AAPC CPC exam prep Compliance and Regulatory

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

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.)

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

D (Rationale: An Advanced Beneficiary Notice (ABN) is used when a 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.)

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.

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.)

Which statement describes a medically necessary service? :

A) Performing a procedure/service based on cost to eliminate wasteful services.

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 lifestyle.

B (Rationale: Medical necessity is using the least radical services/procedure that allows for effective treatment of the patient's complaint or condition.)

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

B (Rationale: According to the LCD, Chronic venous insufficiency is a systemic condition that may result in the need for routine foot care.)

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

C (Rationale: CMS instructions stipulate, "Notifiers must make a good faith effort to insert a reasonable estimate...the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.")

Which act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and affected privacy and security? :

A) HIPAA

B) HITECH

C) SSA

D) PPACA

B

What document assists provider offices with the development of Compliance Manuals?

A) OIG Compliance Plan Guidance

B) OIG Work Plan

C) OIG Suggested Rules and Regulations

D) OIG Internal Compliance Plan

A (Rationale: The OIG has offered compliance program guidance to form the basis of a voluntary compliance program for physician offices. Although this was released in October 2000, it is still considered as active compliance guidance today.)

Select the TRUE statement regarding ABNs.

A) ABNs may not be recognized by non-Medicare payers.

B) ABNs must be signed for emergency or urgent care.

C) ABNs are not required to include an estimate cost for the service.

D) ABNs should be routinely signed by Medicare Beneficiaries in case Medicare doesn't cover a service.

A (Rationale: ABNs may not be recognized by non-Medicare payers. Providers should review their contracts to determine which payers will accept an ABN for services not covered.)

Who would NOT be considered a covered entity under HIPAA?

A) Doctors

C) HMOs

D) Clearinghouses

E) Patients

E (Rationale: Covered entities in relation to HIPAA include Health Care Providers, Health Plans, and Health Care Clearinghouses. The patient is not considered a covered entity although it is the patient's data that is protected.)

What type of profession, other than coding, might skilled coders enter?:

A) Physicians, insurance carriers, nurses

B) Front desk personnel, HR dept

C) Consultants, educators, medical auditors

D) None of the above

C

What is the difference between outpatient and inpatient coding?:

A) Outpatient coders use ICD-10-CM and ICD-10-PCS.

B) Outpatient coders only focuse on hospital services and Inpatient coders focuse on physician services.

C) Inpatient coders have more interaction than Outpatient coders.

D) Inpatient coders use ICD-10-CM and ICD-10-PCS.

D

What is a mid-level provider?

A) Non-licensed PAs

B) Physician withholder

C) Mid-level providers include physician assistants (PA) and nurse practitioners (NP).

D) NPs with Bachelor's Degree

C

What are the different parts of Medicare?

A) Part A, B, D

B) Part A, B, C, D

C) Part E, F, G, H

D) Part A and B

B

Evaluation and management (E/M) services are often provided and documented in a standard format. One such format is SOAP notes. What does SOAP represent?

A) Subjective, Objective, Assessment, Plan

B) Statement, Observation, Action, Prepare

C) Symptoms, Objective, Auscultation, Percussion

D) Subjective, Observation, Action, Plan

A

What are five tips for coding operative (op) reports?

A) Look for key words, Ignore unfamiliar words, Skip the body, Ignore pathology reports, Only code procedures from the header

B) Diagnosis code reporting, Start with the procedures listed, Look for key words, Highlight unfamiliar words, Read the body

C) Highlight familiar words, Look for key words, Read the body, Only code what you have highlighted, Code procedure only

D) Read the headers only, Look for key words, Highlight familiar words, Ignore pathology report, Code diagnosis only

B

What is medical necessity?:

A) Services to a Medicare beneficiary that are billed for unreasonable and unnecessary treatment.

B) The most radical service/procedure that allows for effective treatment of the patient's complaint or condition.

C) Something insurance plans do not care about.

D) Relates to whether a procedure or service is considered appropriate in a given circumstance.

D

What is not a common reason Medicare may deny a procedure or service?:

A) Patient's condition

B) Frequently proposed

C) Covered service

D) Experimental

C

Under the Privacy Rule, the minimum necessary standard does NOT apply to what type of disclosures?:

A) Uses or disclosures to drug companies.

B) Disclosures to or requests by family members.

C) Disclosures to the individual who is the subject of the information.

D) Uses or disclosures to insurance companies.

C

Which is not one of the seven key components of an internal compliance plan?:

A) Develop open lines of communication.

B) Conduct training but not perform education on practice standards and procedures.

C) Enforce disciplinary standards through well-publicized guidelines.

D) Conduct internal monitoring and auditing through the performance of periodic audits.

B

The ____describes whether specific medical items, services, treatment procedures or technologies are considered medically necessary under Medicare:

A) National Coverage Determinations Manual

B) Internet Only Manual

C) Medicare Severity-Diagnosis Related Groups (MS-DRG)

D) Medicare Physician Fee Schedule

A

According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of professional conduct?:

A) Integrity

B) Efficiency

C) Responsibility

D) Commitment

B

According to AAPC's Code of Ethics, an AAPC member shall use only ____ and ____ means in all professional dealings:

A) private and professional

B) legal and ethical

C) legal and profitable

D) efficient and inexpensive

B

What is the definition of medical coding?:

A) Translating documentation into numerical/alphanumerical codes used to obtain reimbursement.

B) Deciphering explanation of benefits provided by an insurance carrier.

C) Translating documentation into software compatible notes.

D) Translating the services a provider performs into documentation.

A

If an NCD does not exist for a particular service/procedure performed on a Medicare patient, who determines coverage?:

A) Medicare Administrative Contractor (MAC)

B) The physician providing the service

C) Current Procedural Terminology (CPT®) guidelines

D) Centers for Medicare & Medicaid Services (CMS)

A

Many coding professionals go on to find work as:

A) Accountants

B) Medical Assistants

C) Financial Planners

D) Consultants

D

LCDs only have jurisdiction in their ____:

A) Locality

B) Region

C) District

D) State

B

A covered entity does NOT include:

A) Health plans

B) Patients

C) Healthcare providers

D) Clearinghouses

B

In what year was HITECH enacted as part of the American Recovery and Reinvestment Act?:

A) 2010

B) 2000

C) 2007

D) 2009

D

HIPAA stands for:

A) Health Insurance Portability and Accountant Advice

B) Health Information Privacy Access Act

C) Health Insurance Provider Assistance Action

D) Health Insurance Portability and Accountability Act

D

Which option below is NOT a covered entity under HIPAA?:

A) Workers' Compensation

B) Medicaid

C) Medicare

D) BCBS

A

AAPC credentialed coders have proven mastery of what information?:

A) Code sets

B) Evaluation and management principles

C) Documentation guidelines

D) All of the above

D

What is PHI?:

A) Provider healthcare interchange

B) Private health insurance

C) Provider healthcare incident-to

D) Protected health information

D

Which of the following choices is NOT a benefit of an active compliance plan?:

A) Eliminates risk of an audit.

B) Fewer billing mistakes.

C) Increases accuracy of provider documentation.

D) Faster, more accurate payment of claims.

A

The Medicare program is made up of several parts. Which part covers provider fees without the use of a private insurer?:

A) Part B

B) Part A

C) Part C

D) Part D

A

When coding an operative report, what action would NOT be recommended?:

A) Highlighting unfamiliar words.

B) Starting with the procedure listed.

C) Coding from the header without reading the body of the report.

D) Reading the body of the report.

C

Evaluation and management services are often provided in a standard format such as SOAP notes. What does the acronym SOAP stand for?:

A) Scope, Observation, Action, Plan

B) Source, Opinion, Advice, Provider

C) Subjective, Objective, Assessment, Plan

D) Standard, Objective, Activity, Period

C

When are providers responsible for obtaining an ABN for a service NOT considered medically necessary?:

A) After a denial has been received from Medicare.

B) During a procedure or service.

C) Prior to providing a service or item to a beneficiary.

D) After providing a service or item to a beneficiary.

C

The AAPC offers over 500 local chapters across the country for the purpose of:

A) Membership dues

B) Continuing education and networking

C) Regulations and bylaws

D) Financial management

B

Which provider is NOT a mid-level provider?

A) Anesthesiologist

B) All choices are mid-level providers

C) Physician Assistant

D) Nurse Practitioner

A

What does MAC stands for?:

A) Medicaid Administrative Contractor

B) Medicare Administrative Contractor

C) Medicare Advisory Contractor

D) Medicaid Alert Contractor

B

In what year did HIPAA become law?:

A) 1992

B) 1997

C) 1996

D) 1995

C

HITECH provides a ____ day window during which any violation not due to willful neglect may be corrected without penalty:

A) 40

B) 60

C) 45

D) 30

D

What form is used to submit a provider's charge to the insurance carrier?:

A) UB-04

B) CMS-1500

C) Provider reimbursement form

D) ABN

B

Which of the following is a BENEFIT of electronic transactions?

A) Payment of claims

B) Security of claims

C) Timely submission of claims

D) None of the above

C