AAPC CPC EXAM PREP COMPLIANCE AND REGULATORY TEST QUESTIONS WITH
ACCURATE SOLUTIONS
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
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
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.
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.)
What is a mid-level provider?
A) Non-licensed PAs
B) Physician withholder
C) Mid-level providers include physician assistants (PA) and nurse practitioners (NP).
D) NPs with Bachelor's Degree
C
What are the different parts of Medicare?
A) Part A, B, D
B) Part A, B, C, D
C) Part E, F, G, H
D) Part A and B
B
Evaluation and management (E/M) services are often provided and documented in a
standard format. One such format is SOAP notes. What does SOAP represent?
A) Subjective, Objective, Assessment, Plan
B) Statement, Observation, Action, Prepare
, C) Symptoms, Objective, Auscultation, Percussion
D) Subjective, Observation, Action, Plan
A
What are five tips for coding operative (op) reports?
A) Look for key words, Ignore unfamiliar words, Skip the body, Ignore pathology reports,
Only code procedures from the header
B) Diagnosis code reporting, Start with the procedures listed, Look for key words, Highlight
unfamiliar words, Read the body
C) Highlight familiar words, Look for key words, Read the body, Only code what you have
highlighted, Code procedure only
D) Read the headers only, Look for key words, Highlight familiar words, Ignore pathology
report, Code diagnosis only
B
What is medical necessity?:
A) Services to a Medicare beneficiary that are billed for unreasonable and unnecessary
treatment.
B) The most radical service/procedure that allows for effective treatment of the patient's
complaint or condition.
C) Something insurance plans do not care about.
D) Relates to whether a procedure or service is considered appropriate in a given
circumstance.
ACCURATE SOLUTIONS
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
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
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.
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.)
What is a mid-level provider?
A) Non-licensed PAs
B) Physician withholder
C) Mid-level providers include physician assistants (PA) and nurse practitioners (NP).
D) NPs with Bachelor's Degree
C
What are the different parts of Medicare?
A) Part A, B, D
B) Part A, B, C, D
C) Part E, F, G, H
D) Part A and B
B
Evaluation and management (E/M) services are often provided and documented in a
standard format. One such format is SOAP notes. What does SOAP represent?
A) Subjective, Objective, Assessment, Plan
B) Statement, Observation, Action, Prepare
, C) Symptoms, Objective, Auscultation, Percussion
D) Subjective, Observation, Action, Plan
A
What are five tips for coding operative (op) reports?
A) Look for key words, Ignore unfamiliar words, Skip the body, Ignore pathology reports,
Only code procedures from the header
B) Diagnosis code reporting, Start with the procedures listed, Look for key words, Highlight
unfamiliar words, Read the body
C) Highlight familiar words, Look for key words, Read the body, Only code what you have
highlighted, Code procedure only
D) Read the headers only, Look for key words, Highlight familiar words, Ignore pathology
report, Code diagnosis only
B
What is medical necessity?:
A) Services to a Medicare beneficiary that are billed for unreasonable and unnecessary
treatment.
B) The most radical service/procedure that allows for effective treatment of the patient's
complaint or condition.
C) Something insurance plans do not care about.
D) Relates to whether a procedure or service is considered appropriate in a given
circumstance.
