AAPC Official CPC Certification Study Guide Notes Study online at https://quizlet.com/_16ndnb 1. "hold harmless clause" * found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-pays. 2. A compliance plan may offer several benefits, including: * more accurate payment of claims * fewer billing mistakes * improved documentation and more accurate coding * less chance of violating self-referral and anti-kickback status 3. A healthcare clearing house is a entity that processes nonstandard health information they receive from another entity into a standard format 4. A key provision in HIPAA is the Minimum Necessary requirement. this means only the minimum necessary protected health information should be shared to satisfy a particular purpose. 5. A medically necessary service is the least radical service/procedure that allows for effective treatment of the pa1 / 23 AAPC Official CPC Certification Study Guide Notes Study online at https://quizlet.com/_16ndnb tients' complaint or condition 6. A patient sustaining an injury to her great saphenous vein would have sustained injury to which of anatomical site? Leg 7. APC Ambulatory Payment Classification 8. ARRA American Recovery and Reinvestment Act (of 2009) 9. ASC Ambulatory Surgical Centers 10. Abuse consists of payment for items or services that are billed by providers in error that should not be paid for by Medicare. 11. An ABN protects the provider's financial interest by creating a paper trail that CMS requires before a provider can bill the patient for payment if Medicare denies coverage for the stated service or procedure. 12. An entity that processes nonstandard health information they receive from another entity into a standard format is considered what? Clearinghouse 13. As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to remove the __________ requirement intent 2 / 23 AAPC Official CPC Certification Study Guide Notes Study online at https://quizlet.com/_16ndnb 14. By statute, all work RVUs, must be examined no less often than every 5 years 15. CF Coversion Factor - fixed dollar amount used to translate the RVUs into fees 16. CMS Centers for Medicare and Medicaid 17. CMS developed polices regarding medical necessity are based on regulations found in title XVIII, $1862(a) of the Social Security Act 18. CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily excluded service CMS-R-131 19. CMS-R-131 ABN form or Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service or procedure. 20. CPT Current Procedural Terminology 21. CY 2013 Conversion Factor $25.0008