AAPC CPC Exam Preparation: Medical Record Management, Coding, and Medicare Regulations, Exams of Medicine

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Chapter 1 AAPC CPC Questions And

Answers.

Which type of information is not maintained in a medical record? a. observations b. medical or surgical interventions c. Treatment outcomes d. Financial records - \d. Financial records EHR stands for: a. Extended health record b. Electronic health response c. Electronic health record d. Establish health record - \C. Electronic health record The Medicare program is made of several parts. Which part covers provider fees without the use of a private insurer? a. Part A b. Part B c. Part C d. Part D - \b. Part B What does CMS-HCC stand for? a. County Mandated Services-Heightened Control Center b. Country Mandated Services- Hospital Coding Initiative c. Centers for Medicare & Medicaid services- Hierarchal Condition Category d. Centers for Medicare & Medicaid Sercies- Hospital Correct Coding Initiative - \c. Centers for Medicare and Medicaid Services- Hierarchal Condition Category Which coding manuals do outpatient coders focus on learning? a. CPT, HCPCS Level II, icd-10-cm, ICD-10-PCS b. ICD-10-CM and ICD-10-PCS c. CPT, HCPCS Levell II, ICD-10-CM d. CPT and ICD-10-CM - \c. CPT, HCPCS Level II, and ICD-10-CM The____describes whether specific medical items, services, treatment procedures or technologies are consider medically necessary under Medicare. A. National Coverage Determinations Manual B. Medicare Physician Fee Schedule

C. Medicare Severity-Diagnosis Related Groups (MS-DRG) D. Internet Only Manual - \A. National Coverage Determinations Manual What does MAC stand for? A. Medicaid Alert Contractor B. Medicare Administrative Contractor C. Medicare Advisory Contractor D. Medicaid Administrative Contractor - \B. Medicare Administrative Contractor LCD's only have jurisdiction in their? A. Locality B. State C. Region D. District - \c. Region When are providers responsible for obtaining an ABN for a service Not considered medically necessary? A. After providing a service or item to a beneficiary B. Prior to providing a service or item to a beneficiary C. During a procedure or service D. After denial has been received from Medicare. - \B. Prior to providing a service or item to a beneficiary In what year did HIPAA become Law? a. 1992 b. 1995 c. 1997 d. 1996 - \d. 1996 Evaluation and management services are often provide in a standard format such as SOAP notes. What does the acronym SOAP stand for? A. Standard, Objective, Activity, Period B. Scope, Observation, Action, Plan C. Subjective, Objective, Assessment, Plan D. Source, Opinion, Advice, Provider - \C. Subjective, Objective, Assessment, Plan Voluntary compliance programs also provide benefits by not only helping to prevent erroneous or ___, but also by showing that the physician practice is making additional good faith efforts to submit claims appropriately. A. Duplicate claims B. Fraudulent claims

C. Mistaken principals D. Over utilized codes - \B. Fraudulent claims According to AAPC's Code of Ethics, a member shall use only __ and ___ means in all professional dealings. A. Private and professional B. Efficient and inexpensive C. Legal and profitable D. Legal and ethical - \D. Legal and ethical What type of health insurance provides coverage for low-income families? A. Medicaid B. Medicare C. Commercial PPO D. Commercial HMO - \A. Medicaid What form is used to submit a providers charge to the insurance carrier? A. UB- B. CMS- C. ABN D. Provider reimbursement form - \B CMS- Which of the followng is a benefit of electronic transactions? A. Payment of claims B. Security of claims C. Timely submission of claims d. None of the above - \C. Timely submission of claims The OIG recommends that provider practices enforce disciplinary actions through well publicized compliance guidelines to ensure actions that are ______. A. Frequent B. Swift and enforceable C. Consistent and appropriate D. Permanent - \C. Consistent and appropriate Which provider is NOT a mid-level provider? A. PA B. NP C. Anesthesiologist D. All choices are mid-level -

\C. Anesthesiologist According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of professional conduct? A. Integrity B. Responsibility C. Efficiency D. Commitment - \C. Efficiency The AAPC offers over 500 local chapters across the country for the purpose of.. A. Continuing education and networking B. Financial management C. Membership dues D. Regulations and bylaws - \A. Continuing education and networking What government organization is responsible for administering Medicare program? A. Social security administration B. Centers for Medicare and Medicaid Services (CMS) C. Department of health and human services D. National Center for Health Statistics - \B. CMS The office of Inspector General (OIG) establishes their work plane for audits in? A. Sept B. July C. Oct D. JAN - \C. OCT The four parts of Medicare are? A. Part A, D H S B. B D C S C. A B C D D. A C D E - \C. A B C D THE DIFFERNCE BETWEEN OB CODING AND IP CODING IS THAT IP USES THE FOLLOWING TO ASSIGN CODES? A. ICD-10 PCS AND MS-DRGS B. ICD-10 VOLUME 3 C. DRG'S D. CPT'S - \A ICD-10 PCS AND MS-DRGS

Evaluation an management documentation is often provided in a standard format such as. A. Subjective, Optional, Assessment, Plan B. Subsequent, Objective, Assessment, Program C. Subjective, Optional, Assessment, Provision D. Subjective, Objective, Assessment, Plan - \D NCD's were developed by? A. CMS B. OIG C. LAW D. FDA - \A. CMS National and Local Coverage determinations help to identify: a. Criteria for payment of services b. Medical necessity c. Frequency a service can be performed d. Who can provide a service to a patient - \b. Medical necessity National Coverage Determinations rule over Local Coverage Determinations: a. True b. False - \b. False CMS pays the ______ to pay Medicare part A and B claims: a. Medicare Administrative Carrier b. Medicaid Administrative counsel c. Medicare Administrative Contractor d. Medical Administrative Contractor - \c. Medicare Administrative Contractor A mid-level provider is considered a (an) a. NP b. PA c. NP and PA d. CRNA - \c. NP and PA Medicaid was created as a health insurance assistance program for the a. Wealthy b. Low income children and pregnant women c. Whoever wants it d. Underinsured -

\b. Low income children and pregnant women All of the following are probably noted in the body of a medical record except: a. Indication for surgery, details of procedures, findings b. CPT codes, modifiers, and diagnosis codes c. Date and time of procedure d. Pre-op and post-op diagnosis - \b. cpt codes, modifiers and diagnosis codes An ABN is required in all situations except A. Doctor visits b. surgeries c. Urgent care and emergency situations d. visits at night - \c. Urgent care and emergency situations HIPAA was created to protect a. Medicare's money b. Patients rights c. Privacy and security of health date provide federal protection for personal health info when held by covered entities d. Doctors and other health care provider - \c.Privacy and security of health date provide federal protection for personal health info when held by covered entities The impact of HITECH on HIPAA is: a.Proper documentation b. Proper information c. Covered entities level of culpability for releasing patient information d. To promote the adoption and meaningful use of health information technology - \d. To promote the adoption and meaningful use of health information technology It is not necessary to have a patient sign an ABN for items/services that are deemed excluded by Medicare a. True b. False - \a. True 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 patients 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 patients lifestyle - \b. Using the least radical service/procedure that allows for effective treatment of the patients 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 d. muscle weakness - \b. chronic venous insufficiency 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? - \ABN Select the true statement regarding ABN's a. ABN's may not be recognized by non Medicare payers. b. abn's must be signed for emergency or urgent care c. abn's are not required to include an estimate of cost for the service. d. abn's should be routinely signed by Medicare Beneficiaries in case Medicare doesn't cover. - \a. ABN's may not be recognized by non Medicare payers When presenting a cost estimate on an ABN for a potentially non covered service, the cost estimate should be within what range of the actual cost? a. $25 or 10 percent b. $100 or 10 percent c. $100 or 25 d. an exact amount - \c. $100. or 25 % Who would not be considered a covered entity under HIPAA? a. doctors b. HMO'S c. Clearinghouses d. Patients - \d. Patients 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 providers office can have access to protected health information - \a. Only 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? a. HIPAA b. HITECH c. SSA d. ACA - \b. HITECH 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 - \a. OIG Compliance Plan guidance What document is referenced when looking for potential problem areas identified by the government indication 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 - \c OIG Work plan

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