CRC PRACTICE QUESTIONS &
ANSWERS
What document is referenced to when looking for potential problem areas identified by
the government indicating scrutiny of the services?
a. OIG Compliance Plan Guidance
b. OIG Security Summary
c. OIG Work Plan
d. OIG Investigation Plan - ANSWERC. 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.
Risk Adjustment Coders should have knowledge in which of the following?
a. Medications and diagnostic testing
b. How to calculate the drip rate for IVs
c. How to take BP readings
d. Treatments and writing out prescription - ANSWERa. Medications and diagnostic
testing
Rationale: Risk Adjustment Coders should have knowledge in the use of medications,
treatments of the patient, and diagnostic testing.
Who would NOT be considered a covered entity under HIPAA?
a. Doctors
b. HMOs
c. Clearinghouses
d. Patients - ANSWERd. 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.
What document assists provider offices with the development of Compliance Manuals?
a. OIG Compliance Plan Guidance
b. OIG Work Plan
c. OIG Suggested Rules and Regulations
d. OIG Internal Compliance Plan - ANSWERa. 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.
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. -
ANSWERb. Using the least radical service/procedure that allows for effective treatment
of the patient's complaint or condition.
Which statement is FALSE regarding Mid-level Providers?
a. Mid-level providers are PAs and NPs.
b. PAs typically require oversight of a provider.
c. NPs have a master's degree.
d. PAs are reimbursed at an equally or higher rate than a provider. - ANSWERd. PAs
are reimbursed at an equally or higher rate than a provider.
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. -
ANSWERa. 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.
Which act was enacted as part of the American Recovery and Reinvestment Act of
2009 (ARRA) and affected privacy and security?
Selected Answer:
a. HIPAA
b. HITECH
c. SSA
d. PPACA - ANSWERb. HITECH
How many components are included in an effective compliance plan?
, a. 4
b. 7
c. 9
d. 3 - ANSWERb. 7
Which CMS product describes whether specific medical items, services, treatment
procedures or technologies are considered medically necessary under Medicare?
a. Medicare Physician Fee Schedule Final Rule
b. Relative Value Files
c. National Coverage Determinations Manual
d. Medicare Claims Processing Manual - ANSWERc. National Coverage Determinations
Manual
HITECH provides a ____ day window during which any violation not due to willful
neglect may be corrected without penalty.
a. 45
b. 30
c. 40
d. 60 - ANSWERb. 30
The OIG releases a ____ outlining its priorities for the fiscal year ahead and beyond.
a. Self-referral law
b. CIA yearly review
c. Work Plan
d. Compliance Plan - ANSWERc. Work Plan
In what year was the AAPC founded? - ANSWER1988
The OIG recommends that provider practices enforce disciplinary actions through well
publicized compliance guidelines to ensure actions that are ______.
a. Frequent
b. Permanent
c. Swift and enforceable
d. Consistent and appropriate - ANSWERd. Consistent and appropriate
The minimum necessary rule applies to
a. Covered entities taking reasonable steps to limit use or disclosure of PHI
b. Disclosures to or requests by a health care provider for treatment purposes.
c. Disclosures to the individual who is the subject of the information.
ANSWERS
What document is referenced to when looking for potential problem areas identified by
the government indicating scrutiny of the services?
a. OIG Compliance Plan Guidance
b. OIG Security Summary
c. OIG Work Plan
d. OIG Investigation Plan - ANSWERC. 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.
Risk Adjustment Coders should have knowledge in which of the following?
a. Medications and diagnostic testing
b. How to calculate the drip rate for IVs
c. How to take BP readings
d. Treatments and writing out prescription - ANSWERa. Medications and diagnostic
testing
Rationale: Risk Adjustment Coders should have knowledge in the use of medications,
treatments of the patient, and diagnostic testing.
Who would NOT be considered a covered entity under HIPAA?
a. Doctors
b. HMOs
c. Clearinghouses
d. Patients - ANSWERd. 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.
What document assists provider offices with the development of Compliance Manuals?
a. OIG Compliance Plan Guidance
b. OIG Work Plan
c. OIG Suggested Rules and Regulations
d. OIG Internal Compliance Plan - ANSWERa. 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.
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. -
ANSWERb. Using the least radical service/procedure that allows for effective treatment
of the patient's complaint or condition.
Which statement is FALSE regarding Mid-level Providers?
a. Mid-level providers are PAs and NPs.
b. PAs typically require oversight of a provider.
c. NPs have a master's degree.
d. PAs are reimbursed at an equally or higher rate than a provider. - ANSWERd. PAs
are reimbursed at an equally or higher rate than a provider.
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. -
ANSWERa. 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.
Which act was enacted as part of the American Recovery and Reinvestment Act of
2009 (ARRA) and affected privacy and security?
Selected Answer:
a. HIPAA
b. HITECH
c. SSA
d. PPACA - ANSWERb. HITECH
How many components are included in an effective compliance plan?
, a. 4
b. 7
c. 9
d. 3 - ANSWERb. 7
Which CMS product describes whether specific medical items, services, treatment
procedures or technologies are considered medically necessary under Medicare?
a. Medicare Physician Fee Schedule Final Rule
b. Relative Value Files
c. National Coverage Determinations Manual
d. Medicare Claims Processing Manual - ANSWERc. National Coverage Determinations
Manual
HITECH provides a ____ day window during which any violation not due to willful
neglect may be corrected without penalty.
a. 45
b. 30
c. 40
d. 60 - ANSWERb. 30
The OIG releases a ____ outlining its priorities for the fiscal year ahead and beyond.
a. Self-referral law
b. CIA yearly review
c. Work Plan
d. Compliance Plan - ANSWERc. Work Plan
In what year was the AAPC founded? - ANSWER1988
The OIG recommends that provider practices enforce disciplinary actions through well
publicized compliance guidelines to ensure actions that are ______.
a. Frequent
b. Permanent
c. Swift and enforceable
d. Consistent and appropriate - ANSWERd. Consistent and appropriate
The minimum necessary rule applies to
a. Covered entities taking reasonable steps to limit use or disclosure of PHI
b. Disclosures to or requests by a health care provider for treatment purposes.
c. Disclosures to the individual who is the subject of the information.
