AAPC CPC Exam Prep Compliance and Regulatory
Questions and Answers
1. What document is referenced to when looking for potential problem areas
identified by the government indicating scrutiny of the services within the
coming year?
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan
ANS 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.)
2. 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
ANS 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.)
,3. 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.
ANS 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.)
4. Which statement describes a medically necessary service?
A) Performing a procedure/service based on cost to eliminate wasteful ser- vices.
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.-
ANS B (Rationale Medical necessity is using the least radical services/procedure that allows for effective treatment of the patient's
complaint or condition.)
5. 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
ANS B (Rationale According to the LCD, Chronic venous insuflciency is a systemic condition that may result in the need
for routine foot care.)
6. 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
ANS 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.")
7. 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
C) SSA
D) PPACA
ANS B
Questions and Answers
1. What document is referenced to when looking for potential problem areas
identified by the government indicating scrutiny of the services within the
coming year?
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan
ANS 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.)
2. 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
ANS 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.)
,3. 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.
ANS 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.)
4. Which statement describes a medically necessary service?
A) Performing a procedure/service based on cost to eliminate wasteful ser- vices.
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.-
ANS B (Rationale Medical necessity is using the least radical services/procedure that allows for effective treatment of the patient's
complaint or condition.)
5. 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
ANS B (Rationale According to the LCD, Chronic venous insuflciency is a systemic condition that may result in the need
for routine foot care.)
6. 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
ANS 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.")
7. 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
C) SSA
D) PPACA
ANS B
