AAPC CPC Chapter 1 | with 100%
Correct Answers and rationale
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.) Correct Answer: 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
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.) Correct Answer: 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?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN
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.)
Correct Answer: 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.
B (Rationale: Medical necessity is using the least radical services/procedure that allows for
effective treatment of the patient's complaint or condition.) Correct Answer: 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.
C (Rationale: According to the LCD, Chronic venous insufficiency is a systemic condition that
may result in the need for routine foot care.) Correct Answer: 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
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.") Correct Answer: 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
B Correct Answer: 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
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.) Correct Answer: 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: 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.) Correct
Answer: 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.
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.) Correct Answer: Who would NOT be considered a covered
entity under HIPAA?
A) Doctors
Correct Answers and rationale
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.) Correct Answer: 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
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.) Correct Answer: 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?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN
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.)
Correct Answer: 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.
B (Rationale: Medical necessity is using the least radical services/procedure that allows for
effective treatment of the patient's complaint or condition.) Correct Answer: 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.
C (Rationale: According to the LCD, Chronic venous insufficiency is a systemic condition that
may result in the need for routine foot care.) Correct Answer: 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
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.") Correct Answer: 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
B Correct Answer: 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
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.) Correct Answer: 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: 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.) Correct
Answer: 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.
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.) Correct Answer: Who would NOT be considered a covered
entity under HIPAA?
A) Doctors
