{"id":113190,"date":"2023-08-15T23:30:23","date_gmt":"2023-08-15T23:30:23","guid":{"rendered":"https:\/\/learnexams.com\/blog\/?p=113190"},"modified":"2023-08-15T23:30:25","modified_gmt":"2023-08-15T23:30:25","slug":"cpc-2021-exam-study-guide","status":"publish","type":"post","link":"https:\/\/www.learnexams.com\/blog\/2023\/08\/15\/cpc-2021-exam-study-guide\/","title":{"rendered":"CPC 2021 Exam Study Guide"},"content":{"rendered":"\n

Documentation (content) – Proper code assignment is determined both by
_<\/em><\/strong><\/em><\/strong> in the medical record and by the unique rules that govern each code
set in that instance
An auditor – The role a coder may take on to verify that the documentation supports the
codes the physician has selected
Query the physician – 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?
Quarterly (usually) – How often are codes and insurance payment policies updated?
NPP – Non-Physician Provider (also known as mid-level providers or physician
extenders)
PA – Physician assistant
NP – Nurse practitioner
Commercial and Government – The two types of primary insurances
Commercial Carriers – Private payers that may offer both group and individual plans
Medicare – The most significant government insurer; a federal health insurance program
People over 65, blind or disabled individuals, and people with permanent kidney failure
or end-stage renal disease – Medicare provides coverage for what kind of people?
ESRD – end-stage renal disease
1 \/ 2
Medicare Part A – Helps cover inpatient hospital care, as well as care provided in skilled
nursing facilities, hospice care, and home healthcare,
Medicare Part B – 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.
Medicare Part C – 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 Medicare.
Medicare Part D – A prescription drug program available to all Medicare beneficiaries.
Medicaid – A health insurance assistance program for some low-income people
(especially children and pregnant women) sponsored by federal and state governments.
RBRVS – Resource-Based Relative Value Scale
Resource-Based Relative Value Scale (RBRVS) – Medicare payments for physician
services are standardized using _<\/strong> and are divided into three components.
The physician work component, practice expense, and professional liability insurance
(PLI) – The three components used to determine resource cost for physician services.
The Physician Work component – 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.
Practice Expense – 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.
PLI – Resource-Based Professional Liability Insurance
Professional Liability Insurance (PLI) – Accounts for 4 percent of the total relative value
for each service
CMS website – Where can you find Physician Fee Schedule (PFS) information?
PFS – Physician Fee Schedule
Medical Necessity – Refers to whether a procedure or service is considered appropriate
in a given circumstance
NCD – National Coverage Determinations<\/p>\n","protected":false},"excerpt":{"rendered":"

Documentation (content) – Proper code assignment is determined both by_ in the medical record and by the unique rules that govern each codeset in that instanceAn auditor – The role a coder may take on to verify that the documentation supports thecodes the physician has selectedQuery the physician – If the medical record is inaccurate […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-113190","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/113190","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=113190"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/113190\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=113190"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=113190"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=113190"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}