Download Q&A on Medicare, HIPAA, ABNs, and Coding and more Exams Medical Genetics in PDF only on Docsity!
AAPC CPC CHAPTER 1
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.) - correct answer 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.) - correct answer 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- C) UB- 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.) - correct answer 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.) - correct answer 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.) - correct answer 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.") - correct answer 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) HMOs D) Clearinghouses E) Patients C - correct answer 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 - correct answer 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 - correct answer 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 - correct answer 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 - correct answer 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 - correct answer 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 - correct answer 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 - correct answer What is not a common reason Medicare may deny a procedure or service?: A) Patient's condition
B) Efficiency C) Responsibility D) Commitment B - correct answer According to AAPC's Code of Ethics, an AAPC member shall use only ____ and ____ means in all professional dealings: A) private and professional B) legal and ethical C) legal and profitable D) efficient and inexpensive A - correct answer What is the definition of medical coding?: A) Translating documentation into numerical/alphanumerical codes used to obtain reimbursement. B) Deciphering explanation of benefits provided by an insurance carrier. C) Translating documentation into software compatible notes. D) Translating the services a provider performs into documentation. A - correct answer If an NCD does not exist for a particular service/procedure performed on a Medicare patient, who determines coverage?: A) Medicare Administrative Contractor (MAC) B) The physician providing the service C) Current Procedural Terminology (CPT®) guidelines D) Centers for Medicare & Medicaid Services (CMS) D - correct answer Many coding professionals go on to find work as: A) Accountants B) Medical Assistants C) Financial Planners
D) Consultants B - correct answer LCDs only have jurisdiction in their ____: A) Locality B) Region C) District D) State B - correct answer A covered entity does NOT include: A) Health plans B) Patients C) Healthcare providers D) Clearinghouses D - correct answer In what year was HITECH enacted as part of the American Recovery and Reinvestment Act?: A) 2010 B) 2000 C) 2007 D) 2009 D - correct answer HIPAA stands for: A) Health Insurance Portability and Accountant Advice B) Health Information Privacy Access Act C) Health Insurance Provider Assistance Action D) Health Insurance Portability and Accountability Act A - correct answer Which option below is NOT a covered entity under HIPAA?: A) Workers' Compensation
D) Part D C - correct answer When coding an operative report, what action would NOT be recommended?: A) Highlighting unfamiliar words. B) Starting with the procedure listed. C) Coding from the header without reading the body of the report. D) Reading the body of the report. C - correct answer Evaluation and management services are often provided in a standard format such as SOAP notes. What does the acronym SOAP stand for?: A) Scope, Observation, Action, Plan B) Source, Opinion, Advice, Provider C) Subjective, Objective, Assessment, Plan D) Standard, Objective, Activity, Period C - correct answer When are providers responsible for obtaining an ABN for a service NOT considered medically necessary?: A) After a denial has been received from Medicare. B) During a procedure or service. C) Prior to providing a service or item to a beneficiary. D) After providing a service or item to a beneficiary. B - correct answer The AAPC offers over 500 local chapters across the country for the purpose of: A) Membership dues B) Continuing education and networking C) Regulations and bylaws D) Financial management
A - correct answer Which provider is NOT a mid-level provider? A) Anesthesiologist B) All choices are mid-level providers C) Physician Assistant D) Nurse Practitioner B - correct answer What does MAC stands for?: A) Medicaid Administrative Contractor B) Medicare Administrative Contractor C) Medicare Advisory Contractor D) Medicaid Alert Contractor C - correct answer In what year did HIPAA become law?: A) 1992 B) 1997 C) 1996 D) 1995 D - correct answer HITECH provides a ____ day window during which any violation not due to willful neglect may be corrected without penalty: A) 40 B) 60 C) 45 D) 30 B - correct answer What form is used to submit a provider's charge to the insurance carrier?: A) UB- B) CMS-
