(answered) AAPC CPC exam Compliance and Regulatory
2022.
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 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
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
C (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.)
2022.
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 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
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
C (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.)
