AAPC CPC Chapter 1 | Questions With Efficient
Solutions
What document is referenced to when looking for potential problem areas
identified by the government indicating scrutiny of the services within the
coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan Correct Answer - 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.)
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?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN Correct Answer - 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.)
Under HIPAA, what would be a policy requirement for "minimum necessary"?
"
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. Correct Answer - 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.)
, Which statement describes a medically necessary service? :
A) Performing a procedure/service based on cost to eliminate wasteful
services.
B) Using the least radical service/procedure that allows for effective
treatment of the patient's complaint or condition.
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. Correct Answer - B (Rationale: Medical necessity is using the
least radical services/procedure that allows for effective treatment of the
patient's complaint or condition.)
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 Correct Answer - C (Rationale: According to the
LCD, Chronic venous insufficiency is a systemic condition that may result in
the need for routine foot care.)
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 Correct Answer - C (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.")
Which act was enacted as part of the American Recovery and Reinvestment
Act of 2009 (ARRA) and affected privacy and security? :
A) HIPAA
B) HITECH
C) SSA
D) PPACA Correct Answer - B
Solutions
What document is referenced to when looking for potential problem areas
identified by the government indicating scrutiny of the services within the
coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan Correct Answer - 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.)
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?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN Correct Answer - 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.)
Under HIPAA, what would be a policy requirement for "minimum necessary"?
"
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. Correct Answer - 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.)
, Which statement describes a medically necessary service? :
A) Performing a procedure/service based on cost to eliminate wasteful
services.
B) Using the least radical service/procedure that allows for effective
treatment of the patient's complaint or condition.
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. Correct Answer - B (Rationale: Medical necessity is using the
least radical services/procedure that allows for effective treatment of the
patient's complaint or condition.)
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 Correct Answer - C (Rationale: According to the
LCD, Chronic venous insufficiency is a systemic condition that may result in
the need for routine foot care.)
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 Correct Answer - C (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.")
Which act was enacted as part of the American Recovery and Reinvestment
Act of 2009 (ARRA) and affected privacy and security? :
A) HIPAA
B) HITECH
C) SSA
D) PPACA Correct Answer - B
