AAPC Official CPC Certification Study Guide Notes Latest Updated 2022

AAPC Official CPC Certification Study Guide Notes Latest Updated 2022 "hold harmless clause" ✔✔* found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-p ...

AAPC Official CPC Certification Study Guide Notes Latest Updated 2022 "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 NonFacility 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 (physician office, private practice) If a sevice fails to support medical necessity requirements per the LCD, and the service is not covered, the practice would be responsible for obtaining a(n) ✔✔Advance Beneficiarly Notice of NonCoverage (Advance Benefiary Notice, or ABN) If an NCD doesn't exist for a particular item, its up to the ______ to determine coverage. ✔✔MAC If an inbuilding pharmacy delivers medication (