Abstractor Correct Answer: hospital employee who converts documented procedurs and diangoses into medical codes
Abuse Correct Answer: coding practices that lead to improper reimbursement by error because they do not meet medical necessity, ex. changing diagnosis to be covered by insurance
A...
CPC Exam questions and answers(all correct) 2022
Abstractor Correct Answer: hospital employee who converts documented procedurs and
diangoses into medical codes
Abuse Correct Answer: coding practices that lead to improper reimbursement by error because
they do not meet medical necessity, ex. changing diagnosis to be covered by insurance
Accreditation Correct Answer: an examination process the healthcare facility goes through to
evaluate the facilities policies, procedures, and performance to meet higher standards.
Accredited Correct Answer: Having seal of approval after being evaluated and demonstrating
quality standards
Act/ Law/ Statute Correct Answer: Legislation passed through Congress and signed by President
or passed over his veto
Actual Charge Correct Answer: The amount the provider charges for medical services or
supplies. Not always paid in full.
Additional Benefits Correct Answer: Health care services not covered by Medicare and are
offered through the Medicare Advantage Organization for no additional premium. The benefits
must equal the ACR (Adjusted Community Rating)
Adjudication Correct Answer: Health Insurance Claims process at the insurance company
Adjusted Average Per Capita Cost (AAPCC) Correct Answer: Estimate of how much Medicare
will spend in a year for an average beneficiary
Administrative Code Sets Correct Answer: Non medical code sets that characterize a general
business situation rather than a medical condition.
Administrative Costs Correct Answer: Medicare, Medicaid, CMS refer to this as their expenses
to have the program, operating expenses, program management, etc.
Administrative Data Correct Answer: Health insurance information stored in automated
information system about enrollment, eligibility, claims, etc.
Administrative Law Judge (ALJ) Correct Answer: hearing officer who presides over appeal
conflicts between providers or beneficiaries, and Medicare contractors (MAC's)
Administrative Simplification Correct Answer: Part of HIPAA authorizing HHS (Health and
Human Services) to 1. adopt standards for transactions & code sets; 2. adopt standard identifiers
for health plans; 3. adopt standards to protect security & privacy of personally identifiable health
information.
, Administrative Simplification Act Correct Answer: Signed 12/17/01 allows HHS (Health &
Human Services) to exclude providers from Medicare for HIPAA non-compliance of electronic
claims and prohibit paper claims except in certain situations
Admission Date Correct Answer: The date the patient was admitted for inpatient care,
outpatient, or start of care.For hospice, enter effective date of election of hospice benefits.
Admitting Physician Correct Answer: The doctor responsible for admitting a patient to the
hospital or other inpatient health facility
Advance Beneficiary Notification (ABN) Correct Answer: A notice from provider to patient that
Medicare may deny payment. Patient must sign before services are provider, otherwise patient is
not responsible if Medicare does not cover.
Advanced Directive Correct Answer: Statement written by patient on how they want medical
decisions to be made. May include a Living Will or Durable Power of Attorney for healthcare.
Allowed Charge Correct Answer: Individual charge determination by carrier for a covered
service or supply.
Ambulatory Care Correct Answer: All types of health services that do not require an overnight
stay.
Ambulatory Care Sensitive Conditions (ACSC) Correct Answer: Medical condtions that if
treated immediatly and managed properly should not require hospitalization.
Ambulatory Payment Classification (APC) Correct Answer: Medicare's outpatient prospective
payment system in which services are grouped based on the resources needed and payment is
fixed within each group
Ambulatory Surgery Center (ASC) Correct Answer: Outpatient surgery center not located in the
hospital. Patient's may stay a few hours up to 1 night.
American Hospital Association (AHA) Correct Answer: Represents concerns of instituitional
providers. They host the National Uniform Billing Committee (NUBC) which consults under
HIPAA
American Medical Association (AMA) Correct Answer: Professional organization maintains
CPT code sets, secretariat to National Uniform Claim Committee (NUCC) which consults under
HIPAA. ASC payment group rate.
ASHIM Correct Answer: American Society of Health Informatics Managers, Inc. is a non-profit
group of computer professionals that specialize in health information technology (HIT). They are
certified through Certified Health Informatics System Professionals (CHISP)
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