AAPC CPC exam prep Compliance and
Regulatory
What document is referenced to when looking for potentialproblem areas identified by the government
indicatingscrutiny of the services within the coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Inves...
AAPC CPC exam prep Compliance and
Regulatory
What document is referenced to when looking for potentialproblem areas identified by the government
indicatingscrutiny of the services within the coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan Ans- 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 servicemay not be covered by Medicare and the patient
may be responsible for the charges?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN Ans- 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. Ans- 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. Ans- 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 Ans- B (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 Ans- 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 Ans- B
What document assists provider offices with the development of Compliance Manuals?
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