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CPC Exam Study Guide Questions & A+ Verified Answers
1. 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
2. An auditor
ANS The role a coder may take on to verify that the documentation supports the codes the physician has selected
3. 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?
4. Quarterly (usually)
ANS How often are codes and insurance payment policies updated?
5. NPP
ANS Non-Physician Provider (also known as mid-level providers or physician extenders)
6. PA
ANS Physician assistant
7. NP
ANS Nurse practitioner
8. Commercial and Government
ANS The two types of primary insurances
9. Commercial Carriers
ANS Private payers that may offer both group and individual plans
10. Medicare
ANS The most significant government insurer; a federal health insurance program
11. 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?
12. ESRD
ANS end-stage renal disease
13. Medicare Part A
ANS Helps cover inpatient hospital care, as well as care provided in skilled nursing facilities, hospice care, and home healthcare,
14. 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.
15. 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
17. Medicaid
ANS A health insurance assistance program for some low-income people (especially children and pregnant women) sponsored by federal and state govern- ments.
18. RBRVS
ANS Resource-Based Relative Value Scale
19. Resource-Based Relative Value Scale (RBRVS)
ANS Medicare payments for physician services are standardized using and are divided into three com- ponents.
20. The physician work component, practice expense, and professional lia- bility
insurance (PLI) ANS The three components used to determine resource cost for physician services.
21. 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.
22. 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.
23. PLI
ANS Resource-Based Professional Liability Insurance
24. Professional Liability Insurance (PLI)
ANS Accounts for 4 percent of the total relative value for each service
25. CMS website
ANS Where can you find Physician Fee Schedule (PFS) information?
26. PFS
ANS Physician Fee Schedule
27. Medical Necessity
ANS Refers to whether a procedure or service is considered appropriate in a given circumstance
28. NCD
ANS National Coverage Determinations
29. National Coverage Determinations (NCD)
ANS Explains when Medicare will pay for items or services
30. MAC
ANS Medicare Administrative Contractor
31. Medicare Administrative Contractor (MAC)
ANS Responsible for interpreting na- tional policies into reginal polices.
32. Local Coverage Determinations (LCD)
ANS Regional policies converted from national polices by a Medicare Administrative Contractor (MAC).
33. ABN
ANS Advance Beneficiary Notice
42. Health Information Technology for Economic and Clinical Health Act
(HITECH)
ANS Requires that an individual be notified if there is an unauthorized disclosure or use of his or her health information.
43. OIG
ANS Office of Inspector General
44. Fraud
ANS To purposely bill for services that were never given or to bill for a service that has a high reimbursement than the services provided; The person does not have to possess knowledge of the violation for it to still be a considered offense.
45. Abuse
ANS Consists of payment for items or services that are billed by providers in error that should not be paid for by Medicare.
46. Compliance Plan
ANS A written set of instructions outlining the process for coding and submitting accurate claims, and what to do if mistakes are found.
47. CPT
ANS Certified Procedural Terminology
48. ICD-10-CM
ANS International Classification of Disease, 10th Revision Clinical Modification
49. MP
ANS Malpractice
50. OCR
ANS Office for Civil Right
51. RVU
ANS Relative Value Unit
61. The word root
ANS The base of a medical term and can stand alone as the main portion of a medical term.
62. Combining vowels
ANS Attachments to a root word to link another root word or suffix and is always placed between two root words, even when the second root word begins with a vowel
63. O and I
ANS The most common combining vowels
64. A Prefix
ANS Typically attached to the beginning of a word to modify or alter its meaning; Indicates location, time, or number
65. A Suffix
ANS Attached to the end of a word to modify or alter its meaning; Indicates procedure, condition, disorder, or disease
66. Anterior (ventral)
ANS Toward the front of the body
67. Posterior (dorsal)
ANS Toward the back of the body
68. Medial
ANS Toward the midline of the body
69. Lateral
ANS Toward the side of the body
70. Proximal
ANS Nearer to the point of attachment or to a given reference point
71. Distal
ANS Farther from the point of attachment of from a given reference point
72. Superior (cranial)
ANS Above; toward the head
73. Inferior (caudal)
ANS Below; toward the lower end of the spine
ng a
brain
lower (inferior) sections
79. The cell
ANS Basic unit of all living things
80. Tissue
ANS A group of similar cells performing a specific task
81. Organs
ANS Two or more kinds of tissue that together perform special body func- tions
82. Body Systems
ANS Groups of organs that work together to perform complex body functions
83. 5 cavities
ANS How many cavities does the human body have?
84. Cranial cavity
ANS The space inside of the skull, or cranium, containi
ining
agus
he
esophagus,
oductiv
e
85. Spinal (vertebral) cavity
ANS The space inside the spinal column conta spinal cord
86. Thoracic (chest) cavity
ANS The space containing the heart, lungs, esoph trachea, bronchi, and thymus
87. Abdominal cavity
ANS The space containing the lowest portion of t the stomach, intestines (excluding the sigmoid colon and rectum), k gallbladder, pancreas, spleen, and ureters
88. Pelvic cavity
ANS The space containing the urinary bladder, certain repr organs, part of the large intestine, and the rectum
ANS The upper layer of the skin
96. Dermis
ANS The lower layer of the skin
97. Stratum Corneum
ANS Also called the horny layer, it is the outermost layer of the epidermis
98. Stratum Lucidum
ANS The clear layer of the epidermis, normally found on the palms of the hands and soles of the feet
99. Stratum Granulosum
ANS A layer of the epidermis that marks the transition between the deeper, metabolically active strata and the dead cells of the more superficial strata
100. Stratum Spinosum
ANS The layer of the epidermis that is composed of prickle cells
101. Stratum Basale (Stratum Germinativum)
ANS Deepest layer of the epidermis, made of basal cells
102. Stratum Papillare
ANS The thin superficial layer of the dermis interlocked with the epidermis
103. Stratum Reticulare
ANS The thick layer of dense, irregular connective tissue of the dermis
104. Subcutaneous/Hypodermis Tissue
ANS The layer beneath the dermis
