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Which statement describes a medically necessary service? - correct answer 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 patien...

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  • August 9, 2024
  • 30
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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CRC Questions and Answers

Which statement describes a medically necessary service? - correct answer 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.



Which code set does risk adjustment coding focus on? - correct answer a.
HCPCS Level II



*b. ICD-10-CM*



c. ICD-10-PCS



d. CPT®



Which statement is FALSE regarding Mid-level Providers? - correct answer a.
Mid-level providers are PAs and NPs.



b. PAs typically require oversight of a provider.



c. NPs have a master's degree.

,*d. PAs are reimbursed at an equally or higher rate than a provider.*



Risk Adjustment Coders should have knowledge in which of the following? - correct answer
*a. Medications and diagnostic testing*



b. How to calculate the drip rate for IVs



c. How to take BP readings



d. Treatments and writing out prescriptions



Which Insurance is the primary government payer in the United States? - correct answer
a. Medicaid



b. Aetna



*c. Medicare*



d. Cigna



Who would NOT be considered a covered entity under HIPAA? - correct answer
a. Doctors



b. HMOs



c. Clearinghouses



*d. Patients*

, Under HIPAA, what would be a policy requirement for "minimum necessary"? - correct answer
*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.



Which act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and
affected privacy and security? - correct answer a. HIPAA



*b. HITECH*



c. SSA



d. PPACA



What document assists provider offices with the development of Compliance Manuals? - correct answer
*a. OIG Compliance Plan Guidance*



b. OIG Work Plan



c. OIG Suggested Rules and Regulations



d. OIG Internal Compliance Plan



What document is referenced to when looking for potential problem areas identified by the government
indicating scrutiny of the services? - correct answer a. OIG Compliance Plan
Guidance

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