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AAPC |! CPMA |! Practice |! Exam |! Study |!
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What |! elements |! must |! be |! in |! a |! medical |! record |! - |! Correct |! answer |! ✔Patient |! ID, |! Assignment |! of |! Benefits, |! medical |! history, |! immunizations, |! physical |! exam, |! lab |! report, |! clinical |! impression, |! physician |! orders What |! is |! the |! minimum |! signature |! assignment |! of |! the |! author |! of |! entry |! in |! the |! medical |! record? |! - |! Correct |! answer |! ✔First |! initial, |! Last |! Name |! and |! credentials Based |! on |! the |! JC |! accreditation |! guidelines |! for |! personal |! data, |! what |! 2 |! elements |! must |! be |! evident |! in |! the |! medical |! record? |! - |! Correct |! answer |! ✔There |! must |! be |! a |! patient |! information |! sheet |! that |! contains |! biographical |! data, |! name, |! address, |! etc. |! along |! with |! authorization |! for |! treatment |! whether |! it |! is |! an |! office |! visit, |! diagnostic |! services |! or |! surgical |! procedure. What |! is |! the |! appropriate |! way |! to |! dispose |! of |! PHI |! that |! is |! no |! longer |! needed? |! - |! Correct |! answer |! ✔Discard |! it |! in |! a |! locked |! shredding |! receptacle When |! must |! ABNs |! be |! signed? |! - |! Correct |! answer |! ✔Far |! enough |! in |! advance |! that |! the |! beneficiary |! or |! representative |! has |! time |! to |! consider |! the |! options |! and |! make |! an |! informed |! decision.
SOAP |! and |! CHEDDAR |! are |! two |! formats |! of |! medical |! record |! documentation. |! Which |! section |! of |! each |! format |! would |! you |! find |! the |! patient's |! history? |! - |! Correct |! answer |! ✔S |! in |! SOAP |! and |! H |! in |! CHEDDAR Patients |! can |! request |! copies |! of |! disclosure |! of |! PHI |! under |! HIPAA: |! - |! Correct |! answer |! ✔For |! a |! six |! (6) |! year |! period |! of |! time When |! can |! a |! RAC |! extrapolate |! the |! overpayment(s) |! on |! claims? |! - |! Correct |! answer |! ✔If |! a |! RAC |! can |! demonstrate |! a |! high |! level |! of |! error, |! the |! RAC |! can |! then |! extrapolate |! the |! findings |! and |! request |! a |! refund. Example: |! Column |! 1 |! Code/Column |! 2 |! Code |! 45385/45380 |! CPT |! Code |! 45385 |! - |! Colonoscopy, |! flexible, |! proximal |! to |! splenic |! flexure; |! with |! removal |! of |! tumor(s), |! polyp(s), |! or |! other |! lesion(s) |! by |! snare |! technique |! CPT |! Code |! 45380 |! - |! Colonoscopy, |! flexible, |! proximal |! to |! splenic |! flexure; |! with |! biopsy, |! single |! or |! multiple |! Policy: |! More |! extensive |! procedure |! Modifier |! -59 |! is: |! - |! Correct |! answer |! ✔Only |! appropriate |! if |! the |! two |! procedures |! are |! performed |! on |! separate |! lesions |! or |! at |! separate |! patient |! encounters. Is |! reporting |! 14000 |! with |! 11401 |! unbundling? |! - |! Correct |! answer |! ✔Yes |! according |! to |! CPT |! guidelines |! the |! excision |! of |! a |! benign |! lesion |! or |! malignant |! lesion |! is |! not |! separately |! reportable. Commercial |! and |! Government |! carriers |! audit |! medical |! records. |! Select |! the |! statement |! that |! is |! TRUE |! regarding |! commercial |! and |! government |! carriers. |! - |! Correct |! answer |! ✔Commercial |! carriers |! and |! Government |! carriers |! both |! use |! claims |! data |! to |! identify |! providers |! and |! services |! to |! audit.
The |! compliance |! program |! guidance |! (CPG) |! document |! identifies |! four |! risk |! areas |! most |! likely |! to |! affect |! a |! physician's |! practice. |! The |! risk |! areas |! include: |! - |! Correct |! answer |! ✔Coding |! and |! billing, |! reasonable |! and |! necessary |! services, |! documentation, |! improper |! inducements True |! or |! False: |! Only |! one |! consult |! is |! reported |! on |! hospital |! admission. |! - |! Correct |! answer |! ✔True. |! Otherwise |! use |! subsequent |! day |! codes |! for |! following |! consults A |! provider |! performs |! two |! procedures |! that |! NCCI |! edits |! state |! should |! not |! be |! reported |! together. |! However |! if |! the |! NCCI |! edit |! does |! not |! allow |! use |! of |! NCCI- associated |! modifiers |! to |! bypass |! it |! and |! the |! documentation |! supports |! and |! qualifies |! as |! an |! unusual |! procedure, |! the |! physician |! may |! report |! the |! column |! one |! HCPCS/CPT® |! procedure |! code |! of |! the |! NCCI |! edit |! with |! which |! modifier? |! - |! Correct |! answer |! ✔modifier |! 22 When |! performing |! a |! retrospective |! audit, |! the |! auditor |! will |! need |! to |! have |! which |! of |! the |! following |! materials? |! - |! Correct |! answer |! ✔patient's |! medical |! record, |! the |! appropriate |! audit |! form, |! coding |! manuals, |! EOB |! or |! Medicare |! RA, |! payer |! policies |! and |! the |! CMS |! 1500 |! claim |! form. A |! provider |! receives |! denials |! from |! a |! private |! payer |! for |! E/M |! services |! performed |! on |! the |! same |! date |! as |! a |! minor |! procedure. |! You |! review |! documentation |! for |! 25 |! records |! and |! the |! payer |! contract |! which |! states |! the |! provider |! must |! follow |! CMS |! coding |! guidelines. |! You |! determine |! that |! 20 |! of |! the |! records |! have |! appropriate |! documentation |! to |! support |! both |! E/M |! and |! the |! procedure |! and |! were |! coded |! correctly |! when |! the |! claim |! was |! originally |! submitted. |! You |! submit |! an |! appeal |! for |! the |! 20 |! dates |! of |! service |! that |! are |!
supported |! by |! documentation. |! To |! support |! you |! findings, |! you |! will |! include |! in |! the |! appeal |! a |! letter |! reporting |! your |! findings, |! claim |! forms, |! copies |! of |! documentation, |! EOB |! copies |! and |! - |! Correct |! answer |! ✔NCCI |! policy |! manual |! for |! modifier |! 25 True |! or |! False: |! The |! admitting |! physician |! must |! append |! modifier |! AI |! Principal |! physician |! of |! record |! to |! the |! admission |! code |! for |! Medicare |! beneficiaries |! - |! Correct |! answer |! ✔True |! - |! even |! if |! only |! one |! provider True |! or |! False: |! Anesthesia |! modifiers |! are |! only |! reported |! on |! aneshtesia |! codes. |! - |! Correct |! answer |! ✔True True |! or |! False: |! Conscious |! sedation |! is |! considered |! anesthesia |! - |! Correct |! answer |! ✔False When |! responding |! to |! a |! subpoena |! for |! medical |! records, |! which |! of |! the |! following |! documents |! would |! likely |! NOT |! be |! required |! to |! be |! copied |! and |! submitted: |! - |! Correct |! answer |! ✔Signed |! authorization |! for |! release |! of |! information You |! are |! preparing |! to |! perform |! a |! surgical |! chart |! audit. |! Which |! of |! the |! following |! resources |! would |! you |! need |! in |! order |! to |! accurately |! conduct |! the |! audit? |! - |! Correct |! answer |! ✔ICD-10-CM, |! CPT®, |! HCPCS |! Level |! II |! code |! books, |! NCCI |! edits, |! medical |! terminology |! book, |! global |! days, |! surgery |! audit |! tool, |! rules |! of |! insurance |! carriers Which |! statement |! is |! TRUE |! regarding |! appending |! modifier |! 78 |! to |! a |! claim |! for |! a |! service |! provided |! to |! a |! Medicare |! beneficiary? |! - |! Correct |! answer |! ✔When |!
Incident |! To |! cannot |! be |! performed |! in |! a |! facility |! setting. |! True |! or |! False? |! - |! Correct |! answer |! ✔TRUE
