AAPC Official CPC Certification Study Guide Notes LATEST UPDATE

AAPC Official CPC Certification Study Guide Notes "hold harmless clause" - * 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: - * 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 - 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 - only the minimum necessary protected health information should be shared to satisfy a particular purpose. A medically necessary service is the - 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? - Leg APC - Ambulatory Payment Classification ARRA - American Recovery and Reinvestment Act (of 2009) ASC - Ambulatory Surgical Centers Abuse consists of - 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 - 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? - Clearinghouse As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to remove the __________ requirement - intent By statute, all work RVUs, must be examined no less often than - every 5 years CF - Coversion Factor - fixed dollar amount used to translate the RVUs into fees CMS - Centers for Medicare and Medicaid CMS developed polices regarding medical necessity are based on regulations found in title XVIII, $1862(a) of the - Social Security Act CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily excluded service - CMS-R-131 CMS-R-131 - ABN form or Advance Beneficiary Notice which explains to