AAPC CPC Chapter 1 Test Questions with Verified Answers
Rated A
What document is referenced to when looking for whose job requires it may have access to
potential problem areas identified by the protected health information.)
government indicating scrutiny of the services
within the coming year?:
A) OIG Compliance Plan Guidance Which statement describes a medically
B) OIG Security Summary necessary service? :
C) OIG Work Plan A) Performing a procedure/service based on cost
D) OIG Investigation Plan - ANSWER -C to eliminate wasteful services.
(Rationale: Twice a year, the OIG releases a B) Using the least radical service/procedure that
allows for effective treatment of the patient's
Work Plan outlining its priorities for the fiscal year
ahead. Within the Work Plan, potential problem complaint or condition.
areas with claims submissions are listed and will C) Using the closest facility to perform a service
be targeted with special scrutiny.) or procedure.
D) Using the appropriate course of treatment to fit
within the patient's lifestyle. - ANSWER -B
What form is provided to a patient to indicate a (Rationale: Medical necessity is using the least
service may not be covered by Medicare and the radical services/procedure that allows for
patient may be responsible for the charges?: effective treatment of the patient's complaint or
A) LCD condition.)
B) CMS-1500
C) UB-04
D) ABN - ANSWER -D (Rationale: An According to the example LCD from Novitas
Advanced Beneficiary Notice (ABN) is used Solutions, which of the following conditions is
when a Medicare beneficiary requests or agrees considered a systemic condition that may result
to receive a procedure or service that Medicare in the need for routine foot care? :
may not cover. This form notifies the patient of A) arthritis
potential out of pocket costs for the patient.) B) chronic venous insufficiency
C) hypertension
D) muscle weakness - ANSWER -C
Under HIPAA, what would be a policy (Rationale: According to the LCD, Chronic
requirement for "minimum necessary"? " venous insufficiency is a systemic condition that
A) Only individuals whose job requires it may may result in the need for routine foot care.)
have access to protected health information.
B) Only the patient has access to his or her own
protected health information. When presenting a cost estimate on an ABN for a
C) Only the treating provider has access to potentially noncovered service, the cost estimate
protected health information. should be within what range of the actual cost?
D) Anyone within the provider's office can have A) $25 or 10 percent
access to protected health information. - B) $100 or 10 percent
ANSWER -A (Rationale: It is the C) $100 or 25 percent
responsibility of a covered entity to develop and D) An exact amount - ANSWER -C
implement policies, best suited to its particular (Rationale: CMS instructions stipulate, "Notifiers
circumstances to meet HIPAA requirements. As must make a good faith effort to insert a
a policy requirement, only those individuals reasonable estimate...the estimate should be
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, AAPC CPC Chapter 1 Test Questions with Verified Answers
Rated A
within $100 or 25 percent of the actual costs,under HIPAA?
whichever is greater.") A) Doctors
C) HMOs
D) Clearinghouses
Which act was enacted as part of the American E) Patients - ANSWER -E (Rationale:
Recovery and Reinvestment Act of 2009 (ARRA) Covered entities in relation to HIPAA include
and affected privacy and security? : Health Care Providers, Health Plans, and Health
A) HIPAA Care Clearinghouses. The patient is not
B) HITECH considered a covered entity although it is the
C) SSA patient's data that is protected.)
D) PPACA - ANSWER -B
What type of profession, other than coding, might
What document assists provider offices with the skilled coders enter?:
development of Compliance Manuals? A) Physicians, insurance carriers, nurses
A) OIG Compliance Plan Guidance B) Front desk personnel, HR dept
B) OIG Work Plan C) Consultants, educators, medical auditors
C) OIG Suggested Rules and Regulations D) None of the above - ANSWER -C
D) OIG Internal Compliance Plan -
ANSWER -A (Rationale: The OIG has
offered compliance program guidance to form the What is the difference between outpatient and
basis of a voluntary compliance program for inpatient coding?:
physician offices. Although this was released inA) Outpatient coders use ICD-10-CM and ICD-
October 2000, it is still considered as active 10-PCS.
compliance guidance today.) B) Outpatient coders only focuse on hospital
services and Inpatient coders focuse on
physician services.
Select the TRUE statement regarding ABNs. C) Inpatient coders have more interaction than
A) ABNs may not be recognized by non- Outpatient coders.
Medicare payers. D) Inpatient coders use ICD-10-CM and ICD-10-
B) ABNs must be signed for emergency or urgent PCS. - ANSWER -D
care.
C) ABNs are not required to include an estimate
cost for the service. What is a mid-level provider?
D) ABNs should be routinely signed by Medicare A) Non-licensed PAs
Beneficiaries in case Medicare doesn't cover a B) Physician withholder
service. - ANSWER -A (Rationale: ABNs C) Mid-level providers include physician
may not be recognized by non-Medicare payers. assistants (PA) and nurse practitioners (NP).
Providers should review their contracts to D) NPs with Bachelor's Degree -
determine which payers will accept an ABN for ANSWER -C
services not covered.)
What are the different parts of Medicare?
Who would NOT be considered a covered entity A) Part A, B, D
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Rated A
What document is referenced to when looking for whose job requires it may have access to
potential problem areas identified by the protected health information.)
government indicating scrutiny of the services
within the coming year?:
A) OIG Compliance Plan Guidance Which statement describes a medically
B) OIG Security Summary necessary service? :
C) OIG Work Plan A) Performing a procedure/service based on cost
D) OIG Investigation Plan - ANSWER -C to eliminate wasteful services.
(Rationale: Twice a year, the OIG releases a B) Using the least radical service/procedure that
allows for effective treatment of the patient's
Work Plan outlining its priorities for the fiscal year
ahead. Within the Work Plan, potential problem complaint or condition.
areas with claims submissions are listed and will C) Using the closest facility to perform a service
be targeted with special scrutiny.) or procedure.
D) Using the appropriate course of treatment to fit
within the patient's lifestyle. - ANSWER -B
What form is provided to a patient to indicate a (Rationale: Medical necessity is using the least
service may not be covered by Medicare and the radical services/procedure that allows for
patient may be responsible for the charges?: effective treatment of the patient's complaint or
A) LCD condition.)
B) CMS-1500
C) UB-04
D) ABN - ANSWER -D (Rationale: An According to the example LCD from Novitas
Advanced Beneficiary Notice (ABN) is used Solutions, which of the following conditions is
when a Medicare beneficiary requests or agrees considered a systemic condition that may result
to receive a procedure or service that Medicare in the need for routine foot care? :
may not cover. This form notifies the patient of A) arthritis
potential out of pocket costs for the patient.) B) chronic venous insufficiency
C) hypertension
D) muscle weakness - ANSWER -C
Under HIPAA, what would be a policy (Rationale: According to the LCD, Chronic
requirement for "minimum necessary"? " venous insufficiency is a systemic condition that
A) Only individuals whose job requires it may may result in the need for routine foot care.)
have access to protected health information.
B) Only the patient has access to his or her own
protected health information. When presenting a cost estimate on an ABN for a
C) Only the treating provider has access to potentially noncovered service, the cost estimate
protected health information. should be within what range of the actual cost?
D) Anyone within the provider's office can have A) $25 or 10 percent
access to protected health information. - B) $100 or 10 percent
ANSWER -A (Rationale: It is the C) $100 or 25 percent
responsibility of a covered entity to develop and D) An exact amount - ANSWER -C
implement policies, best suited to its particular (Rationale: CMS instructions stipulate, "Notifiers
circumstances to meet HIPAA requirements. As must make a good faith effort to insert a
a policy requirement, only those individuals reasonable estimate...the estimate should be
1/6
, AAPC CPC Chapter 1 Test Questions with Verified Answers
Rated A
within $100 or 25 percent of the actual costs,under HIPAA?
whichever is greater.") A) Doctors
C) HMOs
D) Clearinghouses
Which act was enacted as part of the American E) Patients - ANSWER -E (Rationale:
Recovery and Reinvestment Act of 2009 (ARRA) Covered entities in relation to HIPAA include
and affected privacy and security? : Health Care Providers, Health Plans, and Health
A) HIPAA Care Clearinghouses. The patient is not
B) HITECH considered a covered entity although it is the
C) SSA patient's data that is protected.)
D) PPACA - ANSWER -B
What type of profession, other than coding, might
What document assists provider offices with the skilled coders enter?:
development of Compliance Manuals? A) Physicians, insurance carriers, nurses
A) OIG Compliance Plan Guidance B) Front desk personnel, HR dept
B) OIG Work Plan C) Consultants, educators, medical auditors
C) OIG Suggested Rules and Regulations D) None of the above - ANSWER -C
D) OIG Internal Compliance Plan -
ANSWER -A (Rationale: The OIG has
offered compliance program guidance to form the What is the difference between outpatient and
basis of a voluntary compliance program for inpatient coding?:
physician offices. Although this was released inA) Outpatient coders use ICD-10-CM and ICD-
October 2000, it is still considered as active 10-PCS.
compliance guidance today.) B) Outpatient coders only focuse on hospital
services and Inpatient coders focuse on
physician services.
Select the TRUE statement regarding ABNs. C) Inpatient coders have more interaction than
A) ABNs may not be recognized by non- Outpatient coders.
Medicare payers. D) Inpatient coders use ICD-10-CM and ICD-10-
B) ABNs must be signed for emergency or urgent PCS. - ANSWER -D
care.
C) ABNs are not required to include an estimate
cost for the service. What is a mid-level provider?
D) ABNs should be routinely signed by Medicare A) Non-licensed PAs
Beneficiaries in case Medicare doesn't cover a B) Physician withholder
service. - ANSWER -A (Rationale: ABNs C) Mid-level providers include physician
may not be recognized by non-Medicare payers. assistants (PA) and nurse practitioners (NP).
Providers should review their contracts to D) NPs with Bachelor's Degree -
determine which payers will accept an ABN for ANSWER -C
services not covered.)
What are the different parts of Medicare?
Who would NOT be considered a covered entity A) Part A, B, D
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