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AAPC CPC® Chapter 1

This is AAPC Official CPC® Certification Study Guide: Chapter 1

What does RBRVS stand for? Resource-Based Relative Value Scale
What type of private payer carriers may offer both group and individual plans? Commercial
What is the name of the government/federal health insurance program that provides coverage for people over the age of 65, blind or disabled, and people with ESRD? Medicare
What does CMS stand for? Center for Medicare and Medicaid Services
What PART of government/federal health insurance helps cover inpatient hospital care, as well as care provided in skilled nursing facilities, hospice care, and home healthcare? Medicare Part A
What PART of government/federal health insurance helps cover medically necessary physician services, outpatient care, and other medical services not covered elsewhere? Medicare Part B
What PART of a government/federal health insurance combines the benefits of two parts and sometimes the third part? Medicare Part C
What PART of a government/federal health insurance helps cover prescription drugs, and are available to ALL parts? Medicare Part D
What is another name for Medicare Part C? Medicare Advantage
What is the name of a government/federal health insurance that is for some low-income people? Especially for children and pregnant women? Medicaid
What are the 3 components for RBRVS? Physician work, practice expense, and professional liability insurance
What does "medical necessity" mean? Whether a procedure or service is considered appropriate in a given circumstance
What does NCD stand for? National Coverage Determination
What does LCD stand for? Local Coverage Determination
What does MAC stand for? Medicare Administrative Contractors
What does ABN stand for? Advance Beneficiary Notice
What is an ABN? Standardized form that explains to the patient why Medicare may deny the service or procedure
Who may not recognize an ABN? Non-Medicare payers
What does HIPAA stand for? Health Information Portability and Accountability Act
What does HIPPA do? Provides federal protections for personal health information when held by a covered entity
What may be considered a covered entity? Healthcare Provider, Health Plan, Healthcare Clearinghouse
What does PHI stand for? Protected Health Information
What is the Minium Necessity requirement? Only the minimum necessary protected health information should be sent to satisfy a particular purpose.
When does the Minimum Necessity standard NOT apply? Requests by a healthcare provider for treatment purposes, the individual who is the subject of the information, pursuant to an individuals authorizaiton, required for compliance with HIPAA Administrative Simplification Rules, HHS, or by other law.
What does HITECH stand for? Health Information Technology for Economic and Clinical Health
What does ARRA stand for? American Recovery and Reinvestment Act
What is Fraud? It is defined as purposely billing for a service never rendered or billing for a service at a higher reimbursement rate than the service provided
What is Abuse? It is defined as payment for items or services that are billed by providers in error that should not be paid for by Medicare
Created by: jacquelinerose
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