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
Answer: 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 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
(Rationale An Advanced Beneficiary Notice (ABN) is used when a
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,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.
Answer: 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
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, lifestyle.
Answer: 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
Answer: B
(Rationale: According to the LCD, Chronic venous insufficiency 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
Answer: C
(Rationale: CMS instructions stipulate, "Notifiers must make a good faith
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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
Answer: 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 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
(Rationale An Advanced Beneficiary Notice (ABN) is used when a
1/
17
,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.
Answer: 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
2/
17
, lifestyle.
Answer: 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
Answer: B
(Rationale: According to the LCD, Chronic venous insufficiency 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
Answer: C
(Rationale: CMS instructions stipulate, "Notifiers must make a good faith
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17
