 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

Answer:

d.

ABN

Correct

Answer:

d.

ABN

Response

Feedback:

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.

 Question 2

10 out of 10 points

Which statement describes a medically necessary service?

Selected

Answer:

b.

Using the least radical service/procedure that allows for effective treatment of

the patient’s complaint or condition.

Correct

Answer:

b.

Using the least radical service/procedure that allows for effective treatment of

the patient’s complaint or condition.

Response

Feedback:

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

Answer:

a.

OIG Compliance Plan Guidance

Correct

Answer:

a.

OIG Compliance Plan Guidance

Response

Feedback:

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.

 Question 4

10 out of 10 points

Under HIPAA, what would be a policy requirement for “minimum necessary”?

Selected

Answer:

a.

Only individuals whose job requires it may have access to protected health

information.

Correct

Answer:

a.

Only individuals whose job requires it may have access to protected health

information.

Response

Feedback:

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.

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 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:

b.

fibromyalgi

a

Correct

Answer:

b.

fibromyalgi

a

Response

Feedback:

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:

a.

ABNs may not be recognized by non-Medicare payers.

Correct

Answer:

a.

ABNs may not be recognized by non-Medicare payers.

Response

Feedback:

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

Answer:

d.

Patients

Correct

Answer:

d.

Patients

Response

Feedback:

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.

 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

Answer:

c.

$100 or 25 percent

Correct

Answer:

c.

$100 or 25 percent

Response

Feedback:

Rationale: CMS instructions stipulate, “Notifiers must make a good faith effort

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

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(ARRA) and affected privacy and security?

Selected

Answer:

b.

HITECH

Correct

Answer:

b.

HITECH

Response

Feedback

:

Rationale: The Health Information Technology for Economic and Clinical Health

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

Answer:

c.

OIG Work Plan

Correct

Answer:

c.

OIG Work Plan

Response

Feedback:

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.

Sunday, November 19, 2017 9:04:26 AM MST



The minimum necessary rule applies to

Selected

Answer:

b.

Disclosures to or requests by a health care provider for treatment purposes.

Correct

Answer:

d.

Covered entities taking reasonable steps to limit use or disclosure of PHI

Response

Feedback

:

Rationale: The Privacy Rule generally requires covered entities to take

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?

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Selected

Answer:

d.

Commitmen

t

Correct

Answer:

b.

Efficiency

Response

Feedback:

Rationale: It shall be the responsibility of every AAPC member, as a condition

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

Answer:

c.

9

Correct

Answer:

d.

7

Response

Feedback:

Rationale: The following list of components, as set forth in previous OIG

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?

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