Business of Medicine Exam Questions with Correct Answers Latest Update 2025-2026
Who would be considered a covered entity by HIPPA? - Answers Clearinghouse, HMO's, and
Doctors
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? - Answers ABN
What document has been created to assist physician offices with the development of
Compliance Manuals? - Answers OIG Compliance Plan Guidance released in October 2000.
True or False: ABN's may not be recognized by non-Medicare Payers. - Answers True.
Which Act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA)
and affected privacy and security? - Answers HITECH
Under HIPPA, what would be a policy requirement for "Minimum Necessary"? - Answers Only
individuals whose job requires it may have access to protected health information.
What is considered medical necessity? - Answers using the least radical services/procedure
that allows for both effective treatment of the patient's complaint or condition.
Measurement of Vitamin D levels is indicated for patient's with which condition? - Answers
Fibromyalgia
What document should be referred to when looking for potential problem areas identified by the
government indicating scrutiny of the services within the coming year? - Answers OIG Work Plan
When presenting a cost estimate on an ABN for a potentially non-covered service, the cost
estimate should be within what range of the actual cost? - Answers $100 or 25% whichever is
greater
What does the minimum necessary standard require? - Answers covered entities are to evaluate
their practices and enhance safeguards as needed to limit unnecessary or inappropriate access
to and disclosure of protected health information.
According to the OIG, internal monitoring and auditing should be performed by what means? -
Answers Periodic Audits
Local Coverage Determinations(LCD) are administered by whom? - Answers Each Regional
MAC(Medicare Administrative Contractor). They are responsible for interpreting national
policies into regional policies
What does CMS-HCC stand for? - Answers Centers for Medicare and Medicaid Services-
Hierarchal Condition Category.
According to AAPC's Code of Ethics, a member shall use only ____ and _____ means in all
, professional dealings: - Answers legal and ethical
When coding an operative report, which parts should be used to further clarify or define both
procedures and diagnosis? - Answers Detail of Procedure.
What does EHR stand for? - Answers Electronic Health Record
How many types of payers are there? - Answers Private Payers and Government
What are Private payers? - Answers offer both group and individual health plans.
What do Private Payers offer? - Answers Varies: may include hospitalization, basic, and major
medical coverage.
Who is the most significant government insurer? - Answers Medicare
Who administers this program? - Answers Centers for Medicare & Medicaid Services (CMS)
Who is covered by Medicare? - Answers age 65 or older, blind, disabled, ESRD
Who serves as the last word in coding requirements for both Medicare & non Medicare payers
alike? - Answers CMS
What types of coverage does Medicare have? - Answers A, B, C, D
What does Part A cover? - Answers IP Hospital Care, SNF's, Hospice Care, and Home Health
What does Part B cover? - Answers Medically Necessary Dr's, OP Hospital, other medical
services not covered by part A.
Who pays for Part B? - Answers Patient must pay premiums, annual deductible, and 20% co-
insurance of Medicare allowed amounts.
What does Part C cover? - Answers This is Medicare Advantage: combines A, B, and sometimes
D.
Who manages Part C coverage? - Answers private insurers approve by Medicare. Can include
PPO's, HMO's and others.
What may the plans charge for? - Answers Copayments, Co-insurance, and Deductibles
What does CMS-HCC model provide to these Advantage/HMO plans? - Answers adjusted
payment on a patient's disease and demographic factors.
If a coder does not include all pertinent diagnosis and comorbidities what can happen to the
provider? - Answers may lose out on additional reimbursement that they are entitled.
What is Part D coverage? - Answers Prescription Drug coverage program available to all
Who would be considered a covered entity by HIPPA? - Answers Clearinghouse, HMO's, and
Doctors
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? - Answers ABN
What document has been created to assist physician offices with the development of
Compliance Manuals? - Answers OIG Compliance Plan Guidance released in October 2000.
True or False: ABN's may not be recognized by non-Medicare Payers. - Answers True.
Which Act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA)
and affected privacy and security? - Answers HITECH
Under HIPPA, what would be a policy requirement for "Minimum Necessary"? - Answers Only
individuals whose job requires it may have access to protected health information.
What is considered medical necessity? - Answers using the least radical services/procedure
that allows for both effective treatment of the patient's complaint or condition.
Measurement of Vitamin D levels is indicated for patient's with which condition? - Answers
Fibromyalgia
What document should be referred to when looking for potential problem areas identified by the
government indicating scrutiny of the services within the coming year? - Answers OIG Work Plan
When presenting a cost estimate on an ABN for a potentially non-covered service, the cost
estimate should be within what range of the actual cost? - Answers $100 or 25% whichever is
greater
What does the minimum necessary standard require? - Answers covered entities are to evaluate
their practices and enhance safeguards as needed to limit unnecessary or inappropriate access
to and disclosure of protected health information.
According to the OIG, internal monitoring and auditing should be performed by what means? -
Answers Periodic Audits
Local Coverage Determinations(LCD) are administered by whom? - Answers Each Regional
MAC(Medicare Administrative Contractor). They are responsible for interpreting national
policies into regional policies
What does CMS-HCC stand for? - Answers Centers for Medicare and Medicaid Services-
Hierarchal Condition Category.
According to AAPC's Code of Ethics, a member shall use only ____ and _____ means in all
, professional dealings: - Answers legal and ethical
When coding an operative report, which parts should be used to further clarify or define both
procedures and diagnosis? - Answers Detail of Procedure.
What does EHR stand for? - Answers Electronic Health Record
How many types of payers are there? - Answers Private Payers and Government
What are Private payers? - Answers offer both group and individual health plans.
What do Private Payers offer? - Answers Varies: may include hospitalization, basic, and major
medical coverage.
Who is the most significant government insurer? - Answers Medicare
Who administers this program? - Answers Centers for Medicare & Medicaid Services (CMS)
Who is covered by Medicare? - Answers age 65 or older, blind, disabled, ESRD
Who serves as the last word in coding requirements for both Medicare & non Medicare payers
alike? - Answers CMS
What types of coverage does Medicare have? - Answers A, B, C, D
What does Part A cover? - Answers IP Hospital Care, SNF's, Hospice Care, and Home Health
What does Part B cover? - Answers Medically Necessary Dr's, OP Hospital, other medical
services not covered by part A.
Who pays for Part B? - Answers Patient must pay premiums, annual deductible, and 20% co-
insurance of Medicare allowed amounts.
What does Part C cover? - Answers This is Medicare Advantage: combines A, B, and sometimes
D.
Who manages Part C coverage? - Answers private insurers approve by Medicare. Can include
PPO's, HMO's and others.
What may the plans charge for? - Answers Copayments, Co-insurance, and Deductibles
What does CMS-HCC model provide to these Advantage/HMO plans? - Answers adjusted
payment on a patient's disease and demographic factors.
If a coder does not include all pertinent diagnosis and comorbidities what can happen to the
provider? - Answers may lose out on additional reimbursement that they are entitled.
What is Part D coverage? - Answers Prescription Drug coverage program available to all
