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CRC practice questions & answers.What document is referenced to when looking for potential problem areas identified by the government
indicating scrutiny of the services?
a. OIG Compliance Plan Guidance
b. OIG Security Summary
c. OIG Work Plan
d. OIG Investigation Plan ANS - C. OIG Work Plan
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.
Risk Adjustment Coders should have knowledge in which of the following?
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 prescription ANS - a. Medications and diagnostic testing
Rationale: Risk Adjustment Coders should have knowledge in the use of medications, treatments of the
patient, and diagnostic testing.
Who would NOT be considered a covered entity under HIPAA?
a. Doctors
b. HMOs
c. Clearinghouses
,d. Patients ANS - d. Patients
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.
What document assists provider offices with the development of Compliance Manuals?
a. OIG Compliance Plan Guidance
b. OIG Work Plan
c. OIG Suggested Rules and Regulations
d. OIG Internal Compliance Plan ANS - a. OIG Compliance Plan Guidance
Rationale: The OIG has offered compliance program guidance to form the basis of a voluntary
compliance program for physician offices. Although this was released in October 2000, it is still active
compliance guidance today.
Which statement describes a medically necessary service?
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. ANS - b. Using the least
radical service/procedure that allows for effective treatment of the patient's complaint or condition.
Which statement is FALSE regarding Mid-level Providers?
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. ANS - d. PAs are reimbursed at an
equally or higher rate than a provider.
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. Only
individuals whose job requires it may have access to protected health information
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.
Which act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and
affected privacy and security?
Selected Answer:
a. HIPAA
b. HITECH
c. SSA
d. PPACA ANS - b. HITECH
How many components are included in an effective compliance plan?
a. 4
b. 7
c. 9
d. 3 ANS - b. 7
, Which CMS product describes whether specific medical items, services, treatment procedures or
technologies are considered medically necessary under Medicare?
a. Medicare Physician Fee Schedule Final Rule
b. Relative Value Files
c. National Coverage Determinations Manual
d. Medicare Claims Processing Manual ANS - c. National Coverage Determinations Manual
HITECH provides a ____ day window during which any violation not due to willful neglect may be
corrected without penalty.
a. 45
b. 30
c. 40
d. 60 ANS - b. 30
The OIG releases a ____ outlining its priorities for the fiscal year ahead and beyond.
a. Self-referral law
b. CIA yearly review
c. Work Plan
d. Compliance Plan ANS - c. Work Plan
In what year was the AAPC founded? ANS - 1988
The OIG recommends that provider practices enforce disciplinary actions through well publicized
compliance guidelines to ensure actions that are ______.
a. Frequent
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