CPC final exam prep questions-CPCO Medical Coding Training-AAPC,
American Academy of Professional Coders
• 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 Answer: d.
ABN
Correct Answer: d.
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
Feedback: that 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 Answer: a.
OIG Compliance Plan Guidance
Correct Answer: a.
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 Answer: b.
fibromyalgia
Correct Answer: b.
fibromyalgia
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 Answer: a.
ABNs may not be recognized by non-Medicare payers.
Correct Answer: a.
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 Answer: d.
Patients
Correct Answer: d.
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 Answer: c.
$100 or 25 percent
, Correct Answer: c.
$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 Answer: b.
HITECH
Correct Answer: b.
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 Answer: c.
OIG Work Plan
Correct Answer: c.
OIG Work Plan
Response Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities
Feedback: for 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 Answer: b.
Disclosures to or requests by a health care provider for treatment purposes.
Correct Answer: d.
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 Answer: d.
Commitment
Correct Answer: b.
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 Answer: c.
9
Correct Answer: d.
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
American Academy of Professional Coders
• 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 Answer: d.
ABN
Correct Answer: d.
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
Feedback: that 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 Answer: a.
OIG Compliance Plan Guidance
Correct Answer: a.
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 Answer: b.
fibromyalgia
Correct Answer: b.
fibromyalgia
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 Answer: a.
ABNs may not be recognized by non-Medicare payers.
Correct Answer: a.
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 Answer: d.
Patients
Correct Answer: d.
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 Answer: c.
$100 or 25 percent
, Correct Answer: c.
$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 Answer: b.
HITECH
Correct Answer: b.
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 Answer: c.
OIG Work Plan
Correct Answer: c.
OIG Work Plan
Response Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities
Feedback: for 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 Answer: b.
Disclosures to or requests by a health care provider for treatment purposes.
Correct Answer: d.
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 Answer: d.
Commitment
Correct Answer: b.
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 Answer: c.
9
Correct Answer: d.
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
