AAPC CPC Chapter 1 Test Questions and Answers
What document is referenced to when looking for
potential problem areas identified by the
government indicating scrutiny of the services Which statement describes a medically
within the coming year?: necessary service? :
A) OIG Compliance Plan Guidance A) Performing a procedure/service based on cost
B) OIG Security Summary to eliminate wasteful services.
C) OIG Work Plan B) Using the least radical service/procedure that
D) OIG Investigation Plan - ANSWER -C allows for effective treatment of the patient's
(Rationale: Twice a year, the OIG releases a complaint or condition.
C) Using the closest facility to perform a service
Work Plan outlining its priorities for the fiscal year
ahead. Within the Work Plan, potential problem or procedure.
areas with claims submissions are listed and will D) Using the appropriate course of treatment to fit
be targeted with special scrutiny.) within the patient's lifestyle. - ANSWER -B
(Rationale: Medical necessity is using the least
radical services/procedure that allows for
What form is provided to a patient to indicate a effective treatment of the patient's complaint or
service may not be covered by Medicare and the condition.)
patient may be responsible for the charges?:
A) LCD
B) CMS-1500 According to the example LCD from Novitas
C) UB-04 Solutions, which of the following conditions is
D) ABN - ANSWER -D (Rationale: An considered a systemic condition that may result
Advanced Beneficiary Notice (ABN) is used in the need for routine foot care? :
when a Medicare beneficiary requests or agrees A) arthritis
to receive a procedure or service that Medicare B) chronic venous insufficiency
may not cover. This form notifies the patient of C) hypertension
potential out of pocket costs for the patient.) D) muscle weakness - ANSWER -C
(Rationale: According to the LCD, Chronic
venous insufficiency is a systemic condition that
Under HIPAA, what would be a policy may result in the need for routine foot care.)
requirement for "minimum necessary"? "
A) Only individuals whose job requires it may
have access to protected health information. When presenting a cost estimate on an ABN for a
B) Only the patient has access to his or her own potentially noncovered service, the cost estimate
protected health information. should be within what range of the actual cost?
C) Only the treating provider has access to A) $25 or 10 percent
protected health information. B) $100 or 10 percent
D) Anyone within the provider's office can have C) $100 or 25 percent
access to protected health information. - D) An exact amount - ANSWER -C
ANSWER -A (Rationale: It is the (Rationale: CMS instructions stipulate, "Notifiers
responsibility of a covered entity to develop and must make a good faith effort to insert a
implement policies, best suited to its particular reasonable estimate...the estimate should be
circumstances to meet HIPAA requirements. As within $100 or 25 percent of the actual costs,
a policy requirement, only those individuals whichever is greater.")
whose job requires it may have access to
protected health information.)
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, AAPC CPC Chapter 1 Test Questions and Answers
Which act was enacted as part of the American Health Care Providers, Health Plans, and Health
Recovery and Reinvestment Act of 2009 (ARRA) Care Clearinghouses. The patient is not
and affected privacy and security? : considered a covered entity although it is the
A) HIPAA patient's data that is protected.)
B) HITECH
C) SSA
D) PPACA - ANSWER -B What type of profession, other than coding, might
skilled coders enter?:
A) Physicians, insurance carriers, nurses
What document assists provider offices with the B) Front desk personnel, HR dept
development of Compliance Manuals? C) Consultants, educators, medical auditors
A) OIG Compliance Plan Guidance D) None of the above - ANSWER -C
B) OIG Work Plan
C) OIG Suggested Rules and Regulations
D) OIG Internal Compliance Plan - What is the difference between outpatient and
ANSWER -A (Rationale: The OIG has inpatient coding?:
offered compliance program guidance to form the A) Outpatient coders use ICD-10-CM and ICD-
basis of a voluntary compliance program for 10-PCS.
physician offices. Although this was released in B) Outpatient coders only focuse on hospital
October 2000, it is still considered as active services and Inpatient coders focuse on
compliance guidance today.) physician services.
C) Inpatient coders have more interaction than
Outpatient coders.
Select the TRUE statement regarding ABNs. D) Inpatient coders use ICD-10-CM and ICD-10-
A) ABNs may not be recognized by non- PCS. - ANSWER -D
Medicare payers.
B) ABNs must be signed for emergency or urgent
care. What is a mid-level provider?
C) ABNs are not required to include an estimate A) Non-licensed PAs
cost for the service. B) Physician withholder
D) ABNs should be routinely signed by Medicare C) Mid-level providers include physician
Beneficiaries in case Medicare doesn't cover a assistants (PA) and nurse practitioners (NP).
service. - ANSWER -A (Rationale: ABNs D) NPs with Bachelor's Degree -
may not be recognized by non-Medicare payers. ANSWER -C
Providers should review their contracts to
determine which payers will accept an ABN for
services not covered.) What are the different parts of Medicare?
A) Part A, B, D
B) Part A, B, C, D
Who would NOT be considered a covered entity C) Part E, F, G, H
under HIPAA? D) Part A and B - ANSWER -B
A) Doctors
C) HMOs
D) Clearinghouses Evaluation and management (E/M) services are
E) Patients - ANSWER -E (Rationale: often provided and documented in a standard
Covered entities in relation to HIPAA include format. One such format is SOAP notes. What
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What document is referenced to when looking for
potential problem areas identified by the
government indicating scrutiny of the services Which statement describes a medically
within the coming year?: necessary service? :
A) OIG Compliance Plan Guidance A) Performing a procedure/service based on cost
B) OIG Security Summary to eliminate wasteful services.
C) OIG Work Plan B) Using the least radical service/procedure that
D) OIG Investigation Plan - ANSWER -C allows for effective treatment of the patient's
(Rationale: Twice a year, the OIG releases a complaint or condition.
C) Using the closest facility to perform a service
Work Plan outlining its priorities for the fiscal year
ahead. Within the Work Plan, potential problem or procedure.
areas with claims submissions are listed and will D) Using the appropriate course of treatment to fit
be targeted with special scrutiny.) within the patient's lifestyle. - ANSWER -B
(Rationale: Medical necessity is using the least
radical services/procedure that allows for
What form is provided to a patient to indicate a effective treatment of the patient's complaint or
service may not be covered by Medicare and the condition.)
patient may be responsible for the charges?:
A) LCD
B) CMS-1500 According to the example LCD from Novitas
C) UB-04 Solutions, which of the following conditions is
D) ABN - ANSWER -D (Rationale: An considered a systemic condition that may result
Advanced Beneficiary Notice (ABN) is used in the need for routine foot care? :
when a Medicare beneficiary requests or agrees A) arthritis
to receive a procedure or service that Medicare B) chronic venous insufficiency
may not cover. This form notifies the patient of C) hypertension
potential out of pocket costs for the patient.) D) muscle weakness - ANSWER -C
(Rationale: According to the LCD, Chronic
venous insufficiency is a systemic condition that
Under HIPAA, what would be a policy may result in the need for routine foot care.)
requirement for "minimum necessary"? "
A) Only individuals whose job requires it may
have access to protected health information. When presenting a cost estimate on an ABN for a
B) Only the patient has access to his or her own potentially noncovered service, the cost estimate
protected health information. should be within what range of the actual cost?
C) Only the treating provider has access to A) $25 or 10 percent
protected health information. B) $100 or 10 percent
D) Anyone within the provider's office can have C) $100 or 25 percent
access to protected health information. - D) An exact amount - ANSWER -C
ANSWER -A (Rationale: It is the (Rationale: CMS instructions stipulate, "Notifiers
responsibility of a covered entity to develop and must make a good faith effort to insert a
implement policies, best suited to its particular reasonable estimate...the estimate should be
circumstances to meet HIPAA requirements. As within $100 or 25 percent of the actual costs,
a policy requirement, only those individuals whichever is greater.")
whose job requires it may have access to
protected health information.)
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, AAPC CPC Chapter 1 Test Questions and Answers
Which act was enacted as part of the American Health Care Providers, Health Plans, and Health
Recovery and Reinvestment Act of 2009 (ARRA) Care Clearinghouses. The patient is not
and affected privacy and security? : considered a covered entity although it is the
A) HIPAA patient's data that is protected.)
B) HITECH
C) SSA
D) PPACA - ANSWER -B What type of profession, other than coding, might
skilled coders enter?:
A) Physicians, insurance carriers, nurses
What document assists provider offices with the B) Front desk personnel, HR dept
development of Compliance Manuals? C) Consultants, educators, medical auditors
A) OIG Compliance Plan Guidance D) None of the above - ANSWER -C
B) OIG Work Plan
C) OIG Suggested Rules and Regulations
D) OIG Internal Compliance Plan - What is the difference between outpatient and
ANSWER -A (Rationale: The OIG has inpatient coding?:
offered compliance program guidance to form the A) Outpatient coders use ICD-10-CM and ICD-
basis of a voluntary compliance program for 10-PCS.
physician offices. Although this was released in B) Outpatient coders only focuse on hospital
October 2000, it is still considered as active services and Inpatient coders focuse on
compliance guidance today.) physician services.
C) Inpatient coders have more interaction than
Outpatient coders.
Select the TRUE statement regarding ABNs. D) Inpatient coders use ICD-10-CM and ICD-10-
A) ABNs may not be recognized by non- PCS. - ANSWER -D
Medicare payers.
B) ABNs must be signed for emergency or urgent
care. What is a mid-level provider?
C) ABNs are not required to include an estimate A) Non-licensed PAs
cost for the service. B) Physician withholder
D) ABNs should be routinely signed by Medicare C) Mid-level providers include physician
Beneficiaries in case Medicare doesn't cover a assistants (PA) and nurse practitioners (NP).
service. - ANSWER -A (Rationale: ABNs D) NPs with Bachelor's Degree -
may not be recognized by non-Medicare payers. ANSWER -C
Providers should review their contracts to
determine which payers will accept an ABN for
services not covered.) What are the different parts of Medicare?
A) Part A, B, D
B) Part A, B, C, D
Who would NOT be considered a covered entity C) Part E, F, G, H
under HIPAA? D) Part A and B - ANSWER -B
A) Doctors
C) HMOs
D) Clearinghouses Evaluation and management (E/M) services are
E) Patients - ANSWER -E (Rationale: often provided and documented in a standard
Covered entities in relation to HIPAA include format. One such format is SOAP notes. What
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