CPC Chapter 1 test 2025

A Medicare patient is receiving chemotherapy at her oncologists office. While the patient is receiving chemotherapy, the oncologist calls in a prescription for pain medication to a pharmacy in the same building. The pharmacy delivers the medication to the patient in the oncologists office to take home. What part of Medicare should be billed for the pain medication by the pharmacy?

• Part A

• Part B

• Part C

• Part D

Part D

What is medical coding?

- Reporting services on a CMS-1500
- translating medical documentation into coding
- Programing an EHR
- Creating a 5010 electronic file for transmission

Translating medical documentation into coding

Which one is not a covered entity of HIPPA?

- Medicare
- Workers' compensation
- Dentists
- Pharmacies

Workers’ Compensation

Which one falls under a commercial payer?

• Medicare

• Medicaid

• Blue cross Blue Shield

• All of the above are commercial payers

Blue Cross Blue Shield

When should an ABN be signed?

- When a service is considered medically necessary by Medicare
- When a service is not expected to be covered by Medicare
- Routinely for any services given to a Medicare patient
- After service is denied and the patient should be billed

When a service is not expected to be covered by Medicare

The amount on an ABN should be within how much of the cost to the patient?

- $250 of cost
- $100 or 25% of cost
- $10 or 10% of cost
- $100 or 10% of cost

$100 or 25% of cost

An entity that processes nonstandard health information they receive from another entity into a standard is considered what?

- Billing Company
- Electronic Health Record Vendor
- Clearinghouse
- Practice Management Vendor

Clearinghouse

What is PHI?

- Personal Heath information
- Problem with history of infection
- Partial health interaction
- Protected health information

Protected Health Information

International billing of services not provided is considered .

• Deceptive Billing

• Fraud

• Abuse

• Common practice

Fraud

What OIG document should a provider review for potential problem areas that will receive special scrutiny in the upcoming year?

- Compliance Program Guidance

- Safe Harbor Regulations

- Red Flag Rules

- OIG Work Plan

OIG Work Plan

Which of the following best describes outpatient coding?

the process of assigning codes to medical services provided to patients who are not admitted to a hospital

What does ABN stand for?

Advanced Beneficiary Notification

What does AMA stand for?

American Medical Association

What does APC stand for?

Ambulatory Payment Classification

What does APM stand for?

Advanced Alternative Payment Models

What does ARRA stand for?

American Recovery and Reinvestment Act of 2009

What does ASC stand for?

Ambulatory Surgical Center

What does CF stand for?

Conversion Factor

CMS

Centers for Medicare and Medicaid Services

CMS-HCC

Centers for Medicare and Medicaid Services - Hierarchal Condition Category

CPC

Certified Professional Coder

CPT

Current Procedural Terminology

DRG

Diagnosis-Related group

EHR

Electronic Health Record

EIN

Employeer Identification Number

E/M or E&M

Evaluation and management

GPCI

Geographic Practice Cost Index

HCPCS

Healthcare Common Procedure Coding System

HIS

Department of Health and Human Services

What does HIPPA stand for?

Health Insurance Portability and Accountability Act

HITECH

Health Information Technology for Economic and Clinical Health Act

HMO

health maintenance organization

ICD-10-CM

International Classification of Diseases, 10th Revision, Clinical Modification

LCD

Local Coverage Determination

MAC

Medicare Administrative Contractor

MACRA

Medicare Access and CHIP Reauthorization Act

MIPS

Merit-based Incentive Payment System

MP

Malpractice

MS-DRG

Medicare Severity-Diagnosis Related Group

NCD

National Coverage Determination

NP

nurse practitioner

NPI

National Provider Identifier

OCR

Office for Civil Rights

OIG

Office of Inspector General

PA

physician's assistant

PE

Physician Expense

PFS

Physician Fee Schedule

PHI

Protected Health Information

PPACA

Patient Protection and Affordable Care Act

PLI

Professional liability insurance

RUC

Relative Value Scale (RVS) Update Committee

RVU

Relative Value Unit

RBRVS

Resource Based Relative Value System

Which type of coder would focus on coding strictly in ICD-10-CM?

Risk adjustment coder

What is the Advanced Beneficiary Notice (ABN) used for in medical billing?

To notify patients of services not covered by Medicare before they are provided

What is the purpose of National Coverage Determinations (NCDs) in the Medicare program?

to establish national policies that determine whether specific medical services or procedures are covered by Medicare

What is the main difference between fraud and abuse in healthcare?

Fraud requires intent but abuse does not