2022/2023 CPC FINAL EXAM PREP QUESTIONS

CPC FINAL EXAM PREP QUESTIONS 2022/2023 • Question 1 10 out of 10 points 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? Selected d. Answer: ABN Correct d. Answer: ABN Response Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare Feedback: 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. • Question 2 10 out of 10 points Which statement describes a medically necessary service? Selected Answer: Correct Answer: Response Feedback: b. Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition. b. Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition. Rationale: Medical necessity is using the least radical services/procedure that allows for effective treatment of the patient’s complaint or condition. • Question 3 10 out of 10 points What document assists provider offices with the development of Compliance Manuals? Selected a. Answer: OIG Compliance Plan Guidance Correct a. Answer: OIG Compliance Plan Guidance Response Rationale: The OIG has offered compliance program guidance to form the Feedback: basis of a voluntary compliance program for physician offices. Although this was released in October 2000, it is still active compliance guidance today. • Question 4 10 out of 10 points Under HIPAA, what would be a policy requirement for “minimum necessary”? Selected a. Answer: Only individuals whose job requires it may have access to protected health information. Correct a. Answer: Only individuals whose job requires it may have access to protected health information. Response Rationale: It is the responsibility of a covered entity to develop and implement Feedback: 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. • Question 5 10 out of 10 points According to the example LCD from Novitas Solutions, measurement of vitamin D levels is indicated for patients with which condition? Selected Answer: Correct Answer: Response Feedback: b. fibromyalgi a b. fibromyalgi a Rationale: According to the LCD, measurement of vitamin D levels is indicated for patients with fibromyalgia. • Question 6 10 out of 10 points Select the TRUE statement regarding ABNs. Selected Answer: Correct Answer: Response Feedback: a. ABNs may not be recognized by non-Medicare payers. a. ABNs may not be recognized by non-Medicare payers. 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. • Question 7 10 out of 10 points Who would NOT be considered a covered entity under HIPAA? Selected d. Answer: Patients Correct d. Answer: Patients Response Rationale: Covered entities in relation to HIPAA include Health Care Providers, Feedback: Health Plans, and Health Care Clearinghouses. The patient is not considered a covered entity although it is the patient’s data that is protected. • Question 8 10 out of 10 points 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? Selected c. Answer: $100 or 25 percent Correct c. Answer: $100 or 25 percent Response Rationale: CMS instructions stipulate, “Notifiers must make a good faith effort Feedback: to insert a reasonable estimate…the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.” • Question 9 10 out of 10 points Which act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and affected privacy and security? Selected b. Answer: HITECH Correct b. Answer: HITECH Response Rationale: The Health Information Technology for Economic and Clinical Health Feedback Act (HITECH) was enacted as a part of the American Recovery and : Reinvestment Act of 2009 (ARRA) to promote the adoption and meaningful use of health information technology. Portions of HITECH strengthen HIPAA rules by addressing privacy and security concerns associated with the electronic transmission of health information. • Question 10 10 out of 10 points What document is referenced to when looking for potential problem areas identified by the government indicating scrutiny of the services within the coming year? Selected c. Answer: OIG Work Plan Correct c. Answer: OIG Work Plan Response Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for Feedback: the fiscal year ahead. Within the Work Plan, potential problem areas with claims submissions are listed and will be targeted with special scrutiny. Sunday, November 19, 2017 9:04:26 AM MST • The minimum necessary rule applies to • Selected b. Answer: Disclosures to or requests by a health care provider for treatment purposes. Correct d. Answer: Covered entities taking reasonable steps to limit use or disclosure of PHI Response Rationale: The Privacy Rule generally requires covered entities to take Feedback : reasonable steps to limit the use or disclosure of, and requests for, protected health information to the minimum necessary to accomplish the intended purpose. The minimum necessary standard does not apply to the following: · Disclosures to or requests by a health care provider for treatment purposes. · Disclosures to the individual who is the subject of the information. · Uses or disclosures made pursuant to an individual’s authorization. · Uses or disclosures required for compliance with the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Rules. · Disclosures to the Department of Health & Human Services (HHS) when disclosure of information is required under the Privacy Rule for enforcement purposes. · Uses or disclosures that are required by other law. Question 2 0 out of 4 points According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of professional conduct? Selected d. Answer: Commitmen t Correct b. Answer: Efficiency Response Rationale: It shall be the responsibility of every AAPC member, as a condition Feedback: of continued membership, to conduct themselves in all professional activities in a manner consistent with ALL of the following ethical principles of professional conduct: · · Integrity · Respect · Commitment · Competence · Fairness · Responsibility • Question 3 0 out of 4 points How many components are included in an effective compliance plan? Selected c. Answer: 9 Correct d. Answer: 7 Response Rationale: The following list of components, as set forth in previous OIG Feedback: Compliance Program Guidance for Individual and Small Group Physician Practices, can form the basis of a voluntary compliance program for a provider practice: • Conducting internal monitoring and auditing through the performance of periodic audits; • Implementing compliance and practice standards through the development of written standards and procedures; • Designating a compliance officer or contact(s) to monitor compliance efforts and enforce practice standards; • Conducting appropriate training and education on practice standards and procedures; • Responding appropriately to detected violations through the investigation of allegations and the disclosure of incidents to appropriate Government entities; • Developing open lines of communication, such as (1) discussions at staff meetings regarding how to avoid erroneous or fraudulent conduct, and (2) community bulletin boards, to keep practice employees updated regarding compliance activities; and • Enforcing disciplinary standards through well-publicized guidelines. These seven components provide a solid basis upon which a provider practice can create a compliance program. • Question 4 4 out of 4 points According to the OIG, internal monitoring and auditing should be performed by what means? Selected a. Answer: Periodic audits. Correct a. Answer: Periodic audits. Response Rationale: A key component of an effective compliance program includes Feedback internal monitoring and auditing through the performance of periodic audits. : This ongoing evaluation includes not only whether the provider practice’s standards and procedures are in fact current and accurate, but also whether the compliance program is working, (for example, whether individuals are properly carrying out their responsibilities and claims are submitted appropriately). • Question 5 4 out of 4 points When coding an operative report, what action would NOT be recommended? Selected Answer: Correct Answer: Response Feedback: b. Coding from the header without reading the body of the report. b. Coding from the header without reading the body of the report. Rationale: Operative report coding tips include reviewing the documentation in the detail of the procedure to further clarify or define both procedures and diagnoses. • Question 6 4 out of 4 points Which of the following choices is NOT a benefit of an active compliance plan? Selected Answer: Correct Answer: Response Feedback: a. Eliminates risk of an audit. a. Eliminates risk of an audit. Rationale: Although voluntary, a compliance plan may offer several benefits, among them: • Faster, more accurate payment of claims. • Fewer billing mistakes. • Diminished chances of a payer audit. • Less chance of violating self-referral and anti-kickback statutes. Additionally, the increased accuracy of provider documentation that may result from a compliance program actually may assist in enhancing patient care. • Question 7 4 out of 4 points HIPAA stands for Selected Answer: Correct Answer: Response Feedback: d. Health Insurance Portability and Accountability Act d. Health Insurance Portability and Accountability Act Rationale: Health Insurance Portability and Accountability Act (HIPAA) • Question 8 4 out of 4 points In what year was HITECH enacted as part of the American Recovery and Reinvestment Act? Selected a. Answer: 2009 Correct a. Answer: 2009 Response Rationale: The Health Information Technology for Economic and Clinical Health Feedback (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act : of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. • Question 9 4 out of 4 points The Medicare program is made up of several parts. Which part covers provider fees without the use of a private insurer? Selected d. Answer: Part B Correct d. Answer: Part B Response Rationale: Medicare Part B helps to cover medically necessary provider Feedback services, outpatient care and other medical services (including some : preventive services) not covered under Medicare Part A. Medicare Part B is an optional benefit for which the patient pays a monthly premium, an annual deductible, and generally has a 20% co-insurance except for preventive services covered under the healthcare law. • Question 10 4 out of 4 points Healthcare providers are responsible for developing and policies and procedures regarding privacy in their practices. Selected Answer: Correct Answer: Response Feedback: c. Notices of Privacy Practices c. Notices of Privacy Practices Rationale: Healthcare providers are responsible for developing Notices of Privacy Practices and policies and procedures regarding privacy in their practices. • Question 11 4 out of 4 points Evaluation and management services are often provided in a standard format such as SOAP notes. What does the acronym SOAP stand for? Selected Answer: Correct Answer: c. Subjective, Objective, Assessment, Plan c. Subjective, Objective, Assessment, Plan Response Rationale: S-Subjective, O-Objective, A-Assessment, P-Plan Feedback: • Question 12 4 out of 4 points What type of health insurance provides coverage for low-income families? Selected Answer: Correct Answer: Response Feedback: b. Medicai d b. Medicai d Rationale: Medicaid is a health insurance assistance program for some low- income people (especially children and pregnant women) sponsored by federal and state governments. • Question 13 0 out of 4 points The OIG recommends that provider practices enforce disciplinary actions through well publicized compliance guidelines to ensure actions that are . Selected a. Answer: Frequent Correct b. Consistent Answer: and appropriate Response Rationale: The OIG recommends that a provider practice’s enforcement and Feedback: disciplinary mechanisms ensure that violations of the practice’s compliance policies will result in consistent and appropriate sanctions, including the possibility of termination, against the offending individual. • Question 14 4 out of 4 points What is the value of a remittance advice? Selected c. Answer: It states what will be paid and why any changes to charges were made. Correct c. Answer: It states what will be paid and why any changes to charges were made. Response Rationale: The determination of the payer is sent to the provider in the form of Feedback: a remittance advice. The remittance advice explains the outcome of the insurance adjudication on the claim, including the payment amount, contractual adjustments and reason(s) for denial. • Question 15 4 out of 4 points HITECH provides a day window during which any violation not due to willful neglect may be corrected without penalty. Selected Answer: Correct Answer: c. 30 c. 30 Response Rationale: HITECH also lowers the bar for what constitutes a violation, but Feedback: provides a 30-day window during which any violation not due to willful neglect may be corrected without penalty.