"hold harmless clause" Correct 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: Correct Answer: * more accurate payment of claims
* fewer billing mis...
AAPC Official CPC Certification Study Guide Notes
"hold harmless clause" Correct 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: Correct 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 Correct 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 Correct Answer:
only the minimum necessary protected health information should be shared to satisfy a particular
purpose.
A medically necessary service is the Correct 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? Correct Answer: Leg
ARRA Correct Answer: American Recovery and Reinvestment Act (of 2009)
ASC Correct Answer: Ambulatory Surgical Centers
Abuse consists of Correct 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 Correct 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? Correct Answer: Clearinghouse
As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of
fraud to remove the __________ requirement Correct Answer: intent
By statute, all work RVUs, must be examined no less often than Correct Answer: every 5 years
CF Correct Answer: Coversion Factor - fixed dollar amount used to translate the RVUs into fees
, CMS Correct Answer: Centers for Medicare and Medicaid
CMS developed polices regarding medical necessity are based on regulations found in title
XVIII, $1862(a) of the Correct Answer: Social Security Act
CMS will accept the ____________ for either a "potentially non=covered" service or for a
statutorily excluded service Correct Answer: CMS-R-131
CMS-R-131 Correct Answer: ABN form
or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular
service or procedure.
CPT Correct Answer: Current Procedural Terminology
Commercial (non-Medicare) may develop their own medical policies which do not follow
Medicare guidelines and are specified in Correct Answer: private contracts between the payer
and practice or provider
DRG Correct Answer: Diagnosis Related Group
Does Medicare Part B generally require a yearly deductable and copayment? Correct Answer:
yes
E/M OR E&M Correct Answer: Evaluation and Management
EHR Correct Answer: Electronic Health Record
Formula for Calculating Facility Payment amounts Correct Answer: [(Work RVU * Work
GPCI) + (Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
Formula for Non-Facility Pricing Amount Correct Answer: [(Work RVU * Work GPCI) +
(Transitioned Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * (CF)
GPCI Correct Answer: Geographic Practice Cost Index
GPCI is used to Correct Answer: realize the varying cost based on geographic location
HCPCS Correct Answer: Healthcare Common Procedure Coding System
HHS Correct Answer: Department of Health and Human Services
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