AAPC CPC EXAM PREP COMPLIANCE AND REGULATORY|
MULTIPLE CHOICES, Q& A LATEST 2025
1. What document is referenced to when looking for potential problem areas
identified by the government indicating scrutiny of the services within the com
ing year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan: C (Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities
for the fiscal year ahead. Within the Work Plan, potential problem areas with claims submissions are listed and will be
targeted with special scrutiny.)
2. What form is provided to a patient to indicate a servicemay not be covered
by Medicare and the patient may be responsible for the charges?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN: D (Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare beneficiary requests or agrees
to receive a procedure or service that Medicare may not cover. This form notifies the patient of potential out of pocket costs
for the patient.)
3. Under HIPAA, what would be a policy requirement for "minimum necessary"?
https://www.stuvia.com/user/MBOFFIN
, "
A) Only individuals whose job requires it may have access to protected health
information.
B) Only the patient has access to his or her own protected health information.
C) Only the treating provider has access to protected health information.
D) Anyone within the provider's office can have access to protected health
information.: A (Rationale: It is the responsibility of a covered entity to develop and implement policies, best suited
to its particular circumstances to meet HIPAA requirements. As a policy requirement, only those individuals whose job
requires it may have access to protected health information.)
4. Which statement describes a medically necessary service? :
A) Performing a procedure/service based on cost to eliminate wasteful ser-
vices.
B) Using the least radical service/procedure that allows for effective treatment
of the patient's complaint or condition.
https://www.stuvia.com/user/MBOFFIN
, C) Using the closest facility to perform a service or procedure.
D) Using the appropriate course of treatment to fit within the patient's lifestyle.-
: B (Rationale: Medical necessity is using the least radical services/procedure that allows for ettective treatment of the
patient's complaint or condition.)
5. According to the example LCD from Novitas Solutions, which of the following
conditions is considered a systemic condition that may result in the need for
routine foot care? :
A) arthritis
B) chronic venous insufficiency
C) hypertension
D) muscle weakness: B (Rationale: According to the LCD, Chronic venous insuflciency is a systemic condition
that may result in the need for routine foot care.)
6. When presenting a cost estimate on an ABN for a potentially noncovered
service, the cost estimate should be within what range of the actual cost?
A) $25 or 10 percent
B) $100 or 10 percent
C) $100 or 25 percent
D) An exact amount: C (Rationale: CMS instructions stipulate, "Notifiers must make a good faith ettort to insert a
reasonable estimate...the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.")
7. Which act was enacted as part of the American Recovery and Reinvestment
Act of 2009 (ARRA) and affected privacy and security? :
https://www.stuvia.com/user/MBOFFIN
MULTIPLE CHOICES, Q& A LATEST 2025
1. What document is referenced to when looking for potential problem areas
identified by the government indicating scrutiny of the services within the com
ing year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan: C (Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities
for the fiscal year ahead. Within the Work Plan, potential problem areas with claims submissions are listed and will be
targeted with special scrutiny.)
2. What form is provided to a patient to indicate a servicemay not be covered
by Medicare and the patient may be responsible for the charges?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN: D (Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare beneficiary requests or agrees
to receive a procedure or service that Medicare may not cover. This form notifies the patient of potential out of pocket costs
for the patient.)
3. Under HIPAA, what would be a policy requirement for "minimum necessary"?
https://www.stuvia.com/user/MBOFFIN
, "
A) Only individuals whose job requires it may have access to protected health
information.
B) Only the patient has access to his or her own protected health information.
C) Only the treating provider has access to protected health information.
D) Anyone within the provider's office can have access to protected health
information.: A (Rationale: It is the responsibility of a covered entity to develop and implement policies, best suited
to its particular circumstances to meet HIPAA requirements. As a policy requirement, only those individuals whose job
requires it may have access to protected health information.)
4. Which statement describes a medically necessary service? :
A) Performing a procedure/service based on cost to eliminate wasteful ser-
vices.
B) Using the least radical service/procedure that allows for effective treatment
of the patient's complaint or condition.
https://www.stuvia.com/user/MBOFFIN
, C) Using the closest facility to perform a service or procedure.
D) Using the appropriate course of treatment to fit within the patient's lifestyle.-
: B (Rationale: Medical necessity is using the least radical services/procedure that allows for ettective treatment of the
patient's complaint or condition.)
5. According to the example LCD from Novitas Solutions, which of the following
conditions is considered a systemic condition that may result in the need for
routine foot care? :
A) arthritis
B) chronic venous insufficiency
C) hypertension
D) muscle weakness: B (Rationale: According to the LCD, Chronic venous insuflciency is a systemic condition
that may result in the need for routine foot care.)
6. When presenting a cost estimate on an ABN for a potentially noncovered
service, the cost estimate should be within what range of the actual cost?
A) $25 or 10 percent
B) $100 or 10 percent
C) $100 or 25 percent
D) An exact amount: C (Rationale: CMS instructions stipulate, "Notifiers must make a good faith ettort to insert a
reasonable estimate...the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.")
7. Which act was enacted as part of the American Recovery and Reinvestment
Act of 2009 (ARRA) and affected privacy and security? :
https://www.stuvia.com/user/MBOFFIN
