AAPC CPC exam prep Compliance and Regulatory with
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correct answers |
What |document |is |referenced |to |when |looking |for |potentialproblem |areas |identified |by |the |
government |indicatingscrutiny |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 |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 |- |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 |B |(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
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correct answers |
What |document |is |referenced |to |when |looking |for |potentialproblem |areas |identified |by |the |
government |indicatingscrutiny |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 |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 |- |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 |B |(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
