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 ... [Show More] with claims submissions are listed and will be targeted with special scrutiny.)
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.)
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.)
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.)
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.)
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.")
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
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.)
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.)
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.)
Who would NOT be considered a covered entity under HIPAA?
A) Doctors
C) HMOs
D) Clearinghouses
E) Patients
C
What type of profession, other than coding, might skilled coders enter?:
A) Physicians, insurance carriers, nurses
B) Front desk personnel, HR dept
C) Consultants, educators, medical auditors
D) None of the above
D
What is the difference between outpatient and inpatient coding?:
A) Outpatient coders use ICD-10-CM and ICD-10-PCS.
B) Outpatient coders only focuse on hospital services and Inpatient coders focuse on physician services.
C) Inpatient coders have more interaction than Outpatient coders.
D) Inpatient coders use ICD-10-CM and ICD-10-PCS.
C
What is a mid-level provider?
A) Non-licensed PAs
B) Physician withholder
C) Mid-level providers include physician assistants (PA) and nurse practitioners (NP).
D) NPs with Bachelor's Degree
B
What are the different parts of Medicare?
A) Part A, B, D
B) Part A, B, C, D
C) Part E, F, G, H
D) Part A and B
A
Evaluation and management (E/M) services are often provided and documented in a standard format. One such format is SOAP notes. What does SOAP represent?
A) Subjective, Objective, Assessment, Plan
B) Statement, Observation, Action, Prepare
C) Symptoms, Objective, Auscultation, Percussion
D) Subjective, Observation, Action, Plan
B
What are five tips for coding operative (op) reports?
A) Look for key words, Ignore unfamiliar words, Skip the body, Ignore pathology reports, Only code procedures from the header
B) Diagnosis code reporting, Start with the procedures listed, Look for key words, Highlight unfamiliar words, Read the body
C) Highlight familiar words, Look for key words, Read the body, Only code what you have highlighted, Code procedure only
D) Read the headers only, Look for key words, Highlight familiar words, Ignore pathology report, Code diagnosis only
D
What is medical necessity?:
A) Services to a Medicare beneficiary that are billed for unreasonable and unnecessary treatment.
B) The most radical service/procedure that allows for effective treatment of the patient's complaint or condition.
C) Something insurance plans do not care about.
D) Relates to whether a procedure or service is considered appropriate in a given circumstance.
C
What is not a common reason Medicare may deny a procedure or service?:
A) Patient's condition
B) Frequently proposed
C) Covered service
D) Experimental
C
Under the Privacy Rule, the minimum necessary standard does NOT apply to what type of disclosures?:
A) Uses or disclosures to drug companies.
B) Disclosures to or requests by family members.
C) Disclosures to the individual who is the subject of the information.
D) Uses or disclosures to insurance companies.
B
Which is not one of the seven key components of an internal compliance plan?:
A) Develop open lines of communication.
B) Conduct training but not perform education on practice standards and procedures.
C) Enforce disciplinary standards through well-publicized guidelines.
D) Conduct internal monitoring and auditing through the performance of periodic audits.
A
The ____describes whether specific medical items, services, treatment procedures or technologies are considered medically necessary under Medicare:
A) National Coverage Determinations Manual
B) Internet Only Manual
C) Medicare Severity-Diagnosis Related Groups (MS-DRG)
D) Medicare Physician Fee Schedule [Show Less]
