) sponsored by federal and state
governments.
RBRVS - Answer--Resource-Based Relative Value Scale
Resource-Based Relative Value Scale (RBRVS) - Answer--Medicare payments for
physician services are standardized using _____ and are divided into three
components.
The physician work component, practice expense, and professional liability
insurance (PLI) - Answer--The three components used to determine resource cost
for physician services.
The Physician Work component - Answer--Accounts for just over half (52 percent) of
a procedure's/service's total relative value and is measured by time it takes to
perform a service, technical skill, and physical effort.
Practice Expense - Answer--Accounts for 44 percent of the total relative value for
each service and differ by site of service. For example, the expense of providing
services in the hospital vs a physician's office.
PLI - Answer--Resource-Based Professional Liability Insurance
Professional Liability Insurance (PLI) - Answer--Accounts for 4 percent of the total
relative value for each service
CMS website - Answer--Where can you find Physician Fee Schedule (PFS)
information?
Update Of 2026/2027
Documentation (content) - Answer--Proper code assignment is determined both by
_____________ in the medical record and by the unique rules that govern each
code set in that instance
An auditor - Answer--The role a coder may take on to verify that the documentation
supports the codes the physician has selected
Query the physician - Answer--If the medical record is inaccurate or incomplete, it
will not translate properly to the language of codes. What can a coder do in order for
the medical record to be complete and accurate so they can bill properly?
Quarterly (usually) - Answer--How often are codes and insurance payment policies
updated?
NPP - Answer--Non-Physician Provider (also known as mid-level providers or
physician extenders)
PA - Answer--Physician assistant
NP - Answer--Nurse practitioner
Commercial and Government - Answer--The two types of primary insurances
Commercial Carriers - Answer--Private payers that may offer both group and
individual plans
Medicare - Answer--The most significant government insurer; a federal health
insurance program
People over 65, blind or disabled individuals, and people with permanent kidney
failure or end-stage renal disease - Answer--Medicare provides coverage for what
kind of people?
ESRD - Answer--end-stage renal disease
, Medicare Part A - Answer--Helps cover inpatient hospital care, as well as care
provided in skilled nursing facilities, hospice care, and home healthcare,
Medicare Part B - Answer--Covers medically necessary physicians' services,
outpatient care, and other medical services (including some preventive services) not
covered under Medicare Part A. It can be an optional benefit.
Medicare Part C - Answer--Also called Medicare Advantage, combines the benefits
of Medicare Part A, Part B, and-sometimes- Part D. The plans are managed by
private insurers approved by Medicare.
Medicare Part D - Answer--A prescription drug program available to all Medicare
beneficiaries.
Medicaid - Answer--A health insurance assistance program for some low-income
people (especially children and pregnant women) sponsored by federal and state
governments.
RBRVS - Answer--Resource-Based Relative Value Scale
Resource-Based Relative Value Scale (RBRVS) - Answer--Medicare payments for
physician services are standardized using _____ and are divided into three
components.
The physician work component, practice expense, and professional liability
insurance (PLI) - Answer--The three components used to determine resource cost
for physician services.
The Physician Work component - Answer--Accounts for just over half (52 percent) of
a procedure's/service's total relative value and is measured by time it takes to
perform a service, technical skill, and physical effort.
Practice Expense - Answer--Accounts for 44 percent of the total relative value for
each service and differ by site of service. For example, the expense of providing
services in the hospital vs a physician's office.
PLI - Answer--Resource-Based Professional Liability Insurance
Professional Liability Insurance (PLI) - Answer--Accounts for 4 percent of the total
relative value for each service
CMS website - Answer--Where can you find Physician Fee Schedule (PFS)
information?
