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CPC-Physician Based Medical Coding > CPC Ch1- Business of Medicine Review Questions > Flashcards

CPC Ch1- Business of Medicine Review Questions Flashcards

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USMLE® Step 1 flashcards
1
Q

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.

A

B. Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition.

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2
Q

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

A

B. Chronic venous insufficiency

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3
Q

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

D. ABN

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4
Q

Select the TRUE statement regarding ABNs
A. ABNs may not be recognized by non-Medicare payers.
B. ABNs must be signed for emergency or urgent care.
C. ABNs are not required to include an estimate cost for the service.
D. ABNs should be routinely signed by Medicare Beneficiaries in case Medicare doesn’t cover a service.

A

A. ABNs may not be recognized by non-Medicare payers.

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5
Q

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?
A. $25 or 10 percent
B. $100 or 10 percent
C. $100 or 25 percent
D. An exact amount

A

C. $100 or 25 percent

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6
Q

Who would NOT be considered a covered entity under HIPAA?
A. Doctors
B. HMOs
C. Clearinghouses
D. Patients

A

D. Patients

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7
Q

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.

A

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

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8
Q

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

A

B. HITECH

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9
Q

What document assists provider offices with the development of compliance manuals?
A. OIG Compliance Program Guidance
B. OIG Work Plan
C. OIG Suggested Rules and Regulations
D. OIG Internal Compliance Plan

A

A. OIG Compliance Program Guidance

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10
Q

What document is referenced when looking for potential problem areas identified by the government indicating scrutiny of the services?
A. OIG Compliance Program Guidance
B. OIG Security Summary
C. OIG Work Plan
D. OIG Investigation Plan

A

C. OIG Work Plan

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11
Q

The minimum necessary rule is based on sound current practice that protected health information should NOT be used or disclosed when it is not necessary to satisfy a particular purpose or carry out a function. What does this mean?

A

Providers should develop safeguards to prevent unauthorized access to protected health information.

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12
Q

Which type of information is NOT maintained in a medical record?
A. Financial records
B. Treatment outcomes
C. Medical or surgical interventions
D. Observations

A

A. Financial records

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13
Q

Which of the following is NOT an example of an Advanced Alternative Payment Model (AAPM)?

A

Bundled Payments for Home Care Services

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14
Q

According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of professional conduct?
A. Efficiency
B. Responsibility
C. Commitment
D. Integrity

A

A. Efficiency

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15
Q

What type of provider goes through approximately 26 ½ months of education, after completion of a bachelor’s degree, and is licensed to practice medicine with the oversight of a physician?

A

Physician Assistant (PA)

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16
Q

The OIG recommends that provider practices enforce disciplinary actions through well publicized compliance guidelines to ensure actions that are ______.

A

Consistent and appropriate

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17
Q

HITECH provides a ______ day window during which any violation not due to willful neglect may be corrected without penalty.

A

30

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18
Q

Healthcare providers are responsible for developing ____ ____ and policies and procedures regarding privacy in their practices.

A

Notices of Privacy Practices

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19
Q

When are providers responsible for obtaining an ABN for a service NOT considered medically necessary?
A. After a denial has been received from Medicare.
B. Prior to providing a service or item to a beneficiary.
C. During a procedure or service.
D. After providing a service or item to a beneficiary.

A

B. Prior to providing a service or item to a beneficiary.

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20
Q

HIPAA stands for
A. Health Information Privacy Access Act
B. Health Insurance Portability and Accountant Advice
C. Health Insurance Portability and Accountability Act
D. Health Insurance Provider Assistance Action

A

C. Health Insurance Portability and Accountability Act

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21
Q

What is the purpose of National Coverage Determinations?

A

To explain CMS policies on when Medicare will pay for items or services.

22
Q

Professionals who specialize in coding are called:
A. Medical Assistants
B. Scribes
C. Coding specialists
D. Information technologists

A

C. Coding specialists

23
Q

Many coding professionals go on to find work as:
A. Financial Planners
B. Accountants
C. Consultants
D. Medical Assistants

A

C. Consultants

24
Q

Which provider is NOT a mid-level provider?
A. Anesthesiologist
B. Physician Assistant
C. Nurse Practitioner
D. All choices are mid-level providers

A

A. Anesthesiologist

25
Q

What is the definition of medical coding?

A

Translating documentation into numerical/alphanumerical codes used to obtain reimbursement.

26
Q

Voluntary compliance programs also provide benefits by not only helping to prevent erroneous or ____, but also by showing that the provider practice is making additional good faith efforts to submit claims appropriately.

A

Fraudulent claims

27
Q

A covered entity may obtain consent from an individual to use or disclose protected health information to carry out all of the following EXCEPT what?

A

Research

28
Q

Which CMS product describes whether specific medical items, services, treatment procedures or technologies are considered medically necessary under Medicare?

A

National Coverage Determinations Manual

29
Q

What form is used to submit a provider’s charge to the insurance carrier?

A

CMS-1500

30
Q

Which of the following choices is NOT a benefit of an active compliance plan?

A

Eliminates risk of an audit.

31
Q

In what year was HITECH enacted as part of the American Recovery and Reinvestment Act?
A. 2009
B. 2007
C. 2010
D. 2000

A

2009

32
Q

The Medicare program is made up of several parts. Which part covers provider fees without the use of a private insurer?
A. Part B
B. Part A
C. Part D
D. Part C

A

A. Part B

33
Q

What is PHI?

A

Protected health information

34
Q

A covered entity does NOT include

A

Patients

35
Q

The minimum necessary rule applies to

A

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

36
Q

Local Coverage Determinations are administered by whom?
A. LMRPs
B. State Law
C. Each regional MAC
D. NCDs

A

C. Each regional MAC

37
Q

In what year did HIPAA become law?
A. 1992
B. 1996
C. 1995
D. 1997

A

B. 1996

38
Q

Evaluation and management services are often provided in a standard format such as SOAP notes. What does the acronym SOAP stand for?
A. Source, Opinion, Advice, Provider
B. Standard, Objective, Activity, Period
C. Scope, Observation, Action, Plan
D. Subjective, Objective, Assessment, Plan

A

D. Subjective, Objective, Assessment, Plan

39
Q

LCDs only have jurisdiction in their ____.
A. Region
B. District
C. State
D. Locality

A

A. Region

40
Q

If an NCD does not exist for a particular service/procedure performed on a Medicare patient, who determines coverage?
A. Medicare Administrative Contractor (MAC)
B. Centers for Medicare & Medicaid Services (CMS)
C. Current Procedural Terminology (CPT®) guidelines
D. The physician providing the service

A

A. Medicare Administrative Contractor (MAC)

41
Q

What will the scope of a compliance program depend on?
A. The size and resources of the provider’s practice.
B. How many patients are seen in the office on a daily basis.
C. The number of insurance carriers the provider is contracted with.
D. The specific guidelines set forth in the OIG compliance plan.

A

A. The size and resources of the provider’s practice.

42
Q

EHR stands for:
A. Extended health record
B. Electronic health record
C. Electronic health response
D. Established health record

A

B. Electronic health record

43
Q

Which coding manuals do outpatient coders focus on learning?
A. CPT®, HCPCS Level II and ICD-10-CM
B. ICD-10-CM and ICD-10-PCS
C. CPT®, HCPCS Level II, ICD-10-CM, ICD-10-PCS
D. CPT® and ICD-10-CM

A

A. CPT®, HCPCS Level II and ICD-10-CM

44
Q

When coding an operative report, what action would NOT be recommended?
A. Reading the body of the report.
B. Starting with the procedure listed.
C. Coding from the header without reading the body of the report.
D. Highlighting unfamiliar words.

A

C. Coding from the header without reading the body of the report.

45
Q

Which statement is TRUE regarding the Merit-Based Incentive Program (MIPS)?
A. Providers are excluded from MIPS if they are enrolled in a Qualifying APM program.
B. All Medicare providers must participate in MIPS.
C. Providers with less than $90,000 in Part C allowed charges for covered professional services are exempted.
D. Providers with less than 300 Part-B enrolled patients are exempt from MIPS.

A

A. Providers are excluded from MIPS if they are enrolled in a Qualifying APM program.

46
Q

What type of insurance is Medicare Part D?
A. Provider coverage requiring monthly premiums.
B. Hospital coverage available to all Medicare beneficiaries.
C. A Medicare Advantage program managed by private insurers.
D. Prescription drug coverage available to all Medicare beneficiaries.

A

D. Prescription drug coverage available to all Medicare beneficiaries.

47
Q

What is the value of a remittance advice?
A. It confirms the provider is part of the plan in question.
B. It states when to schedule the patient’s next appointment.
C. It states what will be paid and why any changes to charges were made.
D. It catalogs the patient’s coverage benefits.

A

C. It states what will be paid and why any changes to charges were made.

48
Q

How many components are included in an effective compliance plan?
A. 3
B. 9
C. 4
D. 7

A

D. 7

49
Q

What does the abbreviation MAC stand for?
A. Medicaid Administrative Contractor
B. Medicare Advisory Contractor
C. Medicaid Alert Contractor
D. Medicare Administrative Contractor

A

D. Medicare Administrative Contractor

50
Q

Which of the following is a BENEFIT of electronic transactions?
A. Payment of claims
B. Security of claims
C. Timely submission of claims
D. None of the above

A

C. Timely submission of claims

51
Q

The OIG releases a ____ outlining its priorities for the fiscal year ahead and beyond.
A. Work Plan
B. CIA yearly review
C. Compliance Plan
D. Self-referral law

A

A. Work Plan

CPC-Physician Based Medical Coding (45 decks)

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