1. 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 - 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 service may not
be covered by Medicare and the patient may be responsible for
the charges?
A) LCD
B) CMS-1500
C) UB-04
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 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. - 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 services.
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