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AAPC CPC exam prep Compliance and Regulatory | with 100% Correct Answers|AAPC Official CPC Certification Study Guide Notes

What document is referenced to when looking for potentialproblem areas identified by the government indicatingscrutiny of the services within the coming year?: A) OIG Compliance Plan Guidance B) OI... G Security Summary C) OIG Work Plan D) OIG Investigation Plan Correct Answer: 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.) What form is provided to a patient to indicate a servicemay not be covered by Medicare and the patient may be responsible for the charges?: A) LCD B) CMS-1500 C) UB-04 D) ABN Correct Answer: 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.) 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. Correct Answer: 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.) 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. Correct Answer: B (Rationale: Medical necessity is using the least radical services/procedure that allows for effective treatment of the patient's complaint or condition.) According to the example LCD from Novitas Solutions, which of the following conditions is considered a systemic condition that may result in the need for routine foot care? : A) arthritis B) chronic venous insufficiency C) hypertension"hold harmless clause" Correct Answer: * found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-pays. A compliance plan may offer several benefits, including: Correct Answer: * more accurate payment of claims * fewer billing mistakes * improved documentation and more accurate coding * less chance of violating self-referral and anti-kickback status A healthcare clearing house is a Correct Answer: entity that processes nonstandard health information they receive from another entity into a standard format A key provision in HIPAA is the Minimum Necessary requirement. this means Correct Answer: only the minimum necessary protected health information should be shared to satisfy a particular purpose. A medically necessary service is the Correct Answer: least radical service/procedure that allows for effective treatment of the patients' complaint or condition A patient sustaining an injury to her great saphenous vein would have sustained injury to which of anatomical site? Correct Answer: Leg APC Correct Answer: Ambulatory Payment Classification ARRA Correct Answer: American Recovery and Reinvestment Act (of 2009) ASC Correct Answer: Ambulatory Surgical Centers Abuse consists of Correct Answer: payment for items or services that are billed by providers in error that should not be paid for by Medicare. An ABN protects the provider's financial interest by Correct Answer: creating a paper trail that CMS requires before a provider can bill the patient for payment if Medicare denies coverage for the stated service or procedure. An entity that processes nonstandard health information they receive from another entity into a standard format is considered what? Correct Answer: Clearinghouse [Show More]

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