CPC 2021 Exam Study Guide
Documentation (content) - ANS-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 - ANS-The role a coder may take on to verify that the documentation
supports the codes the physician has selected
Query the physician - ANS-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) - ANS-How often are codes and insurance payment policies
updated?
NPP - ANS-Non-Physician Provider (also known as mid-level providers or physician
extenders)
PA - ANS-Physician assistant
NP - ANS-Nurse practitioner
Commercial and Government - ANS-The two types of primary insurances
Commercial Carriers - ANS-Private payers that may offer both group and individual
plans
Medicare - ANS-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 - ANS-Medicare provides coverage for what kind of people?
ESRD - ANS-end-stage renal disease
Medicare Part A - ANS-Helps cover inpatient hospital care, as well as care provided in
skilled nursing facilities, hospice care, and home healthcare,
, Medicare Part B - ANS-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 - ANS-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 - ANS-A prescription drug program available to all Medicare
beneficiaries.
Medicaid - ANS-A health insurance assistance program for some low-income people
(especially children and pregnant women) sponsored by federal and state governments.
RBRVS - ANS-Resource-Based Relative Value Scale
Resource-Based Relative Value Scale (RBRVS) - ANS-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) - ANS-The three components used to determine resource cost for physician
services.
The Physician Work component - ANS-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 - ANS-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 - ANS-Resource-Based Professional Liability Insurance
Professional Liability Insurance (PLI) - ANS-Accounts for 4 percent of the total relative
value for each service
CMS website - ANS-Where can you find Physician Fee Schedule (PFS) information?
PFS - ANS-Physician Fee Schedule
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Hkane. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $7.99. You're not tied to anything after your purchase.
