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 sp
...
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 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
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.) -
✔✔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
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.) - ✔✔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.
B (Rationale: Medical necessity is using the least radical services/procedure that allows
for effective treatment of the patient's complaint or condition.) - ✔✔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.
C (Rationale: According to the LCD, Chronic venous insufficiency is a systemic
condition that may result in the need for routine foot care.) - ✔✔According to the
[Show More]
.png)
.png)
.png)
.png)
.png)
.png)
.png)
.png)
.png)
