Question 1
10 out of 10 points
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?
Selected d.
Answer: ABN
Correct d.
Answer: ABN
Response Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare
Feedback: 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.
• Question 2
10 out of 10 points
Which statement describes a medically necessary service?
Selected b.
Answer: Using the least radical service/procedure that allows for effective treatment of
the patient’s complaint or condition.
Correct b.
Answer: Using the least radical service/procedure that allows for effective treatment of
the patient’s complaint or condition.
Response Rationale: Medical necessity is using the least radical services/procedure that
Feedback: allows for effective treatment of the patient’s complaint or condition.
• Question 3
10 out of 10 points
What document assists provider offices with the development of Compliance Manuals?
Selected a.
Answer: OIG Compliance Plan Guidance
Correct a.
Answer: OIG Compliance Plan Guidance
Response Rationale: The OIG has offered compliance program guidance to form the
Feedback: basis of a voluntary compliance program for physician offices. Although this
was released in October 2000, it is still active compliance guidance today.
• Question 4
10 out of 10 points
Under HIPAA, what would be a policy requirement for ―minimum necessary‖?
,Selected a.
Answer: Only individuals whose job requires it may have access to protected health
information.
Correct a.
Answer: Only individuals whose job requires it may have access to protected health
information.
Response Rationale: It is the responsibility of a covered entity to develop and implement
Feedback: 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.
,• Question B5
10 B out B of B 10 B points
According Bto Bthe Bexample BLCD Bfrom BNovitas BSolutions, Bmeasurement Bof Bvitamin BD Blevels
Bis Bindicated Bfor Bpatients Bwith Bwhich Bcondition?
Selected b.
BAnswer: Bfibromyalgi
Ba
Correct b.
BAnswer: Bfibromyalgi
Ba
Response Rationale: BAccording Bto Bthe BLCD, Bmeasurement Bof Bvitamin BD Blevels Bis
BFeedback Bindicated Bfor Bpatients Bwith Bfibromyalgia.
:
• Question B6
10 B out B of B 10 B points
Select B the B TRUE B statement B regarding
B ABNs.
Selected a.
BAnswer:
ABNs B may B not B be B recognized B by B non-Medicare B payers.
Correct a.
BAnswer:
ABNs B may B not B be B recognized B by B non-Medicare B payers.
Response Rationale: BABNs Bmay Bnot Bbe Brecognized Bby Bnon-Medicare Bpayers. BProviders
BFeedback Bshould Breview Btheir Bcontracts Bto Bdetermine Bwhich Bpayers Bwill Baccept Ban
: BABN Bfor Bservices Bnot Bcovered.
• Question B7
10 B out B of B 10 B points
Who Bwould BNOT B be Bconsidered Ba Bcovered Bentity B under
B HIPAA?
Selected d.
BAnswer:
Patients
Correct d.
BAnswer: Patients
Response Rationale: BCovered Bentities Bin Brelation Bto BHIPAA Binclude BHealth BCare
BFeedback BProviders, BHealth BPlans, Band BHealth BCare BClearinghouses. BThe Bpatient Bis Bnot
: Bconsidered Ba Bcovered Bentity Balthough Bit Bis Bthe Bpatient’s Bdata Bthat Bis
B protected.
• Question B8
10 B out B of B 10 B points
When Bpresenting Ba Bcost Bestimate Bon Ban BABN Bfor Ba Bpotentially Bnoncovered Bservice, Bthe
Bcost Bestimate Bshould Bbe Bwithin Bwhat Brange Bof Bthe Bactual Bcost?
Selected c.
BAnswer:
$100 Bor B25 B percent
Correct c.
BAnswer:
$100 Bor B25 B percent
Response Rationale: BCMS Binstructions Bstipulate, B―Notifiers Bmust Bmake Ba Bgood Bfaith
BFeedback Beffort Bto Binsert Ba Breasonable Bestimate…the Bestimate Bshould Bbe Bwithin B$100
: Bor B25 Bpercent Bof Bthe Bactual Bcosts, Bwhichever Bis Bgreater.‖
• Question B9
10 B out B of B 10 B points
Which B act Bwas Benacted Bas B part B of Bthe B American BRecovery B and BReinvestment B Act B of B2009
, (ARRA) Band B affected Bprivacy B and Bsecurity?
Selected b.
BAnswer:
HITECH
Correct b.
BAnswer: HITECH
Response Rationale: BThe BHealth BInformation BTechnology Bfor BEconomic Band BClinical
BFeedbac BHealth BAct B(HITECH) Bwas Benacted Bas Ba Bpart Bof Bthe BAmerican BRecovery Band
k B Reinvestment BAct Bof B2009 B(ARRA) Bto Bpromote Bthe Badoption Band Bmeaningful
: Buse Bof Bhealth Binformation Btechnology. BPortions Bof BHITECH Bstrengthen BHIPAA
B rules Bby Baddressing Bprivacy Band Bsecurity Bconcerns Bassociated Bwith Bthe
B electronic Btransmission Bof Bhealth Binformation.
• Question B10
10 B out B of B 10 B points
What Bdocument Bis Breferenced Bto Bwhen Blooking Bfor Bpotential Bproblem Bareas Bidentified Bby
Bthe Bgovernment Bindicating Bscrutiny Bof Bthe Bservices Bwithin Bthe Bcoming Byear?
Selected c.
BAnswer:
OIG BWork BPlan
Correct c.
BAnswer:
OIG BWork BPlan
Response Rationale: BTwice Ba Byear, Bthe BOIG Breleases Ba BWork BPlan Boutlining Bits Bpriorities
BFeedback Bfor Bthe Bfiscal Byear Bahead. BWithin Bthe BWork BPlan, Bpotential Bproblem Bareas
: Bwith Bclaims Bsubmissions Bare Blisted Band Bwill Bbe Btargeted Bwith Bspecial
scrutiny.
B
Sunday, BNovember B19, B2017 B9:04:26 BAM BMST
•
The B minimum B necessary B rule B applies B to
Selected b.
BAnswer:
Disclosures Bto Bor Brequests Bby Ba Bhealth Bcare Bprovider Bfor Btreatment Bpurposes.
Correct d.
BAnswer:
Covered Bentities Btaking Breasonable Bsteps Bto Blimit Buse Bor Bdisclosure Bof BPHI
Response Rationale: BThe BPrivacy BRule Bgenerally Brequires Bcovered Bentities Bto Btake
BFeedbac Breasonable Bsteps Bto Blimit Bthe Buse Bor Bdisclosure Bof, Band Brequests Bfor,
k Bprotected Bhealth Binformation Bto Bthe Bminimum Bnecessary Bto Baccomplish Bthe
: Bintended Bpurpose. BThe Bminimum Bnecessary Bstandard Bdoes Bnot Bapply Bto Bthe
B following:
· Disclosures Bto Bor Brequests Bby Ba Bhealth Bcare Bprovider Bfor
Btreatment Bpurposes.
· Disclosures B to B the B individual B who B is B the B subject B of B the B information.
· Uses B or B disclosures B made B pursuant B to B an B individual’s B authorization.
· Uses Bor Bdisclosures Brequired Bfor Bcompliance Bwith Bthe BHealth BInsurance
BPortability Band BAccountability BAct B(HIPAA) BAdministrative BSimplification
BRules.
· Disclosures Bto Bthe BDepartment Bof BHealth B& BHuman BServices B(HHS)
Bwhen Bdisclosure Bof Binformation Bis Brequired Bunder Bthe BPrivacy BRule Bfor
Benforcement Bpurposes.
· Uses Bor Bdisclosures Bthat Bare Brequired Bby Bother Blaw.
• Question B2
0 Bout Bof B4 Bpoints
According Bto Bthe BAAPC BCode Bof BEthics, Bwhich Bterm Bis BNOT Blisted Bas Ban Bethical Bprinciple
Bof Bprofessional Bconduct?
10 out of 10 points
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?
Selected d.
Answer: ABN
Correct d.
Answer: ABN
Response Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare
Feedback: 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.
• Question 2
10 out of 10 points
Which statement describes a medically necessary service?
Selected b.
Answer: Using the least radical service/procedure that allows for effective treatment of
the patient’s complaint or condition.
Correct b.
Answer: Using the least radical service/procedure that allows for effective treatment of
the patient’s complaint or condition.
Response Rationale: Medical necessity is using the least radical services/procedure that
Feedback: allows for effective treatment of the patient’s complaint or condition.
• Question 3
10 out of 10 points
What document assists provider offices with the development of Compliance Manuals?
Selected a.
Answer: OIG Compliance Plan Guidance
Correct a.
Answer: OIG Compliance Plan Guidance
Response Rationale: The OIG has offered compliance program guidance to form the
Feedback: basis of a voluntary compliance program for physician offices. Although this
was released in October 2000, it is still active compliance guidance today.
• Question 4
10 out of 10 points
Under HIPAA, what would be a policy requirement for ―minimum necessary‖?
,Selected a.
Answer: Only individuals whose job requires it may have access to protected health
information.
Correct a.
Answer: Only individuals whose job requires it may have access to protected health
information.
Response Rationale: It is the responsibility of a covered entity to develop and implement
Feedback: 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.
,• Question B5
10 B out B of B 10 B points
According Bto Bthe Bexample BLCD Bfrom BNovitas BSolutions, Bmeasurement Bof Bvitamin BD Blevels
Bis Bindicated Bfor Bpatients Bwith Bwhich Bcondition?
Selected b.
BAnswer: Bfibromyalgi
Ba
Correct b.
BAnswer: Bfibromyalgi
Ba
Response Rationale: BAccording Bto Bthe BLCD, Bmeasurement Bof Bvitamin BD Blevels Bis
BFeedback Bindicated Bfor Bpatients Bwith Bfibromyalgia.
:
• Question B6
10 B out B of B 10 B points
Select B the B TRUE B statement B regarding
B ABNs.
Selected a.
BAnswer:
ABNs B may B not B be B recognized B by B non-Medicare B payers.
Correct a.
BAnswer:
ABNs B may B not B be B recognized B by B non-Medicare B payers.
Response Rationale: BABNs Bmay Bnot Bbe Brecognized Bby Bnon-Medicare Bpayers. BProviders
BFeedback Bshould Breview Btheir Bcontracts Bto Bdetermine Bwhich Bpayers Bwill Baccept Ban
: BABN Bfor Bservices Bnot Bcovered.
• Question B7
10 B out B of B 10 B points
Who Bwould BNOT B be Bconsidered Ba Bcovered Bentity B under
B HIPAA?
Selected d.
BAnswer:
Patients
Correct d.
BAnswer: Patients
Response Rationale: BCovered Bentities Bin Brelation Bto BHIPAA Binclude BHealth BCare
BFeedback BProviders, BHealth BPlans, Band BHealth BCare BClearinghouses. BThe Bpatient Bis Bnot
: Bconsidered Ba Bcovered Bentity Balthough Bit Bis Bthe Bpatient’s Bdata Bthat Bis
B protected.
• Question B8
10 B out B of B 10 B points
When Bpresenting Ba Bcost Bestimate Bon Ban BABN Bfor Ba Bpotentially Bnoncovered Bservice, Bthe
Bcost Bestimate Bshould Bbe Bwithin Bwhat Brange Bof Bthe Bactual Bcost?
Selected c.
BAnswer:
$100 Bor B25 B percent
Correct c.
BAnswer:
$100 Bor B25 B percent
Response Rationale: BCMS Binstructions Bstipulate, B―Notifiers Bmust Bmake Ba Bgood Bfaith
BFeedback Beffort Bto Binsert Ba Breasonable Bestimate…the Bestimate Bshould Bbe Bwithin B$100
: Bor B25 Bpercent Bof Bthe Bactual Bcosts, Bwhichever Bis Bgreater.‖
• Question B9
10 B out B of B 10 B points
Which B act Bwas Benacted Bas B part B of Bthe B American BRecovery B and BReinvestment B Act B of B2009
, (ARRA) Band B affected Bprivacy B and Bsecurity?
Selected b.
BAnswer:
HITECH
Correct b.
BAnswer: HITECH
Response Rationale: BThe BHealth BInformation BTechnology Bfor BEconomic Band BClinical
BFeedbac BHealth BAct B(HITECH) Bwas Benacted Bas Ba Bpart Bof Bthe BAmerican BRecovery Band
k B Reinvestment BAct Bof B2009 B(ARRA) Bto Bpromote Bthe Badoption Band Bmeaningful
: Buse Bof Bhealth Binformation Btechnology. BPortions Bof BHITECH Bstrengthen BHIPAA
B rules Bby Baddressing Bprivacy Band Bsecurity Bconcerns Bassociated Bwith Bthe
B electronic Btransmission Bof Bhealth Binformation.
• Question B10
10 B out B of B 10 B points
What Bdocument Bis Breferenced Bto Bwhen Blooking Bfor Bpotential Bproblem Bareas Bidentified Bby
Bthe Bgovernment Bindicating Bscrutiny Bof Bthe Bservices Bwithin Bthe Bcoming Byear?
Selected c.
BAnswer:
OIG BWork BPlan
Correct c.
BAnswer:
OIG BWork BPlan
Response Rationale: BTwice Ba Byear, Bthe BOIG Breleases Ba BWork BPlan Boutlining Bits Bpriorities
BFeedback Bfor Bthe Bfiscal Byear Bahead. BWithin Bthe BWork BPlan, Bpotential Bproblem Bareas
: Bwith Bclaims Bsubmissions Bare Blisted Band Bwill Bbe Btargeted Bwith Bspecial
scrutiny.
B
Sunday, BNovember B19, B2017 B9:04:26 BAM BMST
•
The B minimum B necessary B rule B applies B to
Selected b.
BAnswer:
Disclosures Bto Bor Brequests Bby Ba Bhealth Bcare Bprovider Bfor Btreatment Bpurposes.
Correct d.
BAnswer:
Covered Bentities Btaking Breasonable Bsteps Bto Blimit Buse Bor Bdisclosure Bof BPHI
Response Rationale: BThe BPrivacy BRule Bgenerally Brequires Bcovered Bentities Bto Btake
BFeedbac Breasonable Bsteps Bto Blimit Bthe Buse Bor Bdisclosure Bof, Band Brequests Bfor,
k Bprotected Bhealth Binformation Bto Bthe Bminimum Bnecessary Bto Baccomplish Bthe
: Bintended Bpurpose. BThe Bminimum Bnecessary Bstandard Bdoes Bnot Bapply Bto Bthe
B following:
· Disclosures Bto Bor Brequests Bby Ba Bhealth Bcare Bprovider Bfor
Btreatment Bpurposes.
· Disclosures B to B the B individual B who B is B the B subject B of B the B information.
· Uses B or B disclosures B made B pursuant B to B an B individual’s B authorization.
· Uses Bor Bdisclosures Brequired Bfor Bcompliance Bwith Bthe BHealth BInsurance
BPortability Band BAccountability BAct B(HIPAA) BAdministrative BSimplification
BRules.
· Disclosures Bto Bthe BDepartment Bof BHealth B& BHuman BServices B(HHS)
Bwhen Bdisclosure Bof Binformation Bis Brequired Bunder Bthe BPrivacy BRule Bfor
Benforcement Bpurposes.
· Uses Bor Bdisclosures Bthat Bare Brequired Bby Bother Blaw.
• Question B2
0 Bout Bof B4 Bpoints
According Bto Bthe BAAPC BCode Bof BEthics, Bwhich Bterm Bis BNOT Blisted Bas Ban Bethical Bprinciple
Bof Bprofessional Bconduct?
