AAPC CPC exam prep Compliance and Regulatory | with
100% Correct Answers
What document is referenced to when looking for potentialproblem areas identified by the
government indicatingscrutiny of the services within the coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan Correct Answer: 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 Correct Answer: 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. Correct
Answer: 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. Correct Answer:
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 Correct Answer: 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 Correct Answer: 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 Correct Answer: 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 Correct Answer: 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. Correct Answer: 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 Correct Answer: 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?:
100% Correct Answers
What document is referenced to when looking for potentialproblem areas identified by the
government indicatingscrutiny of the services within the coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan Correct Answer: 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 Correct Answer: 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. Correct
Answer: 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. Correct Answer:
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 Correct Answer: 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 Correct Answer: 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 Correct Answer: 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 Correct Answer: 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. Correct Answer: 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 Correct Answer: 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?:
