12/31/25, 12:36 PM AAPC CPC exam prep Compliance and Regulatory Flashcards | Quizlet
AAPC CPC exam prep Compliance
and Regulatory with question and
answer 100%correct
C
Terms in this set (45)
What document is referenced to when C (Rationale: Twice a year, the OIG releases a Work Plan
looking for potentialproblem areas outlining its priorities for the fiscal year ahead. Within the Work
identified by the government Plan, potential problem areas with claims submissions are
indicatingscrutiny of the services within the listed and will be targeted with special scrutiny.)
coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan
What form is provided to a patient to D (Rationale: An Advanced Beneficiary Notice (ABN) is used
indicate a servicemay not be covered by when a Medicare beneficiary requests or agrees to receive a
Medicare and the patient may be procedure or service that Medicare may not cover. This form
responsible for the charges?: notifies the patient of potential out of pocket costs for the
A) LCD patient.)
B) CMS-1500
C) UB-04
D) ABN
Under HIPAA, what would be a policy A (Rationale: It is the responsibility of a covered entity to
requirement for "minimum necessary"? " develop and implement policies, best suited to its particular
A) Only individuals whose job requires it circumstances to meet HIPAA requirements. As a policy
may have access to protected health requirement, only those individuals whose job requires it may
information. 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.
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, 12/31/25, 12:36 PM AAPC CPC exam prep Compliance and Regulatory Flashcards | Quizlet
Which statement describes a medically B (Rationale: Medical necessity is using the least radical
necessary service? : services/procedure that allows for effective treatment of the
A) Performing a procedure/service based patient's complaint or condition.)
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.
According to the example LCD from Novitas B (Rationale: According to the LCD, Chronic venous
Solutions, which of the following conditions insufficiency is a systemic condition that may result in the need
is considered a systemic condition that may for routine foot care.)
result in the need for routine foot care? :
A) arthritis
B) chronic venous insufficiency
C) hypertension
D) muscle weakness
When presenting a cost estimate on an ABN C (Rationale: CMS instructions stipulate, "Notifiers must make
for a potentially noncovered service, the a good faith effort to insert a reasonable estimate...the
cost estimate should be within what range estimate should be within $100 or 25 percent of the actual
of the actual cost? costs, whichever is greater.")
A) $25 or 10 percent
B) $100 or 10 percent
C) $100 or 25 percent
D) An exact amount
Which act was enacted as part of the B
American Recovery and Reinvestment Act
of 2009 (ARRA) and affected privacy and
security? :
A) HIPAA
B) HITECH
C) SSA
D) PPACA
What document assists provider offices with A (Rationale: The OIG has offered compliance program
the development of Compliance Manuals? guidance to form the basis of a voluntary compliance
A) OIG Compliance Plan Guidance program for physician offices. Although this was released in
B) OIG Work Plan October 2000, it is still considered as active compliance
C) OIG Suggested Rules and Regulations guidance today.)
D) OIG Internal Compliance Plan
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AAPC CPC exam prep Compliance
and Regulatory with question and
answer 100%correct
C
Terms in this set (45)
What document is referenced to when C (Rationale: Twice a year, the OIG releases a Work Plan
looking for potentialproblem areas outlining its priorities for the fiscal year ahead. Within the Work
identified by the government Plan, potential problem areas with claims submissions are
indicatingscrutiny of the services within the listed and will be targeted with special scrutiny.)
coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan
What form is provided to a patient to D (Rationale: An Advanced Beneficiary Notice (ABN) is used
indicate a servicemay not be covered by when a Medicare beneficiary requests or agrees to receive a
Medicare and the patient may be procedure or service that Medicare may not cover. This form
responsible for the charges?: notifies the patient of potential out of pocket costs for the
A) LCD patient.)
B) CMS-1500
C) UB-04
D) ABN
Under HIPAA, what would be a policy A (Rationale: It is the responsibility of a covered entity to
requirement for "minimum necessary"? " develop and implement policies, best suited to its particular
A) Only individuals whose job requires it circumstances to meet HIPAA requirements. As a policy
may have access to protected health requirement, only those individuals whose job requires it may
information. 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.
https://quizlet.com/491944312/aapc-cpc-exam-prep-compliance-and-regulatory-flash-cards/ 1/9
, 12/31/25, 12:36 PM AAPC CPC exam prep Compliance and Regulatory Flashcards | Quizlet
Which statement describes a medically B (Rationale: Medical necessity is using the least radical
necessary service? : services/procedure that allows for effective treatment of the
A) Performing a procedure/service based patient's complaint or condition.)
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.
According to the example LCD from Novitas B (Rationale: According to the LCD, Chronic venous
Solutions, which of the following conditions insufficiency is a systemic condition that may result in the need
is considered a systemic condition that may for routine foot care.)
result in the need for routine foot care? :
A) arthritis
B) chronic venous insufficiency
C) hypertension
D) muscle weakness
When presenting a cost estimate on an ABN C (Rationale: CMS instructions stipulate, "Notifiers must make
for a potentially noncovered service, the a good faith effort to insert a reasonable estimate...the
cost estimate should be within what range estimate should be within $100 or 25 percent of the actual
of the actual cost? costs, whichever is greater.")
A) $25 or 10 percent
B) $100 or 10 percent
C) $100 or 25 percent
D) An exact amount
Which act was enacted as part of the B
American Recovery and Reinvestment Act
of 2009 (ARRA) and affected privacy and
security? :
A) HIPAA
B) HITECH
C) SSA
D) PPACA
What document assists provider offices with A (Rationale: The OIG has offered compliance program
the development of Compliance Manuals? guidance to form the basis of a voluntary compliance
A) OIG Compliance Plan Guidance program for physician offices. Although this was released in
B) OIG Work Plan October 2000, it is still considered as active compliance
C) OIG Suggested Rules and Regulations guidance today.)
D) OIG Internal Compliance Plan
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