(Test Bank) Medical Coding Training - Aapc Cpc Final Exam

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Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS 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: Correct Answer: Response Feedback: d. ABN d. ABN 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 Which statement describes a medically necessary service? 10 out of 10 points Selected Answer: Correct Answer: Response Feedback: b. Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition. b. Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition. 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: Correct Answer: Response Feedback: a. OIG Compliance Plan Guidance a. OIG Compliance Plan Guidance 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 Under HIPAA, what would be a policy requirement for ―minimum necessary‖? 10 out of 10 points Selected Answer: Correct Answer: Response Feedback: a. Only individuals whose job requires it may have access to protected health information. a. Only individuals whose job requires it may have access to protected health information. 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. Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS • 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: Correct Answer: Response Feedback: b. fibromyalgi a b. fibromyalgi a Rationale: According to the LCD, measurement of vitamin D levels is indicated for patients with fibromyalgia. • Question 6 Select the TRUE statement regarding ABNs. 10 out of 10 points Selected Answer: Correct Answer: Response Feedback: a. ABNs may not be recognized by non-Medicare payers. a. ABNs may not be recognized by non-Medicare payers. 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 Who would NOT be considered a covered entity under HIPAA? 10 out of 10 points Selected Answer: Correct Answer: Response Feedback: d. Patients d. Patients 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: Correct Answer: Response Feedback: c. $100 or 25 percent c. $100 or 25 percent 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 Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS (ARRA) and affected privacy and security? Selected Answer: Correct Answer: Response Feedback : b. HITECH b. HITECH 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 docume nt is referenced to when looking for potential problem areas identified by the government indicating scrutiny of the services within the coming year? Selected Answer: Correct Answer: Response Feedback: c. OIG Work Plan c. OIG Work Plan 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: Correct Answer: Response Feedback : b. Disclosures to or requests by a health care provider for treatment purposes. d. Covered entities taking reasonable steps to limit use or disclosure of PHI 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? Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS Selected Answer: Correct Answer: Response Feedback: d. Commitmen t b. Efficiency 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 How many components are included in an effective compliance plan? 0 out of 4 points Selected c. Answer: 9 Correct d. Answer: 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 According to the OIG, internal monitoring and auditing should be performed by what means? 4 out of 4 points Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS Selected Answer: Correct Answer: Response Feedback : a. Periodic audits. a. Periodic audits. Rationale: A key component of an effective compliance program includes internal monitoring and auditing through the performance of periodic audits. This ongoing evaluation includes not only whether the provider practice’s standards and procedures are in fact current and accurate, but also whether the compliance program is working, (for example , whether individuals are properly carrying out their responsibilities and claims are submitted appropriately). • Question 5 When coding an operative report, what action would NOT be recommended? 4 out of 4 points Selected Answer: Correct Answer: Response Feedback: b. Coding from the header without reading the body of the report. b. Coding from the header without reading the body of the report. Rationale: Operative report coding tips include reviewing the documentation in the detail of the procedure to further clarify or define both procedures and diagnoses. • Question 6 Which of the following choices is NOT a benefit of an active compliance plan? 4 out of 4 points Selected Answer: Correct Answer: Response Feedback: a. Eliminates risk of an audit. a. Eliminates risk of an audit. Rationale: Although voluntary, a compliance plan may offer several benefits, among them: • Faster, more accurate payment of claims. • Fewer billing mistakes. • Diminished chances of a payer audit. • Less chance of violating self -referral and anti -kickback statutes. Additionally, the increased accuracy of provider documentation that may result from a compliance program actually may assist in enhancing patient care. • Question 7 HIPAA stands for 4 out of 4 points Selected Answer: Correct Answer: Response Feedback: d. Health Insurance Portability and Accountability Act d. Health Insurance Portability and Accountability Act Rationale: Health Insurance Portability and Accountability Act (HIPAA) • Question 8 Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS In what year was HITECH enacted as part of the American Recovery and Reinvestment Act? 4 out of 4 points Selected Answer: Correct Answer: Response Feedback : a. 2009 a. 2009 Rationale: The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. • Question 9 The Medicare program is made up of several parts. Which part covers provider fees without the use of a private insurer? 4 out of 4 points Selected Answer: Correct Answer: Response Feedback : d. Part B d. Part B Rationale: Medicare Part B helps to cover medically necessary provider services, outpatient care and other medical services (including some preventive services) not covered under Medicare Part A. Medicare Part B is an optional benefit for which the patient pays a monthly premium, an annual deducti ble, and generally has a 20% co-insurance except for preventive services covered under the healthcare law. • Question 10 4 out of 4 points Healthcare providers are responsible for developing and policies and procedures regarding privacy in their practices. Selected Answer: Correct Answer: Response Feedback: c. Notices of Privacy Practices c. Notices of Privacy Practices Rationale: Healthcare providers are responsible for developing Notices of Privacy Practices and policies and procedures regarding privacy in their practices. • Question 11 Evaluation and management services are often provided in a standard format such as SOAP notes. What does the acronym SOAP stand for? 4 out of 4 points Selected Answer: Correct Answer: c. Subjective, Objective, Assessment, Plan c. Subjective, Objective, Assessment, Plan Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS Response Feedback: Rationale: S-Subjective, O-Objective, A-Assessment, P-Plan • Question 12 What type of health insurance provides coverage for low-income families? 4 out of 4 points Selected Answer: Correct Answer: Response Feedback: b. Medicai d b. Medicai d Rationale: Medicaid is a health insurance assistance program for some low- income people (especially children and pregnant women) sponsored by federal and state governments. • Question 13 The OIG recommends that provider practices enforce disciplinary actions through well publicized compliance guidelines to ensure actions that are . 0 out of 4 points Selected Answer: Correct Answer: Response Feedback: a. Frequent b. Consistent and appropriate Rationale: The OIG recommends that a provider practice’s enforcement and disciplinary mechanisms ensure that violations of the practice’s compliance policies will result in consistent and appropriate sanctions, including the possibility of termination, against the offending individual. • Question 14 What is the value of a remittance advice? 4 out of 4 points Selected Answer: Correct Answer: Response Feedback: c. It states what will be paid and why any changes to charges were made. c. It states what will be paid and why any changes to charges were made. Rationale: The determination of the payer is sent to the provider in the form of a remittance advice. The remittance advice explains the outcome of the insurance adjudication on the claim, including the payment amount, contractual adjustments and reason(s) for denial. • Question 15 4 out of 4 points HITECH provides a day window during which any violation not due to willful neglect may be corrected without penalty. Selected c. Answer: 30 Correct c. Answer: 30 Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS Response Feedback: Rationale: HITECH also lowers the bar for what constitutes a violation, but provides a 30-day window during which any violation not due to willful neglect may be corrected without penalty. • Question 16 AAPC credentialed coders have proven mastery of what information? 4 out of 4 points Selected Answer: Correct Answer: Response Feedback: d. All of the above d. All of the above Rationale: AAPC credentialed coders have proven mastery of all code sets, evaluation and management principles, and documentation guidelines. • Question 17 What form is used to submit a provider’s charge to the insurance carrier? 4 out of 4 points Selected Answer: Correct Answer: Response Feedback: d. CMS-1500 d. CMS-1500 Rationale: Once documentation is translated into codes, it is then sent on a CMS-1500 form to the insurance carrier for reimbursement. • Question 18 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? 4 out of 4 points Selected Answer: Correct Answer: Response Feedback : b. Providers should develop safeguards to prevent unauthorized access to protected health information. b. Providers should develop safeguards to prevent unauthorized access to protected health information. Rationale: The minimum necessary standard requires covered entities to evaluate their practices and enhance safeguards as needed to limit unnecessary or inappropriate access to and disclosure of protected health information. Only those individuals whose job requires it may have access to PHI. Only the minimum protected information required to do the job should be shared. • Question 19 What is the purpose of National Coverage Determinations? 0 out of 4 points Selected Answer: Correct Answer: d. To set standards for all payers on coverage items. b. To explain CMS policies on when Medicare will pay for items or services. Response Rationale: National Coverage Determinations (NCD) explain CMS policies on Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS Feedback: when Medicare will pay for items or services. • Question 20 Twice a year the OIG releases a outlining its priorities for the fiscal year ahead. 4 out of 4 points Selected Answer: Correct Answer: Response Feedback: b. Work Plan b. Work Plan Rationale: The OIG Work Plan sets forth various projects to be addressed twice during the fiscal year by the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General. • Question 21 What will the scope of a compliance program depend on? 4 out of 4 points Selected Answer: Correct Answer: Response Feedback: d. The size and resources of the provider’s practice. d. The size and resources of the provider’s practice. Rationale: The scope of a compliance program will depend on the size and resources of the provider practice. • Question 22 Which coding manuals do outpatient coders focus on learning? 4 out of 4 points Selected Answer: Correct Answer: Response Feedback: a. CPT®, HCPCS Level II and ICD-10-CM a. CPT®, HCPCS Level II and ICD-10-CM Rationale: Outpatient coding focuses on provider services. Outpatient coders will focus on learning CPT®, HCPCS Level II and ICD-10-CM. • Question 23 What does CMS-HCC stand for? 4 out of 4 points Selected Answer: Correct Answer: Response Feedback: c. Centers for Medicare & Medicaid Services – Hierarchal Condition Category c. Centers for Medicare & Medicaid Services – Hierarchal Condition Category Rationale: Centers for Medicare & Medicaid Services – Hierarchal Condition Category • Question 24 Who is responsible for enforcing the HIPAA security rule? 0 out of 4 points Selected Answer: d. HHS Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS Correct Answer: Response Feedback: b. OCR Rationale: The Office for Civil Rights (OCR) enforces the HIPAA Privacy Rule. • Question 25 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. 4 out of 4 points Selected Answer: Correct Answer: Response Feedback: c. Fraudulent claims c. Fraudulent claims Rationale: Voluntary compliance programs also provide benefits by not only helping to prevent erroneous or fraudulent claims, but also by showing that the provider practice is making additional good faith efforts to submit claims appropriately. Sunday, November 19, 2017 9:05:23 AM MST • Question 1 10 out of 10 points Squamous cell carcinoma and basal cell carcinoma are both cancers of cell tissue of the skin, lining of the blood vessels, respiratory, intestinal, urinary tracts, and other body systems. These carcinomas are found in what type of tissue? Selected Answer: Correct Answer: Response Feedback: d. Epithelial tissue d. Epithelial tissue RATIONALE: Squamous cell carcinoma and basal cell carcinoma are both cancers of cells in epithelial tissue. Epithelial tissues is found in the skin, lining of the blood vessels, respiratory, intestinal, and urinary tracts, and other body systems. • Question 2 Which medical term refers to the cheek? 10 out of 10 points Selected Answer: Correct Answer: Response Feedback: a. Bucca l a. Bucca l RATIONALE: Bucca means cheek. Buccal is relating to the cheek. Buccal swabs can be used for DNA testing. • Question 3 Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS 10 out of 10 points Which layer is the middle layer of the eyeball? Selected Answer: Correct Answer: Response Feedback: b. Choroid b. Choroid RATIONALE: The eyeball has three layers: the retina (innermost), choroid (middle), and sclera (outermost). • Question 4 10 out of 10 points Which anatomical structure in the urinary system differs in position and length between male and female, but serves the same function with regard to urine, and is often treated the same? Selected Answer: Correct Answer: Response Feedback: b. Urethra b. Urethra RATIONALE: The male and female urethras are quite different anatomically in position and length; however, they perform the same function with regard to urine, and are treated similarly for many surgical procedure s in the coding genre. • Question 5 Which structure of the ear is considered the inner ear? 10 out of 10 points Selected Answer: Correct Answer: Response Feedback: b. Labyrint h b. Labyrint h RATIONALE: The ear has three distinct and separate anatomical divisions: the outer ear (external ear), middle ear (tympanic cavity), and inner ear (labyrinth). • Question 6 Based on word parts, what is the definition of a tracheostomy? 10 out of 10 points Selected Answer: Correct Answer: Response Feedback: b. Creation of a hole in the trachea. b. Creation of a hole in the trachea. RATIONALE: The root trache - means trachea. The suffix –ostomy means surgical creation of an opening. A tracheostomy is surgical creation of an opening in the trachea and is used to help a patient breathe. • Question 7 Which structure is not a true endocrine structure? 0 out of 10 points Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS Selected Answer: Correct Answer: Response Feedback: c. Pituitary gland b. Carotid body RATIONALE: The carotid body is not a true endocrine structure, but is made of both glandular and nonglandular tissue. • Question 8 10 out of 10 points Which layer of the epidermis is normally found on the palms of the hands and the soles of the feet? Selected Answer: Correct Answer: Response Feedback: b. Stratum Lucidum b. Stratum Lucidum RATIONALE: The stratum lucidum is a clear layer normally found only on the palms of the hands and the soles of the feet. • Question 9 A cystourethroscopy is examination of what structures? 10 out of 10 points Selected Answer: Correct Answer: Response Feedback: a. Bladder and urethra a. Bladder and urethra RATIONALE: The root cyst - means urinary bladder. The root word urethr - means urethra. A cystourethroscopy is examination of the urinary bladder and urethra. • Question 10 10 out of 10 points Which leukocyte does the body use to protect against allergic reactions and parasites? Selected Answer: Correct Answer: Response Feedback: d. Eosinophil s d. Eosinophil s RATIONALE: The body uses eosinophils to protect against allergic reactions and parasites; elevated levels may indicate an allergic response. Sunday, November 19, 2017 9:05:50 AM MST • Question 1 Lacrimal glands are responsible for which of the following? 4 out of 4 points Selected Answer: c. Production of tears Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS Correct Answer: c. Production of tears • Question 2 Through which vessel is oxygenated blood returned to the heart from the lungs? 4 out of 4 points Selected Answer: Correct Answer: d. Pulmonary vein d. Pulmonary vein • Question 3 Which of the following conditions results from an injury to the head? The symptoms include headache, dizziness and vomiting. 4 out of 4 points Selected Answer: Correct Answer: b. Concussio n b. Concussio n • Question 4 The loop of Henle is located in which structure? 4 out of 4 points Selected Answer: Correct Answer: b. Kidney b. Kidney • Question 5 What is a function of the alveoli in the lungs? 4 out of 4 points Selected Answer: Correct Answer: b. Oxygen exchange b. Oxygen exchange • Question 6 Which gland is located on the superior surface of the kidney? 4 out of 4 points Selected Answer: Correct Answer: d. Adrenal gland d. Adrenal gland • Question 7 Upon leaving the stomach, nutrients move through the small intestine in what order? 4 out of 4 points Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS Selected Answer: Correct Answer: a. Duodenum, jejunum, ileum. a. Duodenum, jejunum, ileum. • Question 8 How many lobes make up the right lung? 4 out of 4 points Selected Answer: Correct Answer: b. three b. three • Question 9 Which of the following is true of the stratum germinativum? 0 out of 4 points Selected Answer: Correct Answer: c. It is composed of about 30 layers of dead, flattened, keratinized cells. a. It lies on top of the dermis and has access to a rich supply of blood. • Question 10 Which layer is NOT considered part of the skin? 4 out of 4 points Selected Answer: Correct Answer: b. Hypodermi s b. Hypodermi s • Question 11 Which of the following is significant of an abdominal aortic aneurysm? 4 out of 4 points Selected Answer: Correct Answer: c. It is a weakness in a large artery and rupture can be deadly c. It is a weakness in a large artery and rupture can be deadly • Question 12 Which chamber of the heart is considered the one working the hardest? 4 out of 4 points Selected Answer: Correct Answer: d. Left ventricle d. Left ventricle • Question 13 What is a myocardial infarction? 4 out of 4 points Medical Coding Training - AAPC CPC Final Exam Test Bank (ALL CPC EXAMS Selected Answer: Correct Answer: b. Lack of oxygen to the heart tissue, resulting in tissue death b. Lack of oxygen to the heart tissue, resulting in tissue death • Question 14 The dome -shaped muscle under the lungs flattening during inspiration is the: 4 out of 4 points Selected Answer: Correct Answer: c. Diaphrag m c. Diaphrag m • Question 15 A condition where the thyroid is overactive is called: 4 out of 4 points Selected Answer: Correct Answer: a. Thyrotoxicosis a. Thyrotoxicosis • Question 16 The meaning of the root blephar/o is: 4 out of 4 points Selected Answer: Correct Answer: d. Eyeli d d. Eyeli d • Question 17 A deficiency of cells in the blood is defined as: 4 out of 4 points Selected Answer: Correct Answer: b. Cytopeni a b. Cytopeni a • Question 18 Cytopathology is the study of: 4 out of 4 points Selected Answer: d. Cell s Correct d.