Question 1

What is a CMS national-level rule that identifies payment coverage for a specific service, procedure, test, or technology based on medical necessity or frequency:

Accepted Answer

A)  local coverage determination 
B)  national coverage determination 
C)  surgical release form 
D)  advance beneficiary notice 
A)  local coverage determination 
B)  national coverage determination 
C)  surgical release form 
D)  advance beneficiary notice B

Question 2

What is an agency that investigates allegations of fraud, waste, abuse, or misconduct and assists the executive branch in identifying and correcting operational deficiencies?

Accepted Answer

A)  FDA 
B)  DEA 
C)  CMS 
D)  OIG 
A)  FDA 
B)  DEA 
C)  CMS 
D)  OIG D

Question 3

All of the following are classifications of AAPC members listed in Chapter 22 except:

Accepted Answer

A)  auditing 
B)  practice management 
C)  compliance 
D)  clinical 
A)  auditing 
B)  practice management 
C)  compliance 
D)  clinical D

Question 4

What is a program designed to encourage correct coding methodologies and control inappropriate payments due to improper coding of Part B claims?

Accepted Answer

A)  medically unlikely edit 
B)  hierarchical condition category 
C)  advance beneficiary notice 
D)  national correct coding initiative 
A)  medically unlikely edit 
B)  hierarchical condition category 
C)  advance beneficiary notice 
D)  national correct coding initiative

Question 5

What is a CMS national-level rule that identifies payment coverage for a specific service, procedure, test, or technology based on medical necessity or frequency:

Accepted Answer

A)  national coverage determination 
B)  surgical release form 
C)  advance beneficiary notice 
D)  local coverage determination 
A)  national coverage determination 
B)  surgical release form 
C)  advance beneficiary notice 
D)  local coverage determination

Question 6

Which penalty may an AAPC member face if he/she is determined to have failed to comply with the AAPC Code of Ethics?

Accepted Answer

A)  imprisonment 
B)  loss of reputation 
C)  loss of credentials 
D)  forced resignation 
A)  imprisonment 
B)  loss of reputation 
C)  loss of credentials 
D)  forced resignation

Question 7

Which category of individuals does Medicaid cover?

Accepted Answer

A)  individuals with income below state-prescribed levels, based on a scale compared to how many individuals live in the household 
B)  individuals who also qualify for state and locally-funded benefits 
C)  individuals falling below the state poverty line 
D)  individuals falling below the national poverty line 
A)  individuals with income below state-prescribed levels, based on a scale compared to how many individuals live in the household 
B)  individuals who also qualify for state and locally-funded benefits 
C)  individuals falling below the state poverty line 
D)  individuals falling below the national poverty line

Question 8

By whom is the Medicare program administered?

Accepted Answer

A)  Centers for Disease Control and Prevention 
B)  Centers for Medicare and Medicaid Services 
C)  Hierarchical Condition Categories 
D)  Department of Health and Human Services 
A)  Centers for Disease Control and Prevention 
B)  Centers for Medicare and Medicaid Services 
C)  Hierarchical Condition Categories 
D)  Department of Health and Human Services

Question 9

In order for a retired member of the military to be eligible for CHAMPVA coverage, he/she may be eligible for Medicare but may not be enrolled in which part of Medicare?

Accepted Answer

A)  Part C 
B)  Part D 
C)  Part A 
D)  Part B 
A)  Part C 
B)  Part D 
C)  Part A 
D)  Part B

Question 10

What must coders acquire and maintain through continued professional development and education in order to advance the coding profession?

Accepted Answer

A)  knowledge, skills, and abilities 
B)  professional competence 
C)  ethical standards 
D)  certification 
A)  knowledge, skills, and abilities 
B)  professional competence 
C)  ethical standards 
D)  certification

Question 11

The specification of a Code of Ethics enables AAPC to clarify to current and future members, and to those served by members, the nature of the ethical responsibilities held in ______ by its members:

Accepted Answer

A)  common 
B)  high esteem 
C)  close contact 
D)  disregard 
A)  common 
B)  high esteem 
C)  close contact 
D)  disregard

Question 12

According to the AAPC Code of Ethics, coders are to use only legal and ethical principles that reflect what?

Accepted Answer

A)  sound moral judgment 
B)  state and local laws 
C)  the coder's employer's code of ethics 
D)  the profession's core values 
A)  sound moral judgment 
B)  state and local laws 
C)  the coder's employer's code of ethics 
D)  the profession's core values

Question 13

The specification of a Code of Ethics enables AAPC to clarify the nature of the ethical responsibilities held in common by its members to all of the following audiences identified in the Code of Ethics listed except:

Accepted Answer

A)  current members 
B)  members in competing organizations 
C)  those served by members 
D)  future members 
A)  current members 
B)  members in competing organizations 
C)  those served by members 
D)  future members

Question 14

On June 1, Susan requests a copy of her CT scan from a radiography laboratory to carry with her to her neurologist's appointment. On what date must the laboratory have provided that CT scan to Susan?

Accepted Answer

A)  July 1 
B)  January 1 
C)  August 1 
D)  September 1 
A)  July 1 
B)  January 1 
C)  August 1 
D)  September 1

Question 15

In a non-PAR provider restriction, what are fees restricted to?

Accepted Answer

A)  the fee for service 
B)  the allowable amount 
C)  the limiting charge 
D)  no more than 150% of the allowable charge 
A)  the fee for service 
B)  the allowable amount 
C)  the limiting charge 
D)  no more than 150% of the allowable charge

Question 16

Who funds Medicaid?

Accepted Answer

A)  states 
B)  states and federal governments 
C)  federal government 
D)  states and local governments 
A)  states 
B)  states and federal governments 
C)  federal government 
D)  states and local governments

Question 17

Select the commitment that is expected of every AAPC member:

Accepted Answer

A)  ethical professional conduct 
B)  timely responses 
C)  establishing a mentorship program in their geographic area 
D)  volunteerism at AAPC events 
A)  ethical professional conduct 
B)  timely responses 
C)  establishing a mentorship program in their geographic area 
D)  volunteerism at AAPC events

Question 18

Any medical or financial information held or managed by a covered entity is:

Accepted Answer

A)  privileged 
B)  demographic information 
C)  protected health information 
D)  personal information 
A)  privileged 
B)  demographic information 
C)  protected health information 
D)  personal information

Question 19

In a non-PAR provider restriction, what are fees restricted to?

Accepted Answer

A)  no more than 150% of the allowable charge 
B)  the allowable amount 
C)  the limiting charge 
D)  the fee for service 
A)  no more than 150% of the allowable charge 
B)  the allowable amount 
C)  the limiting charge 
D)  the fee for service

Question 20

According to the AAPC Code of Ethics, members will avoid actions and circumstances that may appear to compromise good business judgment or create a conflict between what?

Accepted Answer

A)  personal and professional interests 
B)  employer and personal ethical standards 
C)  legal and ethical considerations 
D)  criminal and civil law 
A)  personal and professional interests 
B)  employer and personal ethical standards 
C)  legal and ethical considerations 
D)  criminal and civil law

Exam 21: Practice Management

What is a CMS national-level rule that identifies payment coverage for a specific service, procedure, test, or technology based on medical necessity or frequency:

What is an agency that investigates allegations of fraud, waste, abuse, or misconduct and assists the executive branch in identifying and correcting operational deficiencies?

All of the following are classifications of AAPC members listed in Chapter 22 except:

What is a program designed to encourage correct coding methodologies and control inappropriate payments due to improper coding of Part B claims?

What is a CMS national-level rule that identifies payment coverage for a specific service, procedure, test, or technology based on medical necessity or frequency:

Which penalty may an AAPC member face if he/she is determined to have failed to comply with the AAPC Code of Ethics?

Which category of individuals does Medicaid cover?

By whom is the Medicare program administered?

In order for a retired member of the military to be eligible for CHAMPVA coverage, he/she may be eligible for Medicare but may not be enrolled in which part of Medicare?

What must coders acquire and maintain through continued professional development and education in order to advance the coding profession?

The specification of a Code of Ethics enables AAPC to clarify to current and future members, and to those served by members, the nature of the ethical responsibilities held in ______ by its members:

According to the AAPC Code of Ethics, coders are to use only legal and ethical principles that reflect what?

The specification of a Code of Ethics enables AAPC to clarify the nature of the ethical responsibilities held in common by its members to all of the following audiences identified in the Code of Ethics listed except:

On June 1, Susan requests a copy of her CT scan from a radiography laboratory to carry with her to her neurologist's appointment. On what date must the laboratory have provided that CT scan to Susan?

In a non-PAR provider restriction, what are fees restricted to?

Who funds Medicaid?

Select the commitment that is expected of every AAPC member:

Any medical or financial information held or managed by a covered entity is:

In a non-PAR provider restriction, what are fees restricted to?

According to the AAPC Code of Ethics, members will avoid actions and circumstances that may appear to compromise good business judgment or create a conflict between what?

The Certified Professional Coder

Foundations of ICD-10-CM

ICD-Specific Guidelines

Foundations of CPT

Evaluation and Management

Anesthesia

Surgery Section

Surgery Section: Integumentary System

Surgery Section: Musculoskeletal System

Surgery Section: Respiratory System

Surgery Section: Cardiovascular and Lymphatic Systems

Surgery Section: Digestive System

Surgery Section: Urinary System and Male Reproductive System

Surgery Section: Female Reproductive System and Maternity Care and Delivery

Surgery Section: Nervous System

Surgery Section: Eyes, Ears, and Endocrine System

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Fundamental Coding Guidelines

Coding for Evaluation and Management E&M, Anesthesia, and Surgery Section

Coding for Surgical Procedures on Integumentary, Musculoskeletal, Respiratory, and Cardiovascular/Lymphatic Systems

Coding for Surgical Procedures on Digestive, Urinary, Male and Female Reproductive Systems, Maternity Care, Nervous System, and Eyes, Ears, and Endocrine System

Coding for Radiology, Pathology Laboratory, General Medicine, HCPCS Category II and III, and Practice Management

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