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 responsibl... [Show More] e for the charges?
Selected
Answer:
Correct
Answer:
Response
Feedback:
d.
ABN
d.
ABN
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.
• Question 2
Which statement describes a medically necessary service?
10 out of 10 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
b.
Using the least radical service/procedure that allows for effective treatment of
the patient’s complaint or condition.
b.
Using the least radical service/procedure that allows for effective treatment of
the patient’s complaint or condition.
Rationale: Medical necessity is using the least radical services/procedure 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:
Correct
Answer:
Response
Feedback:
a.
OIG Compliance Plan Guidance
a.
OIG Compliance Plan Guidance
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 active compliance guidance today.
• Question 4
Under HIPAA, what would be a policy requirement for “minimum necessary”?
10 out of 10 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
a.
Only individuals whose job requires it may have access to protected health
information.
a.
Only individuals whose job requires it may have access to protected health
information.
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.
• 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:
Correct
Answer:
Response
Feedback:
b.
fibromyalgi
a
b.
fibromyalgi
a
Rationale: According to the LCD, measurement of vitamin D levels is
indicated for patients with fibromyalgia.
• Question 6
Select the TRUE statement regarding ABNs.
10 out of 10 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
a.
ABNs may not be recognized by non-Medicare payers.
a.
ABNs may not be recognized by non-Medicare payers.
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.
• Question 7
Who would NOT be considered a covered entity under HIPAA?
10 out of 10 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
d.
Patients
d.
Patients
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.
• 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:
Correct
Answer:
Response
Feedback:
c.
$100 or 25 percent
c.
$100 or 25 percent
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.”
• 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:
Correct
Answer:
Response
Feedback
:
b.
HITECH
b.
HITECH
Rationale: The Health Information Technology for Economic and Clinical Health
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:
Correct
Answer:
Response
Feedback:
c.
OIG Work Plan
c.
OIG Work Plan
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.
Sunday, November 19,20219:04:26 AM MST
•
The minimum necessary rule applies to
Selected
Answer:
Correct
Answer:
Response
Feedback
:
b.
Disclosures to or requests by a health care provider for treatment purposes.
d.
Covered entities taking reasonable steps to limit use or disclosure of PHI
Rationale: The Privacy Rule generally requires covered entities to take
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:
Correct
Answer:
Response
Feedback:
d.
Commitmen
t
b.
Efficiency
Rationale: It shall be the responsibility of every AAPC member, as a condition
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
How many components are included in an effective compliance plan?
0 out of 4 points
Selected c.
Answer: 9
Correct d.
Answer: 7
Response
Feedback:
Rationale: The following list of components, as set forth in previous OIG
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
meetings regarding how to avoid erroneous or fraudulent conduct, and (2)
community bulletin boards, to keep practice employees updated regarding
compliance activities; and
• Enforcing disciplinary standards through well-publicized guidelines.
These seven components provide a solid basis upon which a provider practice
can create a compliance program.
• Question 4
According to the OIG, internal monitoring and auditing should be performed by what
means?
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback
:
a.
Periodic audits.
a.
Periodic audits.
Rationale: A key component of an effective compliance program includes
internal monitoring and auditing through the performance of periodic audits.
This ongoing evaluation includes not only whether the provider practice’s
standards and procedures are in fact current and accurate, but also whether
the compliance program is working, (for example, whether individuals are
properly carrying out their responsibilities and claims are submitted
appropriately).
• Question 5
When coding an operative report, what action would NOT be recommended?
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
b.
Coding from the header without reading the body of the report.
b.
Coding from the header without reading the body of the report.
Rationale: Operative report coding tips include reviewing the documentation
in the detail of the procedure to further clarify or define both procedures and
diagnoses.
• Question 6
Which of the following choices is NOT a benefit of an active compliance plan?
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
a.
Eliminates risk of an audit.
a.
Eliminates risk of an audit.
Rationale: Although voluntary, a compliance plan may offer several benefits,
among them:
• Faster, more accurate payment of claims.
• Fewer billing mistakes.
• Diminished chances of a payer audit.
• Less chance of violating self-referral and anti-kickback statutes.
Additionally, the increased accuracy of provider documentation that may
result from a compliance program actually may assist in enhancing patient
care.
• Question 7
HIPAA stands for
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
d.
Health Insurance Portability and Accountability Act
d.
Health Insurance Portability and Accountability Act
Rationale: Health Insurance Portability and Accountability Act (HIPAA)
• Question 8
In what year was HITECH enacted as part of the American Recovery and Reinvestment
Act?
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback
:
a.
2009
a.
2009
Rationale: The Health Information Technology for Economic and Clinical Health
(HITECH) Act, enacted as part of the American Recovery and Reinvestment Act
of 2009, was signed into law on February 17, 2009, to promote the adoption
and meaningful use of health information technology.
• Question 9
The Medicare program is made up of several parts. Which part covers provider fees
without the use of a private insurer?
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback
:
d.
Part B
d.
Part B
Rationale: Medicare Part B helps to cover medically necessary provider
services, outpatient care and other medical services (including some
preventive services) not covered under Medicare Part A. Medicare Part B is an
optional benefit for which the patient pays a monthly premium, an annual
deductible, and generally has a 20% co-insurance except for preventive
services covered under the healthcare law.
• Question 10
4 out of 4 points
Healthcare providers are responsible for developing and policies and procedures
regarding privacy in their practices.
Selected
Answer:
Correct
Answer:
Response
Feedback:
c.
Notices of Privacy
Practices
c.
Notices of Privacy
Practices
Rationale: Healthcare providers are responsible for developing Notices of
Privacy Practices and policies and procedures regarding privacy in their
practices.
• Question 11
Evaluation and management services are often provided in a standard format such as
SOAP notes. What does the acronym SOAP stand for?
4 out of 4 points
Selected
Answer:
Correct
Answer:
c.
Subjective, Objective, Assessment, Plan
c.
Subjective, Objective, Assessment, Plan
Response
Feedback:
Rationale: S-Subjective, O-Objective, A-Assessment, P-Plan
• Question 12
What type of health insurance provides coverage for low-income families?
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
b.
Medicai
d
b.
Medicai
d
Rationale: Medicaid is a health insurance assistance program for some lowincome people (especially children and pregnant women) sponsored by
federal and state governments.
• Question 13
The OIG recommends that provider practices enforce disciplinary actions through well
publicized compliance guidelines to ensure actions that are .
0 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
a.
Frequent
b. Consistent
and
appropriate
Rationale: The OIG recommends that a provider practice’s enforcement and
disciplinary mechanisms ensure that violations of the practice’s compliance
policies will result in consistent and appropriate sanctions, including the
possibility of termination, against the offending individual.
• Question 14
What is the value of a remittance advice?
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
c.
It states what will be paid and why any changes to charges were made.
c.
It states what will be paid and why any changes to charges were made.
Rationale: The determination of the payer is sent to the provider in the form of
a remittance advice. The remittance advice explains the outcome of the
insurance adjudication on the claim, including the payment amount,
contractual adjustments and reason(s) for denial.
• Question 15
4 out of 4 points
HITECH provides a day window during which any violation not due to willful neglect
may be corrected without penalty.
Selected c.
Answer: 30
Correct c.
Answer: 30
Response
Feedback:
Rationale: HITECH also lowers the bar for what constitutes a violation, but
provides a 30-day window during which any violation not due to willful
neglect may be corrected without penalty.
• Question 16
AAPC credentialed coders have proven mastery of what information?
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
d.
All of the above
d.
All of the above
Rationale: AAPC credentialed coders have proven mastery of all code sets,
evaluation and management principles, and documentation guidelines.
• Question 17
What form is used to submit a provider’s charge to the insurance carrier?
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
d.
CMS-1500
d.
CMS-1500
Rationale: Once documentation is translated into codes, it is then sent on a
CMS-1500 form to the insurance carrier for reimbursement.
• Question 18
The minimum necessary rule is based on sound current practice that protected health
information should NOT be used or disclosed when it is not necessary to satisfy a
particular purpose or carry out a function. What does this mean?
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback
:
b.
Providers should develop safeguards to prevent unauthorized access to
protected health information.
b.
Providers should develop safeguards to prevent unauthorized access to
protected health information.
Rationale: The minimum necessary standard requires covered entities to
evaluate their practices and enhance safeguards as needed to limit
unnecessary or inappropriate access to and disclosure of protected health
information. Only those individuals whose job requires it may have access to
PHI. Only the minimum protected information required to do the job should be
shared.
• Question 19
What is the purpose of National Coverage Determinations?
0 out of 4 points
Selected
Answer:
Correct
Answer:
d.
To set standards for all payers on coverage items.
b.
To explain CMS policies on when Medicare will pay for items or services.
Response Rationale: National Coverage Determinations (NCD) explain CMS policies on
Feedback: when Medicare will pay for items or services.
• Question 20
Twice a year the OIG releases a outlining its priorities for the fiscal year ahead.
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
b.
Work Plan
b.
Work Plan
Rationale: The OIG Work Plan sets forth various projects to be addressed twice
during the fiscal year by the Office of Audit Services, Office of Evaluation and
Inspections, Office of Investigations, and Office of Counsel to the Inspector
General.
• Question 21
What will the scope of a compliance program depend on?
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
d.
The size and resources of the provider’s practice.
d.
The size and resources of the provider’s practice.
Rationale: The scope of a compliance program will depend on the size and
resources of the provider practice.
• Question 22
Which coding manuals do outpatient coders focus on learning?
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
a.
CPT®, HCPCS Level II and ICD-10-CM
a.
CPT®, HCPCS Level II and ICD-10-CM
Rationale: Outpatient coding focuses on provider services. Outpatient coders
will focus on learning CPT®, HCPCS Level II and ICD-10-CM.
• Question 23
What does CMS-HCC stand for?
4 out of 4 points
Selected
Answer:
Correct
Answer:
Response
Feedback:
c.
Centers for Medicare & Medicaid Services – Hierarchal Condition Category
c.
Centers for Medicare & Medicaid Services – Hierarchal Condition Category
Rationale: Centers for Medicare & Me [Show Less]
