AAPC Official CPC Certification Study
Guide
"hold harmless clause" - Answer-* 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: - Answer-* 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 - Answer-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 - Answer-only the
minimum necessary protected health information should be shared to satisfy a particular purpose.
,A medically necessary service is the - Answer-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? - Answer-Leg
APC - Answer-Ambulatory Payment Classification
ARRA - Answer-American Recovery and Reinvestment Act (of 2009)
ASC - Answer-Ambulatory Surgical Centers
Abuse consists of - Answer-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 - Answer-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? - Answer-Clearinghouse
As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to
remove the __________ requirement - Answer-intent
By statute, all work RVUs, must be examined no less often than - Answer-every 5 years
CF - Answer-Coversion Factor - fixed dollar amount used to translate the RVUs into fees
, CMS - Answer-Centers for Medicare and Medicaid
CMS developed polices regarding medical necessity are based on regulations found in title XVIII,
$1862(a) of the - Answer-Social Security Act
CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily
excluded service - Answer-CMS-R-131
CMS-R-131 - Answer-ABN form
or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service
or procedure.
CPT - Answer-Current Procedural Terminology
CY 2013 Conversion Factor - Answer-$25.0008
Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare
guidelines and are specified in - Answer-private contracts between the payer and practice or provider
DRG - Answer-Diagnosis Related Group
Does Medicare Part B generally require a yearly deductable and copayment? - Answer-yes
Guide
"hold harmless clause" - Answer-* 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: - Answer-* 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 - Answer-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 - Answer-only the
minimum necessary protected health information should be shared to satisfy a particular purpose.
,A medically necessary service is the - Answer-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? - Answer-Leg
APC - Answer-Ambulatory Payment Classification
ARRA - Answer-American Recovery and Reinvestment Act (of 2009)
ASC - Answer-Ambulatory Surgical Centers
Abuse consists of - Answer-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 - Answer-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? - Answer-Clearinghouse
As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to
remove the __________ requirement - Answer-intent
By statute, all work RVUs, must be examined no less often than - Answer-every 5 years
CF - Answer-Coversion Factor - fixed dollar amount used to translate the RVUs into fees
, CMS - Answer-Centers for Medicare and Medicaid
CMS developed polices regarding medical necessity are based on regulations found in title XVIII,
$1862(a) of the - Answer-Social Security Act
CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily
excluded service - Answer-CMS-R-131
CMS-R-131 - Answer-ABN form
or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service
or procedure.
CPT - Answer-Current Procedural Terminology
CY 2013 Conversion Factor - Answer-$25.0008
Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare
guidelines and are specified in - Answer-private contracts between the payer and practice or provider
DRG - Answer-Diagnosis Related Group
Does Medicare Part B generally require a yearly deductable and copayment? - Answer-yes
