CPC Exam Study Guide – Compliance & Regulatory Section
1. What document is referenced to when looking for C (Rationale: Twice a year,
the OIG
potentialproblem areas identified by the govern- releases a Work Plan
outlining its
ment indicatingscrutiny of the services within the priorities for the fiscal
year ahead.
coming year?: information.
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C)OIG Work Plan
D) OIG Investigation Plan
2. What form is provided to a patient to
indicate a servicemay not be covered by
Medicare and the patient may be
responsible for the charges?:
A) LCD
B) CMS-1500
C)UB-04
D) ABN
3. Under HIPAA, what would be a policy
require- ment 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
pro- tected health information.
D) Anyone within the provider's office can
have access to protected health
, CPC Exam Study Guide – Compliance & Regulatory Section
Within the Work Plan, potential problem areas with claims sub- missions A (Rationale: It is the responsibil-
are listed and will be tar- geted with special scrutiny.) ity of a covered entity to devel-
op and implement policies, best
suited to its particular circum-
D (Rationale: An Advanced Bene- ficiary Notice (ABN) is used when a stances to meet HIPAA require-
Medicare beneficiary requests or agrees to receive a procedure or service ments. As a policy requirement,
that Medicare may not cov- er. This form notifies the patient of potential out only those individuals whose job
of pocket costs for the patient.) requires it may have access to pro-
tected health information.)
4. Which statement describes a medically necessary B (Rationale: Medical
necessity
service? : is using the least radical ser-
A) Performing a procedure/service based on cost vices/procedure that allows
for ef-
, CPC Exam Study Guide – Compliance & Regulatory Section
to eliminate wasteful services. fective treatment of the patient's
B) Using the least radical service/procedure complaint or condition.)
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.
5. According to the example LCD from Novitas Solu- B (Rationale: According to
the LCD,
tions, which of the following conditions is consid- Chronic venous insuflciency
is a
ered a systemic condition that may result systemic condition that may result
in the need for routine foot care? : in the need for routine foot
A) arthritis care.)
B) chronic venous insufficiency
C)hypertension
D) muscle weakness
6. When presenting a cost estimate on an ABN for a C (Rationale: CMS
instructions
potentially noncovered service, the cost estimate stipulate, "Notifiers must
make
should be within what range of the actual Act of 2009
cost? (ARRA) and
A) $25 or 10 percent affected privacy
B) $100 or 10 percent and security? :
C)$100 or 25 percent A) HIPAA
D) An exact amount B) HITECH
7. Which act was enacted as part of the
American Recovery and Reinvestment
1. What document is referenced to when looking for C (Rationale: Twice a year,
the OIG
potentialproblem areas identified by the govern- releases a Work Plan
outlining its
ment indicatingscrutiny of the services within the priorities for the fiscal
year ahead.
coming year?: information.
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C)OIG Work Plan
D) OIG Investigation Plan
2. What form is provided to a patient to
indicate a servicemay not be covered by
Medicare and the patient may be
responsible for the charges?:
A) LCD
B) CMS-1500
C)UB-04
D) ABN
3. Under HIPAA, what would be a policy
require- ment 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
pro- tected health information.
D) Anyone within the provider's office can
have access to protected health
, CPC Exam Study Guide – Compliance & Regulatory Section
Within the Work Plan, potential problem areas with claims sub- missions A (Rationale: It is the responsibil-
are listed and will be tar- geted with special scrutiny.) ity of a covered entity to devel-
op and implement policies, best
suited to its particular circum-
D (Rationale: An Advanced Bene- ficiary Notice (ABN) is used when a stances to meet HIPAA require-
Medicare beneficiary requests or agrees to receive a procedure or service ments. As a policy requirement,
that Medicare may not cov- er. This form notifies the patient of potential out only those individuals whose job
of pocket costs for the patient.) requires it may have access to pro-
tected health information.)
4. Which statement describes a medically necessary B (Rationale: Medical
necessity
service? : is using the least radical ser-
A) Performing a procedure/service based on cost vices/procedure that allows
for ef-
, CPC Exam Study Guide – Compliance & Regulatory Section
to eliminate wasteful services. fective treatment of the patient's
B) Using the least radical service/procedure complaint or condition.)
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.
5. According to the example LCD from Novitas Solu- B (Rationale: According to
the LCD,
tions, which of the following conditions is consid- Chronic venous insuflciency
is a
ered a systemic condition that may result systemic condition that may result
in the need for routine foot care? : in the need for routine foot
A) arthritis care.)
B) chronic venous insufficiency
C)hypertension
D) muscle weakness
6. When presenting a cost estimate on an ABN for a C (Rationale: CMS
instructions
potentially noncovered service, the cost estimate stipulate, "Notifiers must
make
should be within what range of the actual Act of 2009
cost? (ARRA) and
A) $25 or 10 percent affected privacy
B) $100 or 10 percent and security? :
C)$100 or 25 percent A) HIPAA
D) An exact amount B) HITECH
7. Which act was enacted as part of the
American Recovery and Reinvestment
