AAPC CPC FINAL EXAM PREP QUESTIONS AND ANSWERS

CPC FINAL EXAM PREP • Question 1 10 out of 10 points What form is provided to a patient to indicate a service may not be covered by Medicare and the patient may be responsible for the charges? Selected Answer: Correct Answer: Response Feedback: d. ABN d. ABN 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. • Question 2 Which statement describes a medically necessary service? 10 out of 10 points Selected Answer: Correct Answer: Response Feedback: b. Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition. b. Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition. Rationale: Medical necessity is using the least radical services/procedure that allows for effective treatment of the patient’s complaint or condition. • Question 3 10 out of 10 points What document assists provider offices with the development of Compliance Manuals? Selected Answer: Correct Answer: Response Feedback: a. OIG Compliance Plan Guidance a. OIG Compliance Plan Guidance Rationale: The OIG has offered compliance program guidance to form the basis of a voluntary compliance program for physician offices. Although this was released in October 2000, it is still active compliance guidance today. • Question 4 Under HIPAA, what would be a policy requirement for “minimum necessary”? 10 out of 10 points Selected Answer: Correct Answer: Response Feedback: a. Only individuals whose job requires it may have access to protected health information. a. Only individuals whose job requires it may have access to protected health information. 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. • Question 5 10 out of 10 points According to the example LCD from Novitas Solutions, measurement of vitamin D levels is indicated for patients with which condition? Selected Answer: Correct Answer: Response Feedback: b. fibromyalgi a b. fibromyalgi a Rationale: According to the LCD, measurement of vitamin D levels is indicated for patients with fibromyalgia. • Question 6 Select the TRUE statement regarding ABNs. 10 out of 10 points Selected Answer: Correct Answer: Response Feedback: a. ABNs may not be recognized by non-Medicare payers. a. ABNs may not be recognized by non-Medicare payers. Rationale: ABNs may not be recognized by non-Medicare payers. Providers should review their contracts to determine which payers will accept an ABN for services not covered. • Question 7 Who would NOT be considered a covered entity under HIPAA? 10 out of 10 points Selected Answer: Correct Answer: Response Feedback: d. Patients d. Patients Rationale: Covered entities in relation to HIPAA include Health Care Providers, Health Plans, and Health Care Clearinghouses. The patient is not considered a covered entity although it is the patient’s data that is protected. • Question 8 10 out of 10 points 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? Selected Answer: Correct Answer: Response Feedback: c. $100 or 25 percent c. $100 or 25 percent Rationale: CMS instructions stipulate, “Notifiers must make a good faith effort to insert a reasonable estimate…the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.” • Question 9 10 out of 10 points Which act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and affected privacy and security? Selected Answer: Correct Answer: Response Feedback : b. HITECH b. HITECH Rationale: The Health Information Technology for Economic and Clinical Health Act (HITECH) was enacted as a part of the American Recovery and Reinvestment Act of 2009 (ARRA) to promote the adoption and meaningful use of health information technology. Portions of HITECH strengthen HIPAA rules by addressing privacy and security concerns associated with the electronic transmission of health information. • Question 10 10 out of 10 points What document is referenced to when looking for potential problem areas identified by the government indicating scrutiny of the services within the coming year? Selected Answer: Correct Answer: Response Feedback: c. OIG Work Plan c. OIG Work Plan 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. Sunday, November 19, 2017 9:04:26 AM MST • The minimum necessary rule applies to Selected Answer: Correct Answer: Response Feedback : b. Disclosures to or requests by a health care provider for treatment purposes. d. Covered entities taking reasonable steps to limit use or disclosure of PHI Rationale: The Privacy Rule generally requires covered entities to take reasonable steps to limit the use or disclosure of, and requests for, protected health information to the minimum necessary to accomplish the intended purpose. The minimum necessary standard does not apply to the following: · Disclosures to or requests by a health care provider for treatment purposes. · Disclosures to the individual who is the subject of the information. · Uses or disclosures made pursuant to an individual’s authorization. · Uses or disclosures required for compliance with the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Rules. · Disclosures to the Department of Health & Human Services (HHS) when disclosure of information is required under the Privacy Rule for enforcement purposes. · Uses or disclosures that are required by other law. • Question 2 0 out of 4 points According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of professional conduct?