AAPC CHAPTER 1 REVIEW - THE BUSINESS OF MEDICINE COMPLETE & LATEST GUIDE

AAPC CHAPTER 1 REVIEW - THE BUSINESS OF MEDICINE COMPLETE & LATEST GUIDE 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. *Answer: B. Using the least radical service/procedure that allows for effective treatment of the patient's complaint or condition.* 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 *Answer: B. Chronic venous insufficiency* Rationale: According to the LCD, Chronic venous insufficiency is a systemic condition that may result in the need for routine foot care. What form is provided to a patient to indicate a service may not be covered by Medicare and the patient may be responsible for the charges? A. LCD B. CMS-1500 C. UB-04 D. ABN *Answer: D. ABN * 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. Select the TRUE statement regarding ABNs. A. ABNs may not be recognized by non-Medicare payers. B. ABNs must be signed for emergency or urgent care. C. ABNs are not required to include an estimate cost for the service. D. ABNs should be routinely signed by Medicare Beneficiaries in case Medicare doesn't cover a service. *Answer: A. ABNs may not be recognized by non-Medicare payers.* Rationale: ABNs may not be recognized by non-Medicare payers. Providers should review their contracts to determine which payers will accept an ABN for services not covered. 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 *Answer: C. $100 or 25 percent* Rationale: CMS instructions stipulate,