AAPC Official CPC Certification Study Guide Notes already passed graded A+

AAPC Official CPC Certification Study Guide Notes already passed graded A+"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 the patient why Medicare may deny the particular service or procedure. CPT Current Procedural Terminology CY 2013 Conversion Factor $25.0008 Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare guidelines and are specified in private contracts between the payer and practice or provider DRG Diagnosis Related Group Does Medicare Part B generally require a yearly deductable and copayment? yes E/M OR E&M Evaluation and Management EHR Electronic Health Record Formula for Calculating Facility Payment amounts [(Work RVU Work GPCI) + (Transitioned Facility PE RVU PE GPCI) + (MP RVU MP GPCI)] CF Formula for Non-Facility Pricing Amount [(Work RVU Work GPCI) + (Transitioned Non-Facility PE RVU PE GPCI) + (MP RVU MP GPCI)] (CF) GPCI Geographic Practice Cost Index GPCI is used to realize the varying cost based on geographic location HCPCS Healthcare Common Procedure Coding System HHS Department of Health and Human Services HIPAA provides federal protections for personal health information when held by covered entities. HIPAA stands for Health Insurance Portability and Accountability Act of 1996 HITECH The Health Information Technology for Economic and Clinical Health Act HITECH allows patients to request an audit trail showing all disclosures of their health information made through an electronic record. HITECH requires that an individual be notified if there is an unauthorized disclosure or use of his or her health information. HITECH was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) HMO Health Maintenence Organization Hemiplegia is a disorder caused by a defect in which anatomic system? nervous ICD-9-CM International Classification of Disease, 9th Clinical Modification IF: Work RVUs = 0.48 Work GPCI = 1.000 Practice Expense CPCI = 0.943 MP GPCI = 0.572 transitioned non-facility practice RVUs = 0.70 Calculate non-facility pricing amount for cpt code 99212 using 2011 CF of $33.9764 $39.51 Non-facility pricing amount