2024 AAPC CIC - Practice Exams
Study online at https://quizlet.com/_fcyr0v
b. Identify the incorrect entry, and write a signed and dated adden-
dum to the record to make the correction
According to the Medicare Program Integrity Manual, Chapter
3, Section 3.3.2.5.B.: "Regardless of whether a documentation
submission originates from a paper record or an electronic health
record, documents submitted to MACs, CERT, Recovery Auditors,
and ZPICs containing amendments, corrections or addenda must:
What steps should a provider take in order to a change to an entry
1 - Clearly and permanently identify any amendment, correction
in the electronic medical record?
or delayed entry as such, and
2 - Clearly indicate the date and author of any amendment, cor-
a. Erase the incorrect entry and replace it with the correct infor-
rection or delayed entry, and
mation
3 - Not delete but instead clearly identify all original content
b. Identify the incorrect entry, and write a signed and dated ad-
dendum to the record to make the correction
Electronic Health Records (EHR): Medical record keeping within
c. Nothing, records should never be changed
an EHR deserves special considerations; however, the principles
d. Delete the wrong information and write an amendment with the
specified above remain fundamental and necessary for docu-
new information
ment submission to MACs, CERT, Recovery Auditors, SMRC
and ZPICs. Records sourced from electronic systems containing
amendments, corrections or delayed entries must:
a. Distinctly identify any amendment, correction or delayed entry,
and
b. Provide a reliable means to clearly identify the original content,
the modified content, and the date and authorship of each modi-
fication of the record."
a. telephone order, read back
What does the abbreviation "TORB" stands for?
TORB is an abbreviation for "telephone order, read back." The
a. telephone order, read back
Joint Commission requires that telephone orders and verbal order
b. technical order reviewed by
be "read back" when they pertain to critical test results. This
c. tear off, reviewed before
ensures that the scribe has heard the provider correctly and has
d. treatment over, release back
written the order without errors.
Which of the following are data elements are NOT part of the
Uniform Hospital Discharge Data Set (UHDDS)? c. Admitting diagnosis
a. Principal diagnosis Response Feedback: The admitting diagnosis is not an element of
b. Admission date the UHDDS. It must be reported for some payers and may also be
c. Admitting diagnosis useful in quality-of-care studies.
d. Attending physician
In a person suffering from alcohol abuse which of the following
molecules accumulate in the liver?
b. Lipids
a. Water
Response Feedback: Alcohol abuse causes lipids to accumulate
b. Lipids
in the liver.
c. Protein
d. Iron
Which one of the following listed drugs is not a calcium channel
blocking drug? c. Propranolol
a. Diltiazem Response Feedback: Verapamil, amlodipine, and diltiazem are
b. Amlodipine all calcium channel blockers. Propranolol is a beta-adrenergic
c. Propranolol blocking agent.
d. Verapamil
a. Allows coders to review more documentation faster
How does CAC improve coding processes?
Response Feedback: Since its early beginnings in outpatient spe-
a. Allows coders to review more documentation faster
cialty areas, Computer-Assisted Coding (CAC) solutions have
b. It allows coders to not have to read documentation at all
been adopted to improve medical coding workflows, increase
c. It auto-suggests codes so coders don't need to know coding
medical coding accuracy, and balance medical coding resources
rules
to focus on more volume and complex cases. The recent and
d. It makes coding automatic so you no longer need certified
significant increase in the adoption of CAC solutions in inpatient
, 2024 AAPC CIC - Practice Exams
Study online at https://quizlet.com/_fcyr0v
coders environments is linked to the same, compelling, justification ben-
e. None of the above efits.
Documentation by the provider states, "Complications of delivery
include meconium passage, baby was vigorous. infant is at risk for
respiratory distress secondary to meconium delivery, will observe
b. P03.82
respiratory status closely" How should "meconium passage" be
coded?
Meconium passage during delivery is clinically significant. These
infants are monitored since the condition can adversely affect
a. P96.83
newborns. This condition is indexed Passage - Meconium. This is
b. P03.82
a newborn condition.
c. P24.00
d. No code is assigned because the documentation of meconium
is not clinically significant
Which role would have the chief responsibilities of reviewing the
appropriateness of DRG assignment of inpatient claims, report
b. DRG Validator
inconsistencies in DRG assignment, and monitor trends in the
OIG Work Plan.
A DRG Validator must ensure that the selected DRG is appropriate
and is reflective of the documentation in the medical record. The
a. Coding Auditor
DRG validator should report findings, make recommendations,
b. DRG Validator
and monitor trends in the OIG Work Plan.
c. Coding Compliance Officer
d. Documentation Improvement Specialist
d. Annually
How often should a thorough chargemaster review be conducted?
At a minimum, the chargemaster should be reviewed for com-
a. Daily pleteness and accuracy annually. The operational department
b. Every 10 years leaders should be involved with the review of the charges per-
c. Never taining to their departments. Codes deleted should be removed
d. Annually from the chargemaster on January 1, and new CPT/HCPCS codes
should be reviewed to determine if they need to be added.
What is a key factor in determining inpatient status?
a. An admitting order by the attending physician
a. An admitting order by the attending physician
Response Feedback: An admitting order by the attending doctor
b. The number of days the patients stay in the hospital
is the key factor in determining whether a patient is an inpatient or
c. The acuity or of the patient's illness
an outpatient.
d. The specific disease or illness that the patient presents with
Why is selecting the appropriate discharge status is necessary?
b. The discharge disposition will affect how the claim is paid.
a. The discharge disposition alerts the payer where the patient
went after discharge. Payment is altered for the transferring hospital and is based on a
b. The discharge disposition will affect how the claim is paid. per diem rate methodology for type 1 transfers. For type 2 transfers
c. The discharge disposition has no effect on the inpatient stay. the full PPS payment is made to the transferring hospital.
d. The discharge disposition will aid in coordination of care.
Which type of inpatient facility uses case-mix groups (CMGs)
rather than DRGs to group cases that are similar according to their b. Inpatient Rehabilitation Facility
functional motor and cognitive scores and age?
Inpatient Rehabilitation Facility cases are grouped in Rehabil-
a. Skilled Nursing Facility itation Impairment Categories, which are then further grouped
b. Inpatient Rehabilitation Facility into case-mix groups (CMGs) according to their functional motor,
c. Acute Inpatient Facility cognitive scores and age.
d. Long-term Acute Care Facility
Under the Outpatient Prospective Payment System, HCPCS Level
II code J9034, Injection, bendeka, 1 mg, is assigned the status
indicator "K", indicating that it is a non pass-through drug and
a. Paid under a separate APC payment
biological. Therefore, how is the drug and biological payment
made?
The OPPS status indicator "K" is assigned to non pass-through
drugs and biologicals that are paid as a separate APC payment.
a. Paid under a separate APC payment
b. Paid as a percentage of charges using a hospital-specific or
statewide cost-to-charge ratio
, 2024 AAPC CIC - Practice Exams
Study online at https://quizlet.com/_fcyr0v
c. Not eligible for reimbursement
d. Zero, as the payment is packaged into another service provided.
The local coverage determination attached discusses coverage c. II, III and IV are correct.
for colorectal cancer screening. Based on the LCD, which of the
following are true? According to the LCD, a patient with average risk for colon cancer
is covered for a screening colonoscopy every ten years (not every
I. A patient with an average risk of colon cancer is covered for a five years), and a patient with a high risk of colon cancer is covered
screening colonoscopy every five years. for a screening colonoscopy every two years. Medicare covers one
II. A patient with a high risk of colon cancer is covered for a screening Fecal Occult Blood test once a year for patients aged
screening colonoscopy every two years. 50 years or more. One screening FOBT test can consist of two
III. A high-risk patient is who meets one or more of these quali- stool samples from different areas of the stool.
fications: patient who has a sibling or parent who had colorectal Medicare defines high risk of developing colorectal cancer as
cancer, a personal history of adenomatous polyps, or a personal someone who has one or more of the following risk factors:
history of colon cancer. • A close relative (sibling, parent, or child) who has had colorectal
IV. Medicare covers one screening Fecal Occult Blood test once cancer or an adenomatous polyp;
a year for patients aged 50 years or older. • A family history of familial adenomatous polyposis;
• A family history of hereditary nonpolyposis colorectal cancer;
a. I, II, III, and IV are correct. • A personal history of adenomatous polyps;
b. II and III are correct. • A personal history of colorectal cancer; or
c. II, III and IV are correct. • A personal history of inflammatory bowel disease, including
d. I and IV are correct. Crohn's Disease, and ulcerative colitis
c. HINN
Providers must supply a liability notice if services delivered to a
Medicare beneficiary are to be reduced or terminated following
Notices of non-coverage are given to eligible inpatients receiv-
delivery of covered care or thought not to be covered. For Inpatient
ing or previously eligible for non-hospice services covered under
(Bill Type: 11x, 18x, 21x, 41x) what is the liability notice is referred
Medicare Part A (types of bill (TOB) 11x, 18x, 21x, and 41x); but,
to as?
the services at issue no longer meet coverage guidelines, such
as for exceeding the number of covered days in a spell of illness.
a. ABN
In hospitals, these notices are known as Hospital Issued Notice
b. HHABNs
of Non-coverage (HINNs) or hospital notices of non-coverage, in
c. HINN
Skilled Nursing Facilities (SNFs), they may be known as Sarrassat
d. NEMB
notices.
What will failure to supply an ABN to a patient when required will
result in? a. The provider not being able to shift cost to the patient
a. The provider not being able to shift cost to the patient According to CMS, providers must supply a liability notice if ser-
b. The patient being responsible for the non-covered services vices delivered to a Medicare beneficiary are to be reduced or
c. The provider being responsible for both covered & non cov- terminated following delivery of covered care, or thought not to be
ered-charges covered. Failure to provide such notices when required means the
d. The patient being responsible for both covered & non cov- provider will not be able to shift liability to the beneficiary.
ered-charges
b. I, III, and IV
Which staff member would use the PEPPER report?
The PEPPER report outlines services and discharges that might
fall outside the normal expected range and thus be subject to
I. Compliance officer
improper payment. The PEPPER report can identify areas of
II. Risk Management
specific concern, such as: significant changes in billing practices,
III. Coder
possible over- or under-coding, and changes in lengths of stay. The
IV. Quality Assurance
compliance officer can use this information to monitor compliance
and the quality assurance officer can make sure the facility is
a. I and II
remaining within the expected field. This is also a way for the
b. I, III, and IV
compliance officer to know what DRG's may be pulled for audit
c. III and IV
in coming audit periods. The compliance officer can work with the
d. III
coders in the HIM department if any coding issues are identified
in the PEPPER report.
What is the first level of appeal for traditional Medicare called and d. Redetermination, 120 days
how many days does the appellant have after the receipt of the
initial determination to file the request for appeal? The first level of the original Medicare appeal process is known as
the Redetermination process. The first level of appeal is conducted
a. Reconsideration, 120 days by independent staff of the Medicare Administrative Contractor,
b. Redetermination, 180 days responsible for making the original determination. The appellant
Study online at https://quizlet.com/_fcyr0v
b. Identify the incorrect entry, and write a signed and dated adden-
dum to the record to make the correction
According to the Medicare Program Integrity Manual, Chapter
3, Section 3.3.2.5.B.: "Regardless of whether a documentation
submission originates from a paper record or an electronic health
record, documents submitted to MACs, CERT, Recovery Auditors,
and ZPICs containing amendments, corrections or addenda must:
What steps should a provider take in order to a change to an entry
1 - Clearly and permanently identify any amendment, correction
in the electronic medical record?
or delayed entry as such, and
2 - Clearly indicate the date and author of any amendment, cor-
a. Erase the incorrect entry and replace it with the correct infor-
rection or delayed entry, and
mation
3 - Not delete but instead clearly identify all original content
b. Identify the incorrect entry, and write a signed and dated ad-
dendum to the record to make the correction
Electronic Health Records (EHR): Medical record keeping within
c. Nothing, records should never be changed
an EHR deserves special considerations; however, the principles
d. Delete the wrong information and write an amendment with the
specified above remain fundamental and necessary for docu-
new information
ment submission to MACs, CERT, Recovery Auditors, SMRC
and ZPICs. Records sourced from electronic systems containing
amendments, corrections or delayed entries must:
a. Distinctly identify any amendment, correction or delayed entry,
and
b. Provide a reliable means to clearly identify the original content,
the modified content, and the date and authorship of each modi-
fication of the record."
a. telephone order, read back
What does the abbreviation "TORB" stands for?
TORB is an abbreviation for "telephone order, read back." The
a. telephone order, read back
Joint Commission requires that telephone orders and verbal order
b. technical order reviewed by
be "read back" when they pertain to critical test results. This
c. tear off, reviewed before
ensures that the scribe has heard the provider correctly and has
d. treatment over, release back
written the order without errors.
Which of the following are data elements are NOT part of the
Uniform Hospital Discharge Data Set (UHDDS)? c. Admitting diagnosis
a. Principal diagnosis Response Feedback: The admitting diagnosis is not an element of
b. Admission date the UHDDS. It must be reported for some payers and may also be
c. Admitting diagnosis useful in quality-of-care studies.
d. Attending physician
In a person suffering from alcohol abuse which of the following
molecules accumulate in the liver?
b. Lipids
a. Water
Response Feedback: Alcohol abuse causes lipids to accumulate
b. Lipids
in the liver.
c. Protein
d. Iron
Which one of the following listed drugs is not a calcium channel
blocking drug? c. Propranolol
a. Diltiazem Response Feedback: Verapamil, amlodipine, and diltiazem are
b. Amlodipine all calcium channel blockers. Propranolol is a beta-adrenergic
c. Propranolol blocking agent.
d. Verapamil
a. Allows coders to review more documentation faster
How does CAC improve coding processes?
Response Feedback: Since its early beginnings in outpatient spe-
a. Allows coders to review more documentation faster
cialty areas, Computer-Assisted Coding (CAC) solutions have
b. It allows coders to not have to read documentation at all
been adopted to improve medical coding workflows, increase
c. It auto-suggests codes so coders don't need to know coding
medical coding accuracy, and balance medical coding resources
rules
to focus on more volume and complex cases. The recent and
d. It makes coding automatic so you no longer need certified
significant increase in the adoption of CAC solutions in inpatient
, 2024 AAPC CIC - Practice Exams
Study online at https://quizlet.com/_fcyr0v
coders environments is linked to the same, compelling, justification ben-
e. None of the above efits.
Documentation by the provider states, "Complications of delivery
include meconium passage, baby was vigorous. infant is at risk for
respiratory distress secondary to meconium delivery, will observe
b. P03.82
respiratory status closely" How should "meconium passage" be
coded?
Meconium passage during delivery is clinically significant. These
infants are monitored since the condition can adversely affect
a. P96.83
newborns. This condition is indexed Passage - Meconium. This is
b. P03.82
a newborn condition.
c. P24.00
d. No code is assigned because the documentation of meconium
is not clinically significant
Which role would have the chief responsibilities of reviewing the
appropriateness of DRG assignment of inpatient claims, report
b. DRG Validator
inconsistencies in DRG assignment, and monitor trends in the
OIG Work Plan.
A DRG Validator must ensure that the selected DRG is appropriate
and is reflective of the documentation in the medical record. The
a. Coding Auditor
DRG validator should report findings, make recommendations,
b. DRG Validator
and monitor trends in the OIG Work Plan.
c. Coding Compliance Officer
d. Documentation Improvement Specialist
d. Annually
How often should a thorough chargemaster review be conducted?
At a minimum, the chargemaster should be reviewed for com-
a. Daily pleteness and accuracy annually. The operational department
b. Every 10 years leaders should be involved with the review of the charges per-
c. Never taining to their departments. Codes deleted should be removed
d. Annually from the chargemaster on January 1, and new CPT/HCPCS codes
should be reviewed to determine if they need to be added.
What is a key factor in determining inpatient status?
a. An admitting order by the attending physician
a. An admitting order by the attending physician
Response Feedback: An admitting order by the attending doctor
b. The number of days the patients stay in the hospital
is the key factor in determining whether a patient is an inpatient or
c. The acuity or of the patient's illness
an outpatient.
d. The specific disease or illness that the patient presents with
Why is selecting the appropriate discharge status is necessary?
b. The discharge disposition will affect how the claim is paid.
a. The discharge disposition alerts the payer where the patient
went after discharge. Payment is altered for the transferring hospital and is based on a
b. The discharge disposition will affect how the claim is paid. per diem rate methodology for type 1 transfers. For type 2 transfers
c. The discharge disposition has no effect on the inpatient stay. the full PPS payment is made to the transferring hospital.
d. The discharge disposition will aid in coordination of care.
Which type of inpatient facility uses case-mix groups (CMGs)
rather than DRGs to group cases that are similar according to their b. Inpatient Rehabilitation Facility
functional motor and cognitive scores and age?
Inpatient Rehabilitation Facility cases are grouped in Rehabil-
a. Skilled Nursing Facility itation Impairment Categories, which are then further grouped
b. Inpatient Rehabilitation Facility into case-mix groups (CMGs) according to their functional motor,
c. Acute Inpatient Facility cognitive scores and age.
d. Long-term Acute Care Facility
Under the Outpatient Prospective Payment System, HCPCS Level
II code J9034, Injection, bendeka, 1 mg, is assigned the status
indicator "K", indicating that it is a non pass-through drug and
a. Paid under a separate APC payment
biological. Therefore, how is the drug and biological payment
made?
The OPPS status indicator "K" is assigned to non pass-through
drugs and biologicals that are paid as a separate APC payment.
a. Paid under a separate APC payment
b. Paid as a percentage of charges using a hospital-specific or
statewide cost-to-charge ratio
, 2024 AAPC CIC - Practice Exams
Study online at https://quizlet.com/_fcyr0v
c. Not eligible for reimbursement
d. Zero, as the payment is packaged into another service provided.
The local coverage determination attached discusses coverage c. II, III and IV are correct.
for colorectal cancer screening. Based on the LCD, which of the
following are true? According to the LCD, a patient with average risk for colon cancer
is covered for a screening colonoscopy every ten years (not every
I. A patient with an average risk of colon cancer is covered for a five years), and a patient with a high risk of colon cancer is covered
screening colonoscopy every five years. for a screening colonoscopy every two years. Medicare covers one
II. A patient with a high risk of colon cancer is covered for a screening Fecal Occult Blood test once a year for patients aged
screening colonoscopy every two years. 50 years or more. One screening FOBT test can consist of two
III. A high-risk patient is who meets one or more of these quali- stool samples from different areas of the stool.
fications: patient who has a sibling or parent who had colorectal Medicare defines high risk of developing colorectal cancer as
cancer, a personal history of adenomatous polyps, or a personal someone who has one or more of the following risk factors:
history of colon cancer. • A close relative (sibling, parent, or child) who has had colorectal
IV. Medicare covers one screening Fecal Occult Blood test once cancer or an adenomatous polyp;
a year for patients aged 50 years or older. • A family history of familial adenomatous polyposis;
• A family history of hereditary nonpolyposis colorectal cancer;
a. I, II, III, and IV are correct. • A personal history of adenomatous polyps;
b. II and III are correct. • A personal history of colorectal cancer; or
c. II, III and IV are correct. • A personal history of inflammatory bowel disease, including
d. I and IV are correct. Crohn's Disease, and ulcerative colitis
c. HINN
Providers must supply a liability notice if services delivered to a
Medicare beneficiary are to be reduced or terminated following
Notices of non-coverage are given to eligible inpatients receiv-
delivery of covered care or thought not to be covered. For Inpatient
ing or previously eligible for non-hospice services covered under
(Bill Type: 11x, 18x, 21x, 41x) what is the liability notice is referred
Medicare Part A (types of bill (TOB) 11x, 18x, 21x, and 41x); but,
to as?
the services at issue no longer meet coverage guidelines, such
as for exceeding the number of covered days in a spell of illness.
a. ABN
In hospitals, these notices are known as Hospital Issued Notice
b. HHABNs
of Non-coverage (HINNs) or hospital notices of non-coverage, in
c. HINN
Skilled Nursing Facilities (SNFs), they may be known as Sarrassat
d. NEMB
notices.
What will failure to supply an ABN to a patient when required will
result in? a. The provider not being able to shift cost to the patient
a. The provider not being able to shift cost to the patient According to CMS, providers must supply a liability notice if ser-
b. The patient being responsible for the non-covered services vices delivered to a Medicare beneficiary are to be reduced or
c. The provider being responsible for both covered & non cov- terminated following delivery of covered care, or thought not to be
ered-charges covered. Failure to provide such notices when required means the
d. The patient being responsible for both covered & non cov- provider will not be able to shift liability to the beneficiary.
ered-charges
b. I, III, and IV
Which staff member would use the PEPPER report?
The PEPPER report outlines services and discharges that might
fall outside the normal expected range and thus be subject to
I. Compliance officer
improper payment. The PEPPER report can identify areas of
II. Risk Management
specific concern, such as: significant changes in billing practices,
III. Coder
possible over- or under-coding, and changes in lengths of stay. The
IV. Quality Assurance
compliance officer can use this information to monitor compliance
and the quality assurance officer can make sure the facility is
a. I and II
remaining within the expected field. This is also a way for the
b. I, III, and IV
compliance officer to know what DRG's may be pulled for audit
c. III and IV
in coming audit periods. The compliance officer can work with the
d. III
coders in the HIM department if any coding issues are identified
in the PEPPER report.
What is the first level of appeal for traditional Medicare called and d. Redetermination, 120 days
how many days does the appellant have after the receipt of the
initial determination to file the request for appeal? The first level of the original Medicare appeal process is known as
the Redetermination process. The first level of appeal is conducted
a. Reconsideration, 120 days by independent staff of the Medicare Administrative Contractor,
b. Redetermination, 180 days responsible for making the original determination. The appellant
