AAPC Certified Anesthesia and Pain Management Coder (CANPC)™ certification Notes, definitions and questions from AAPC CPC Study Guide Medical Coding Prep 2025 American Academy of Professional Coders

" AAPC Certified Anesthesia and Pain Management Coder (CANPC)™ certification Notes,
definitions and questions from AAPC CPC Study Guide Medical Coding Prep 2025 American
Academy of Professional Coders hold harmless clause" - * found in some non-Medicare 9p 9p 9p 9p 9p 9p 9p 9p




health plan contracts 9p 9p 9p




* prohibits billingto patient foranything beyond deductibles and co-pays.
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A compliance plan may offer several benefits, including: - * more accurate payment of claims
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* fewer billing mistakes
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* improved documentation and more accurate coding
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* less chance of violating self-referral and anti-kickback status
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A healthcare clearing house is a - entitythat processes nonstandard health information they receive
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from another entity into a standard format
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A key provision in HIPAA is the Minimum Necessary requirement. this means - only the minimum
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necessary protected health information should be shared to satisfy a particular purpose.
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A medically necessary service is the - least radical service/procedure that allows for effective
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treatment of the patients' complaint or condition
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A patient sustaining an injury to her great saphenous vein would have sustained injury to which of
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anatomical site? - Leg
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APC - Ambulatory Payment Classification
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ARRA - American Recoveryand Reinvestment Act(of 2009) ASC -
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9p Ambulatory Surgical Centers 9p 9p




Abuse consists of - payment for items or services that are billed by providers in error that
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should not be paid for by Medicare.
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An ABN protects the provider's financial interest by - creating a paper trail that CMS requires
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before a provider can bill the patient for payment if Medicare denies coverage for the stated
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service or procedure.
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An entity that processes nonstandard health information they receivefrom another entity into a
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standard format is considered what? - Clearinghouse
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, As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud
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to remove the
9p 9p requirement - intent 9p 9p 9p 9p




By statute, all work RVUs, must be examined no less often than - every 5 years CF -
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Coversion Factor - fixed dollar amount used to translate the RVUs into fees CMS -
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9p Centers for Medicare and Medicaid 9p 9p 9p 9p




CMS developed polices regarding medical necessity are based on regulations found in title XVIII,
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$1862(a) of the - Social Security Act 9p 9p 9p 9p 9p 9p




CMS will accept the 9p for either a "potentiallynon=covered"service or for a
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statutorily excluded service - CMS-R-131
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CMS-R-131 - ABN form 9p 9p 9p




or



Advance Beneficiary Notice which explains to the patient why Medicare may denythe
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particular service or procedure.
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CPT-Current ProceduralTerminology CY
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2013 Conversion Factor - $25.0008
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Commercial (non-Medicare) may develop their own medical policies which do not follow 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p 9p




Medicare guidelines and are specified in - private contracts between the payer and practice or
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provider
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DRG - Diagnosis Related Group
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Does Medicare Part B generally require a yearly deductable and copayment? - yes E/M OR
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9p E&M - Evaluation and Management 9p 9p 9p 9p




EHR - Electronic Health Record
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Formula for Calculating Facility Payment amounts - [(Work RVU * Work GPCI) + (Transitioned Facility
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PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
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