BUSINESS OF MEDICINE EXAM
UPDATED QUESTIONS AND CORRECT
ANSWERS.
Who would be considered a covered entity by HIPPA? - ANS Clearinghouse, HMO's, and
Doctors
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? - ANS ABN
What document has been created to assist physician offices with the development of
Compliance Manuals? - ANS OIG Compliance Plan Guidance released in October 2000.
True or False: ABN's may not be recognized by non-Medicare Payers. - ANS True.
Which Act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA)
and affected privacy and security? - ANS HITECH
Under HIPPA, what would be a policy requirement for "Minimum Necessary"? - ANS Only
individuals whose job requires it may have access to protected health information.
What is considered medical necessity? - ANS using the least radical services/procedure that
allows for both effective treatment of the patient's complaint or condition.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, Measurement of Vitamin D levels is indicated for patient's with which condition? -
ANS Fibromyalgia
What document should be referred to when looking for potential problem areas identified by
the government indicating scrutiny of the services within the coming year? - ANS OIG Work
Plan
When presenting a cost estimate on an ABN for a potentially non-covered service, the cost
estimate should be within what range of the actual cost? - ANS $100 or 25% whichever is
greater
What does the minimum necessary standard require? - ANS covered entities are to evaluate
their practices and enhance safeguards as needed to limit unnecessary or inappropriate access
to and disclosure of protected health information.
According to the OIG, internal monitoring and auditing should be performed by what means? -
ANS Periodic Audits
Local Coverage Determinations(LCD) are administered by whom? - ANS Each Regional
MAC(Medicare Administrative Contractor). They are responsible for interpreting national
policies into regional policies
What does CMS-HCC stand for? - ANS Centers for Medicare and Medicaid Services-
Hierarchal Condition Category.
According to AAPC's Code of Ethics, a member shall use only ____ and _____ means in all
professional dealings: - ANS legal and ethical
When coding an operative report, which parts should be used to further clarify or define both
procedures and diagnosis? - ANS Detail of Procedure.
What does EHR stand for? - ANS Electronic Health Record
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
UPDATED QUESTIONS AND CORRECT
ANSWERS.
Who would be considered a covered entity by HIPPA? - ANS Clearinghouse, HMO's, and
Doctors
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? - ANS ABN
What document has been created to assist physician offices with the development of
Compliance Manuals? - ANS OIG Compliance Plan Guidance released in October 2000.
True or False: ABN's may not be recognized by non-Medicare Payers. - ANS True.
Which Act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA)
and affected privacy and security? - ANS HITECH
Under HIPPA, what would be a policy requirement for "Minimum Necessary"? - ANS Only
individuals whose job requires it may have access to protected health information.
What is considered medical necessity? - ANS using the least radical services/procedure that
allows for both effective treatment of the patient's complaint or condition.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, Measurement of Vitamin D levels is indicated for patient's with which condition? -
ANS Fibromyalgia
What document should be referred to when looking for potential problem areas identified by
the government indicating scrutiny of the services within the coming year? - ANS OIG Work
Plan
When presenting a cost estimate on an ABN for a potentially non-covered service, the cost
estimate should be within what range of the actual cost? - ANS $100 or 25% whichever is
greater
What does the minimum necessary standard require? - ANS covered entities are to evaluate
their practices and enhance safeguards as needed to limit unnecessary or inappropriate access
to and disclosure of protected health information.
According to the OIG, internal monitoring and auditing should be performed by what means? -
ANS Periodic Audits
Local Coverage Determinations(LCD) are administered by whom? - ANS Each Regional
MAC(Medicare Administrative Contractor). They are responsible for interpreting national
policies into regional policies
What does CMS-HCC stand for? - ANS Centers for Medicare and Medicaid Services-
Hierarchal Condition Category.
According to AAPC's Code of Ethics, a member shall use only ____ and _____ means in all
professional dealings: - ANS legal and ethical
When coding an operative report, which parts should be used to further clarify or define both
procedures and diagnosis? - ANS Detail of Procedure.
What does EHR stand for? - ANS Electronic Health Record
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
