What document is referenced to when looking for potential problem areas
identified by the government indicating scrutiny of the services within the
... [Show More] 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.) [Show Less]