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AAPC CPC Exam Prep Compliance And Regulatory
Questions & Rationalized Answers 100% Correct
1. 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.)
2. 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-
C) UB-
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.)
3. Under HIPAA, what would be a policy requirement for "minimum neces-
sary"? "
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.)
4. Which statement describes a medically necessary service?
A) Performing a procedure/service based on cost to eliminate wasteful ser- vices.
B) Using the least radical service/procedure that allows for effective treat-
ment 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
reasonable estimate...the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.")
7. Which act was enacted as part of the American Recovery and Reinvest- ment
Act of 2009 (ARRA) and affected privacy and security?
A) HIPAA
B) HITECH
C) SSA
D) PPACA
ANS B
8. What document assists provider offices with the development of Compli- ance
Manuals?
A) OIG Compliance Plan Guidance
B) OIG Work Plan
C) OIG Suggested Rules and Regulations
D) OIG Internal Compliance Plan
ANS A (Rationale The OIG has offered compliance program guidance to form the basis of a voluntary compliance program for physi- cian offices. Although this was released in October 2000, it is still considered as active compliance guidance today.)
9. 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. ANS 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.)
10. Who would NOT be considered a covered entity under HIPAA?
A) Doctors
C) HMOs
D) Clearinghouses
E) Patients
ANS 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.)
11. 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
ANS C
12. 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
C) Symptoms, Objective, Auscultation, Percussion
D) Subjective, Observation, Action, Plan
ANS A
16. What are five tips for coding operative (op) reports?
A) Look for key words, Ignore unfamiliar words, Skip the body, Ignore pathol- ogy
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 ANS B
17. What is medical necessity?
ANS
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. ANS D
18. What is not a common reason Medicare may deny a procedure or ser- vice?
ANS
A) Patient's condition
B) Frequently proposed
C) Covered service
D) Experimental
ANS C
19. Under the Privacy Rule, the minimum necessary standard does NOT apply
to what type of disclosures? ANS
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.
ANS C
principle of professional conduct? ANS
A) Integrity
B) Efficiency
C) Responsibility
D) Commitment
ANS B
23. According to AAPC's Code of Ethics, an AAPC member shall use only
and means in all professional dealings ANS
A) private and professional
B) legal and ethical
C) legal and profitable
D) efficient and inexpensive
ANS B
24. What is the definition of medical coding?
ANS
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.
ANS A
25. If an NCD does not exist for a particular service/procedure performed on a
Medicare patient, who determines coverage? ANS
B) Patients
C) Healthcare providers
D) Clearinghouses
ANS B
29. In what year was HITECH enacted as part of the American Recovery and
Reinvestment Act? ANS A) 2010 B) 2000 C) 2007 D) 2009 ANS D
30. HIPAA stands for
ANS
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
ANS D
31. Which option below is NOT a covered entity under HIPAA?
ANS
A) Workers' Compensation
B) Medicaid
C) Medicare
D) BCBS
ANS A
32. AAPC credentialed coders have proven mastery of what information?
ANS
A) Code sets
B) Part A
C) Part C
D) Part D
ANS A
36. When coding an operative report, what action would NOT be recommend- ed?
ANS
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.
ANS C
37. Evaluation and management services are often provided in a standard
format such as SOAP notes. What does the acronym SOAP stand for? ANS
A) Scope, Observation, Action, Plan
B) Source, Opinion, Advice, Provider
C) Subjective, Objective, Assessment, Plan
D) Standard, Objective, Activity, Period
ANS C
38. When are providers responsible for obtaining an ABN for a service NOT
considered medically necessary? ANS
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.
ANS C
39. The AAPC offers over 500 local chapters across the country for the
purpose of ANS
A) Membership dues
B) Continuing education and networking
C) Regulations and bylaws
D) Financial management
ANS B
40. Which provider is NOT a mid-level provider?
A) Anesthesiologist
B) All choices are mid-level providers
C) Physician Assistant
D) Nurse Practitioner
ANS A
41. What does MAC stands for?
ANS
A) Medicaid Administrative Contractor
B) Medicare Administrative Contractor
C) Medicare Advisory Contractor
45. Which of the following is a BENEFIT of electronic transactions?
A) Payment of claims
B) Security of claims
C) Timely submission of claims
D) None of the above
ANS C
