Medical Coding Training - CPC Final Exam Test Bank - Questions And Answers
Question 1
10 out of 10 points
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?
Selected d.
Answer: ABN
Correct d.
Answer: ABN
Response Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare
Feedback: 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.
Question 2
10 out of 10 points
Which statement describes a medically necessary service?
Selected b.
Answer: Using the least radical service/procedure that allows for effective treatment of
the patient’s complaint or condition.
Correct b.
Answer: Using the least radical service/procedure that allows for effective treatment of
the patient’s complaint or condition.
Response Rationale: Medical necessity is using the least radical services/procedure that
Feedback: allows for effective treatment of the patient’s complaint or condition.
Question 3
10 out of 10 points
What document assists provider offices with the development of Compliance Manuals?
Selected a.
Answer: OIG Compliance Plan Guidance
Correct a.
Answer: OIG Compliance Plan Guidance
Response Rationale: The OIG has offered compliance program guidance to form the
Feedback: basis of a voluntary compliance program for physician offices. Although this
was released in October 2000, it is still active compliance guidance today.
Question 4
10 out of 10 points
Under HIPAA, what would be a policy requirement for “minimum necessary”?
Selected a.
Answer: Only individuals whose job requires it may have access to protected health
information.
Correct a.
Answer: Only individuals whose job requires it may have access to protected health
information.
Response Rationale: It is the responsibility of a covered entity to develop and implement
Feedback: 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.
, Question 5
10 out of 10 points
According to the example LCD from Novitas Solutions, measurement of vitamin D levels is
indicated for patients with which condition?
Selected b.
Answer: fibromyalgi
a
Correct b.
Answer: fibromyalgi
a
Response Rationale: According to the LCD, measurement of vitamin D levels is
Feedback: indicated for patients with fibromyalgia.
Question 6
10 out of 10 points
Select the TRUE statement regarding ABNs.
Selected a.
Answer: ABNs may not be recognized by non-Medicare payers.
Correct a.
Answer: ABNs may not be recognized by non-Medicare payers.
Response Rationale: ABNs may not be recognized by non-Medicare payers. Providers
Feedback: should review their contracts to determine which payers will accept an ABN
for services not covered.
Question 7
10 out of 10 points
Who would NOT be considered a covered entity under HIPAA?
Selected d.
Answer: Patients
Correct d.
Answer: Patients
Response Rationale: Covered entities in relation to HIPAA include Health Care Providers,
Feedback: Health Plans, and Health Care Clearinghouses. The patient is not considered a
covered entity although it is the patient’s data that is protected.
Question 8
10 out of 10 points
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?
Selected c.
Answer: $100 or 25 percent
Correct c.
Answer: $100 or 25 percent
Response Rationale: CMS instructions stipulate, “Notifiers must make a good faith effort
Feedback: to insert a reasonable estimate…the estimate should be within $100 or 25
percent of the actual costs, whichever is greater.”
Question 9
10 out of 10 points
Which act was enacted as part of the American Recovery and Reinvestment Act of 2009
, (ARRA) and affected privacy and security?
Selected b.
Answer: HITECH
Correct b.
Answer: HITECH
Response Rationale: The Health Information Technology for Economic and Clinical Health
Feedback Act (HITECH) was enacted as a part of the American Recovery and
: Reinvestment Act of 2009 (ARRA) to promote the adoption and meaningful use
of health information technology. Portions of HITECH strengthen HIPAA rules by
addressing privacy and security concerns associated with the electronic
transmission of health information.
Question 10
10 out of 10 points
What document is referenced to when looking for potential problem areas identified by the
government indicating scrutiny of the services within the coming year?
Selected c.
Answer: OIG Work Plan
Correct c.
Answer: OIG Work Plan
Response Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for
Feedback: the fiscal year ahead. Within the Work Plan, potential problem areas with
claims submissions are listed and will be targeted with special scrutiny.
Sunday, November 19, 2017 9:04:26 AM MST
The minimum necessary rule applies to
Selected b.
Answer: Disclosures to or requests by a health care provider for treatment purposes.
Correct d.
Answer: Covered entities taking reasonable steps to limit use or disclosure of PHI
Response Rationale: The Privacy Rule generally requires covered entities to take
Feedback reasonable steps to limit the use or disclosure of, and requests for, protected
: health information to the minimum necessary to accomplish the intended
purpose. The minimum necessary standard does not apply to the following:
· Disclosures to or requests by a health care provider for treatment
purposes.
· Disclosures to the individual who is the subject of the information.
· Uses or disclosures made pursuant to an individual’s authorization.
· Uses or disclosures required for compliance with the Health Insurance
Portability and Accountability Act (HIPAA) Administrative Simplification Rules.
· Disclosures to the Department of Health & Human Services (HHS) when
disclosure of information is required under the Privacy Rule for enforcement
purposes.
· Uses or disclosures that are required by other law.
Question 2
0 out of 4 points
According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of
professional conduct?
, Selected d.
Answer: Commitmen
t
Correct b.
Answer: Efficiency
Response Rationale: It shall be the responsibility of every AAPC member, as a condition
Feedback: of continued membership, to conduct themselves in all professional activities
in a manner consistent with ALL of the following ethical principles of
professional conduct:
·
· Integrity
· Respect
· Commitment
· Competence
· Fairness
· Responsibility
Question 3
0 out of 4 points
How many components are included in an effective compliance plan?
Selected c.
Answer: 9
Correct d.
Answer: 7
Response Rationale: The following list of components, as set forth in previous OIG
Feedback: 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.
Question 4
4 out of 4 points
According to the OIG, internal monitoring and auditing should be performed by what
means?
Question 1
10 out of 10 points
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?
Selected d.
Answer: ABN
Correct d.
Answer: ABN
Response Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare
Feedback: 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.
Question 2
10 out of 10 points
Which statement describes a medically necessary service?
Selected b.
Answer: Using the least radical service/procedure that allows for effective treatment of
the patient’s complaint or condition.
Correct b.
Answer: Using the least radical service/procedure that allows for effective treatment of
the patient’s complaint or condition.
Response Rationale: Medical necessity is using the least radical services/procedure that
Feedback: allows for effective treatment of the patient’s complaint or condition.
Question 3
10 out of 10 points
What document assists provider offices with the development of Compliance Manuals?
Selected a.
Answer: OIG Compliance Plan Guidance
Correct a.
Answer: OIG Compliance Plan Guidance
Response Rationale: The OIG has offered compliance program guidance to form the
Feedback: basis of a voluntary compliance program for physician offices. Although this
was released in October 2000, it is still active compliance guidance today.
Question 4
10 out of 10 points
Under HIPAA, what would be a policy requirement for “minimum necessary”?
Selected a.
Answer: Only individuals whose job requires it may have access to protected health
information.
Correct a.
Answer: Only individuals whose job requires it may have access to protected health
information.
Response Rationale: It is the responsibility of a covered entity to develop and implement
Feedback: 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.
, Question 5
10 out of 10 points
According to the example LCD from Novitas Solutions, measurement of vitamin D levels is
indicated for patients with which condition?
Selected b.
Answer: fibromyalgi
a
Correct b.
Answer: fibromyalgi
a
Response Rationale: According to the LCD, measurement of vitamin D levels is
Feedback: indicated for patients with fibromyalgia.
Question 6
10 out of 10 points
Select the TRUE statement regarding ABNs.
Selected a.
Answer: ABNs may not be recognized by non-Medicare payers.
Correct a.
Answer: ABNs may not be recognized by non-Medicare payers.
Response Rationale: ABNs may not be recognized by non-Medicare payers. Providers
Feedback: should review their contracts to determine which payers will accept an ABN
for services not covered.
Question 7
10 out of 10 points
Who would NOT be considered a covered entity under HIPAA?
Selected d.
Answer: Patients
Correct d.
Answer: Patients
Response Rationale: Covered entities in relation to HIPAA include Health Care Providers,
Feedback: Health Plans, and Health Care Clearinghouses. The patient is not considered a
covered entity although it is the patient’s data that is protected.
Question 8
10 out of 10 points
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?
Selected c.
Answer: $100 or 25 percent
Correct c.
Answer: $100 or 25 percent
Response Rationale: CMS instructions stipulate, “Notifiers must make a good faith effort
Feedback: to insert a reasonable estimate…the estimate should be within $100 or 25
percent of the actual costs, whichever is greater.”
Question 9
10 out of 10 points
Which act was enacted as part of the American Recovery and Reinvestment Act of 2009
, (ARRA) and affected privacy and security?
Selected b.
Answer: HITECH
Correct b.
Answer: HITECH
Response Rationale: The Health Information Technology for Economic and Clinical Health
Feedback Act (HITECH) was enacted as a part of the American Recovery and
: Reinvestment Act of 2009 (ARRA) to promote the adoption and meaningful use
of health information technology. Portions of HITECH strengthen HIPAA rules by
addressing privacy and security concerns associated with the electronic
transmission of health information.
Question 10
10 out of 10 points
What document is referenced to when looking for potential problem areas identified by the
government indicating scrutiny of the services within the coming year?
Selected c.
Answer: OIG Work Plan
Correct c.
Answer: OIG Work Plan
Response Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for
Feedback: the fiscal year ahead. Within the Work Plan, potential problem areas with
claims submissions are listed and will be targeted with special scrutiny.
Sunday, November 19, 2017 9:04:26 AM MST
The minimum necessary rule applies to
Selected b.
Answer: Disclosures to or requests by a health care provider for treatment purposes.
Correct d.
Answer: Covered entities taking reasonable steps to limit use or disclosure of PHI
Response Rationale: The Privacy Rule generally requires covered entities to take
Feedback reasonable steps to limit the use or disclosure of, and requests for, protected
: health information to the minimum necessary to accomplish the intended
purpose. The minimum necessary standard does not apply to the following:
· Disclosures to or requests by a health care provider for treatment
purposes.
· Disclosures to the individual who is the subject of the information.
· Uses or disclosures made pursuant to an individual’s authorization.
· Uses or disclosures required for compliance with the Health Insurance
Portability and Accountability Act (HIPAA) Administrative Simplification Rules.
· Disclosures to the Department of Health & Human Services (HHS) when
disclosure of information is required under the Privacy Rule for enforcement
purposes.
· Uses or disclosures that are required by other law.
Question 2
0 out of 4 points
According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of
professional conduct?
, Selected d.
Answer: Commitmen
t
Correct b.
Answer: Efficiency
Response Rationale: It shall be the responsibility of every AAPC member, as a condition
Feedback: of continued membership, to conduct themselves in all professional activities
in a manner consistent with ALL of the following ethical principles of
professional conduct:
·
· Integrity
· Respect
· Commitment
· Competence
· Fairness
· Responsibility
Question 3
0 out of 4 points
How many components are included in an effective compliance plan?
Selected c.
Answer: 9
Correct d.
Answer: 7
Response Rationale: The following list of components, as set forth in previous OIG
Feedback: 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.
Question 4
4 out of 4 points
According to the OIG, internal monitoring and auditing should be performed by what
means?
