CPC EXAM STUDY GUIDE | COMPLETE SOLUTIONS | 100% CORRECT.
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Course
CPC.
Institution
CPC.
CPC EXAM STUDY GUIDE | COMPLETE SOLUTIONS | 100% CORRECT.
Documentation (content) - Proper code assignment is determined both by _____________ in the medical record and by the unique rules that govern each code set in that instance
An auditor - The role a coder may take on to v...
CPC EXAM STUDY GUIDE | COMPLETE
SOLUTIONS | 100% CORRECT.
Documentation (content) - Proper code assignment is determined both by
_____________ in the medical record and by the unique rules that govern each code
set in that instance
An auditor - The role a coder may take on to verify that the documentation supports the
codes the physician has selected
Query the physician - If the medical record is inaccurate or incomplete, it will not
translate properly to the language of codes. What can a coder do in order for the
medical record to be complete and accurate so they can bill properly?
Quarterly (usually) - How often are codes and insurance payment policies updated?
NPP - Non-Physician Provider (also known as mid-level providers or physician
extenders)
PA - Physician assistant
NP - Nurse practitioner
Commercial and Government - The two types of primary insurances
Commercial Carriers - Private payers that may offer both group and individual plans
Medicare - The most significant government insurer; a federal health insurance
program
People over 65, blind or disabled individuals, and people with permanent kidney failure
or end-stage renal disease - Medicare provides coverage for what kind of people?
ESRD - end-stage renal disease
Medicare Part A - Helps cover inpatient hospital care, as well as care provided in
skilled nursing facilities, hospice care, and home healthcare,
, Medicare Part B - Covers medically necessary physicians' services, outpatient care,
and other medical services (including some preventive services) not covered under
Medicare Part A. It can be an optional benefit.
Medicare Part C - Also called Medicare Advantage, combines the benefits of Medicare
Part A, Part B, and-sometimes- Part D. The plans are managed by private insurers
approved by Medicare.
Medicare Part D - A prescription drug program available to all Medicare beneficiaries.
Medicaid - A health insurance assistance program for some low-income people
(especially children and pregnant women) sponsored by federal and state governments.
RBRVS - Resource-Based Relative Value Scale
Resource-Based Relative Value Scale (RBRVS) - Medicare payments for physician
services are standardized using _____ and are divided into three components.
The physician work component, practice expense, and professional liability insurance
(PLI) - The three components used to determine resource cost for physician services.
The Physician Work component - Accounts for just over half (52 percent) of a
procedure's/service's total relative value and is measured by time it takes to perform a
service, technical skill, and physical effort.
Practice Expense - Accounts for 44 percent of the total relative value for each service
and differ by site of service. For example, the expense of providing services in the
hospital vs a physician's office.
PLI - Resource-Based Professional Liability Insurance
Professional Liability Insurance (PLI) - Accounts for 4 percent of the total relative value
for each service
CMS website - Where can you find Physician Fee Schedule (PFS) information?
PFS - Physician Fee Schedule
Medical Necessity - Refers to whether a procedure or service is considered appropriate
in a given circumstance
NCD - National Coverage Determinations
National Coverage Determinations (NCD) - Explains when Medicare will pay for items
or services
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