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AAPC - CPC Chapter 1: The Business of Medicine – Final. All questions with 100% accurate answers, rated A+

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Under HIPAA, what would be a policy requirement for minimum necessary? - ☑☑Only individuals whose job requires it may have access to protected health information Which Act was enacted as part o... f the American Recovery and Reinvestment Act (ARRA) of 2009 and affected privacy and security? - ☑☑HITECH What document assists provider offices with the development of compliance manuals? - ☑☑OIG Compliance Plan Guidance What type of profession, other than coding, might skilled coders enter? - ☑☑Consultants, educators, and medical auditors What is the difference between outpatient and inpatient coding? - ☑☑Inpatient coders use ICD-10-CM and ICD-10-PCS What are the different parts of Medicare? - ☑☑Parts A,B,C, and D Evaluation and Management (E/M) services are often provided and documented in a standard SOAP format. What does SOAP represent? - ☑☑Subjective Objective Assessment Plan What are 5 tips for coding operative reports? - ☑☑Diagnosis code reporting Start with procedures listed Look for key words Highlight unfamiliar words Read the body What is medical necessity? - ☑☑Relates to whether a procedure or service is considered appropriate in a given circumstance What is NOT a common reason Medicare may deny a procedure or service? - ☑☑Covered service Which is NOT one of the seven key components of an internal compliance plan? - ☑☑Conduct training but not perform education on practice standards and procedures What is the value of a remittance advice? - ☑☑It states what will be paid and why any changes to charges were made The ____________ describes whether specific medical items, services, treatment procedures or technologies are considered medically necessary under Medicare? - ☑☑National Coverage Determinations Manual Which option is NOT a covered entity under HIPAA? - ☑☑Workers' Compensation What type of insurance is Medicare Part D? - ☑☑Prescription drug coverage available to all Medicare beneficiaries According to AAPC's Code of Ethics, an AAPC member shall use only _______ and _______ means in all professional dealings? - ☑☑Legal and ethical Voluntary compliance programs also provide benefits by not only helping to prevent erroneous or _________, but also by showing that the provider is making additional good faith efforts to submit claims appropriately? - ☑☑Fraudulent claims 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? - ☑☑Research Healthcare providers are responsible for developing ___________ and policies and procedures regarding privacy in their practices? - ☑☑Notice of Privacy Practices EHR - ☑☑Electronic health record If an NCD does not exist for a particular service/procedure performed on a Medicare patient, who determines coverage? - ☑☑Medicare Administrative Contractor (MAC) ABN - ☑☑Advance Beneficiary Notice Professionals who specialize in coding are called? - ☑☑Coding specialists According to OIG, internal monitoring and auditing should be performed by what means? - ☑☑Periodic audits AAPC credentialed coders have proven mastery of what information? - ☑☑Code sets Evaluation and Management principles Documentation guidelines When are providers responsible for obtaining an ABN for a service NOT considered medically necessary? - ☑☑Prior to providing a service or item to a beneficiary How many components are included in an effective compliance plan? - ☑☑7 MAC - ☑☑Medicare Administrative Contractor The ____describes whether specific medical items, services, treatment procedures or technologies are considered medically necessary under Medicare - ☑☑National Coverage Determinations Manual According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of professional conduct? - ☑☑Efficiency The Medicare program is made up of several parts. Which part covers provider fees without the use of a private insurer? - ☑☑Part B When coding an operative report, what action would NOT be recommended? - ☑☑Coding from the header without reading the body of the report. The AAPC offers over 500 local chapters across the country for the purpose of? - ☑☑Continuing education and networking HITECH provides a ____ day window during which any violation not due to willful neglect may be corrected without penalty: - ☑☑30 Which of the following is a BENEFIT of electronic transactions? - ☑☑Timely submission of claims 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? - ☑☑$100 or 25 percent 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." Who would NOT be considered a covered entity under HIPAA? - ☑☑Patients Response Feedback: 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. Select the TRUE statement regarding ABNs. - ☑☑ABNs may not be recognized by non-Medicare payers. Response Feedback: 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. 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 Response Feedback: 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 document assists provider offices with the development of Compliance Manuals - ☑☑OIG Compliance Plan Guidance Response Feedback: 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 considered as active compliance guidance today. Which statement describes a medically necessary service? - ☑☑Using the least radical service/procedure that allows for effective treatment of the patient's complaint or condition. Response Feedback: Rationale: Medical necessity is using the least radical services/procedure that allows for effective treatment of the patient's complaint or condition. [Show More]

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