AAPC CPC EXAM PREP COMPLIANCE AND REGULATORY QUESTIONS AND ANSWERS

AAPC CPC EXAM PREP COMPLIANCE
AND REGULATORY QUESTIONS AND
ANSWERS

What document is referenced to when looking for potentialproblem areas identified by the go
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vernment indicatingscrutiny of the services within the coming year?:
km km km km km km km km




A) OIG Compliance Plan Guidance
km km km km




B) OIG Security Summary
km km km




C) OIG Work Plan
km km km




D) OIG Investigation Plan - ans-
km km km km km




C (Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for the fiscal y
km km km km km km km km km km km km km km km km km




ear ahead. Within the Work Plan, potential problem areas with claims submissions are listed
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and will be targeted with special scrutiny.)
km km km km km km




What form is provided to a patient to indicate a servicemay not be covered by Medicare and t
km km km km km km km km km km km km km km km km km




he patient may be responsible for the charges?:
km km km km km km km




A) LCD km




B) CMS-1500
km




C) UB-04 km




D) ABN - ans-
km km km




D (Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare beneficiary re
km km km km km km km km km km km km km




quests or agrees to receive a procedure or service that Medicare may not cover. This form no
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tifies the patient of potential out of pocket costs for the patient.)
km km km km km km km km km km km




Under HIPAA, what would be a policy requirement for "minimum necessary"? "
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A) Only individuals whose job requires it may have access to protected health information.
km km km km km km km km km km km km km




B) Only the patient has access to his or her own protected health information.
km km km km km km km km km km km km km




C) Only the treating provider has access to protected health information.
km km km km km km km km km km




D) Anyone within the provider's office can have access to protected health information. - ans-
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A (Rationale: It is the responsibility of a covered entity to develop and implement policies, bes
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t suited to its particular circumstances to meet HIPAA requirements. As a policy requirement,
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only those individuals whose job requires it may have access to protected health information.
km km km km km km km km km km km km km




)

Which statement describes a medically necessary service? :
km km km km km km km




A) Performing a procedure/service based on cost to eliminate wasteful services.
km km km km km km km km km km




B) Using the least radical service/
km km km km km




procedure that allows for effective treatment of the patient's complaint or condition.
km km km km km km km km km km km




C) Using the closest facility to perform a service or procedure.
km km km km km km km km km km




D) Using the appropriate course of treatment to fit within the patient's lifestyle. - ans-
km km km km km km km km km km km km km km




B (Rationale: Medical necessity is using the least radical services/
km km km km km km km km km




procedure that allows for effective treatment of the patient's complaint or condition.)
km km km km km km km km km km km




According to the example LCD from Novitas Solutions, which of the following conditions is co
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nsidered a systemic condition that may result in the need for routine foot care? :
km km km km km km km km km km km km km km




A) arthritis
km




B) chronic venous insufficiency
km km km




C) hypertension
km

, D) muscle weakness - ans-
km km km km




B (Rationale: According to the LCD, Chronic venous insufficiency is a systemic condition that
km km km km km km km km km km km km km km




may result in the need for routine foot care.)
km km km km km km km km




When presenting a cost estimate on an ABN for a potentially noncovered service, the cost est
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imate should be within what range of the actual cost?
km km km km km km km km km




A) $25 or 10 percent
km km km km




B) $100 or 10 percent
km km km km




C) $100 or 25 percent
km km km km




D) An exact amount - ans-
km km km km km




C (Rationale: CMS instructions stipulate, "Notifiers must make a good faith effort to insert a re
km km km km km km km km km km km km km km km




asonable estimate...the estimate should be within $100 or 25 percent of the actual costs, whi
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chever is greater.") km km




Which act was enacted as part of the American Recovery and Reinvestment Act of 2009 (AR
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RA) and affected privacy and security? :
km km km km km km




A) HIPAA km




B) HITECH km




C) SSA km




D) PPACA - ans-B
km km km




What document assists provider offices with the development of Compliance Manuals?
km km km km km km km km km km




A) OIG Compliance Plan Guidance
km km km km




B) OIG Work Plan
km km km




C) OIG Suggested Rules and Regulations
km km km km km




D) OIG Internal Compliance Plan - ans-
km km km km km km




A (Rationale: The OIG has offered compliance program guidance to form the basis of a volunt
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ary compliance program for physician offices. Although this was released in October 2000, it i
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s still considered as active compliance guidance today.)
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Select the TRUE statement regarding ABNs.
km km km km km




A) ABNs may not be recognized by non-Medicare payers.
km km km km km km km km




B) ABNs must be signed for emergency or urgent care.
km km km km km km km km km




C) ABNs are not required to include an estimate cost for the service.
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D) ABNs should be routinely signed by Medicare Beneficiaries in case Medicare doesn't cove
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r a service. - ans-A (Rationale: ABNs may not be recognized by non-
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Medicare payers. Providers should review their contracts to determine which payers will acce
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pt an ABN for services not covered.)
km km km km km km




Who would NOT be considered a covered entity under HIPAA?
km km km km km km km km km




A) Doctors km




C) HMOs km




D) Clearinghouses
km




E) Patients - ans-
km km km




E (Rationale: Covered entities in relation to HIPAA include Health Care Providers, Health Pla
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ns, and Health Care Clearinghouses. The patient is not considered a covered entity although
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it is the patient's data that is protected.)
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What type of profession, other than coding, might skilled coders enter?:
km km km km km km km km km km




A) Physicians, insurance carriers, nurses
km km km km




B) Front desk personnel, HR dept
km km km km km




C) Consultants, educators, medical auditors
km km km km




D) None of the above - ans-C
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