AAPC CPC Chapter 1 Test Review

Question 1_4 out of 4 points What is the value of a remittance advice? Selected Answer: c. It states what will be paid and why any changes to charges were made. Correct Answer: c. It states what will be paid and why any changes to charges were made. Response Feedback: Rationale: The determination of the payer is sent to the provider in the form of a remittance advice. The remittance advice explains the outcome of the insurance adjudication on the claim, including the payment amount, contractual adjustments and reason(s) for denial.  Question 2_4 out of 4 points What is the purpose of National Coverage Determinations? Selected Answer: d. To explain CMS policies on when Medicare will pay for items or services. Correct Answer: d. To explain CMS policies on when Medicare will pay for items or services. Response Feedback: Rationale: National Coverage Determinations (NCD) explain CMS policies on when Medicare will pay for items or services.  Question 3_4 out of 4 points How many components are included in an effective compliance plan? Selected Answer: d. 7 Correct Answer: d. 7 Response Feedback: Rationale: The following list of components, as set forth in previous OIG Compliance Program Guidance for Individual and Small Group Physician Practices, can form the basis of a voluntary compliance program for a provider practice: • Conducting internal monitoring and auditing through the performance of periodic audits; • Implementing compliance and practice standards through the development of written standards and procedures; • Designating a compliance officer or contact(s) to monitor compliance efforts and enforce practice standards; • Conducting appropriate training and education on practice standards and procedures; • Responding appropriately to detected violations through the investigation of allegations and the disclosure of incidents to appropriate Government entities; • Developing open lines of communication, such as (1) discussions at staff meetings regarding how to avoid erroneous or fraudulent conduct, and (2) community bulletin boards, to keep practice employees updated regarding compliance activities; and • Enforcing disciplinary standards through well-publicized guidelines. These seven components provide a solid basis upon which a provider practice can create a compliance program.