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AAPC CPC® Chapter 1
This is AAPC Official CPC® Certification Study Guide: Chapter 1
| Question | Answer |
|---|---|
| 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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