ASIPP Record Keeping, Quality Assurance, and Practice Management Questions Flashcards

1
Q
  1. What is the arrangement of CPT?
    A. CPT is arranged into six sections involving evaluation
    and management, anesthesiology, surgery, radiology,
    pathology, and medicine
    B. CPT is arranged into six sections with anesthesiology,
    surgery, radiology, physical medicine rehabilitation,
    pathology, and cardiology
    C. CPT is arranged into six sections with surgery, radiology,
    oncology, pathology, medicine, and neurosurgery
    D. CPT is arranged into six sections with psychiatry, physiatry,
    medicine, surgery, radiology, and pathology
    E. CPT is arranged into six sections designated as evaluation,
    management, surgery, techniques, pathology, and
    radiology
A
  1. Answer: A

Source: Laxmaiah Manchikanti, MD

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2
Q
  1. A 44-year-old patient suffering from alcoholism enters
    a residential treatment program that emphasizes group
    therapy but uses pharmacologic agents adjunctively.
    The patient is given a drug the decreases the craving for
    alcohol, possibly by interference with the neuroregulatory
    functions of opioid peptides. Since the drug will not
    cause adverse effects if the patient consumes alcoholic
    beverages, it can be identifi ed as
    A. Bupropion
    B. Disulfi ram
    C. Nalbuphine
    D. Naltrexone
    E. Sertraline
A
  1. Answer: D
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3
Q
  1. Physicians may bill for ancillary services that are
    “incident to” services rendered by non-physician,
    auxiliary personnel as long as:Choose the answer that
    best completes this sentence.
    A. The service takes place in a physician’s offi ce.
    B. The non-physician, auxiliary personnel is an employee
    of a physician.
    C. The physician is physically on-site and immediately
    available when the auxiliary practitioner is providing
    service.
    D. The physician is immediately available.
    E. Physicians are never permitted to bill for “incident to”
    services under the Civil False Claims Act.
A
  1. Answer: C
    Explanation:
    Physicians may bill and be paid for ancillary services that
    are “incident to” services rendered by non-physician,
    auxiliary personnel in the physician’s private offi ce setting,
    as long as supervision requirements are satisfi ed. The
    physician must be physically on-site and immediately
    available when the auxiliary practitioner is providing
    services.
    Source: See Medicare Carriers Manual, Part 3, Claims
    Process, § 2050.
    Source: Erin Brisbay McMahon, JD, Sep 2005
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4
Q
1913. The degree to which the CPT and ICD-9 codes selected
accurately refl ect the diagnoses and procedures are
described as:
A. Reliability
B. Validity
C. Completeness
D. Timeliness
E. Accuracy
A
  1. Answer: B
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5
Q
  1. In assigning critical Evaluation and Management (E/M)
    codes, three critical components are used. These are
    A. History, nature of the presenting problem, time
    B. History, examination, counseling
    C. History, examination, time
    D. History, examination, medical-decision making
    E. History, medical-decision making, counseling
A
  1. Answer: D
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6
Q

1915.Which of the following is coded as an adverse effect in
ICD-9-CM?
A. Paralysis secondary to multiple sclerosis
B. Rejection of transplanted heart
C. Dizziness due to side effect following administration of
Gabapentin
D. Non-functioning spinal cord stimulator due to defective
design.
E. Reaction to antibiotic administered prophylactically

A
  1. Answer: C
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7
Q
  1. What are important aspects of Needlestick Safety and
    Prevention Act of 2001
    A. 24 areas of change
    B. Two terms were added to defi nitions
    C. It was enacted due to total of over 20 million needle
    sticks a year
    D. Risks of contracting disease were minimal
    E. Psychological stress was the only issue
A
  1. Answer: B
    Explanation:
    Needlestick Safety & Prevention Act 0f 2001- Nov. 6, 2000
    * Four areas of change
    * Two terms added to defi nitions
    * Why
    - Total > 600, 000 Needle sticks a year
    - 2/3 rd Hospital
    - Risk of contracting disease
    - Adverse side effects of treatments
    - Psychological stress
    Modifi cation of Defi nitions - Area 1
    * Relating to Engineering Controls
    - Defi nition: Includes all control measures that isolate
    or remove a hazard from the workplace.
    - Examples: blunt suture needles, plastic or mylar
    wrapped capillary tubes, sharps disposal containers, and
    bio-safety cabinets
    Modifi cation of Defi nitions - Area 2
    * Revision and Updating of the Exposure Control Plan
    - Review no less than annually
    - Refl ect a new or modifi ed task/ procedure
    - Revised employee positions
    - Refl ect changes in technology
    - Document consideration and/or implementation of
    medical devices
    Modifi cation of Defi nitions - Area 3
    * Solicitation of Employee Input
    - Non-managerial employees who are responsible for
    direct patient care and potentially exposed to injury
    - Identifi cation, evaluation, selection of effective
    engineering and work practice controls
    - Document employee solicitation in Exposure Control
    Plan
    Modifi cation of Defi nitions - Area 4
    * Record Keeping
    - Sharps Injury Log
    Type and brand of device involved
    Department or work area of exposure incident
    Explanation of how the incident occurred
    Source: Laxmaiah Manchikanti, MD
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8
Q
  1. A potential False Claims Act issue is billing patients for
    medically unnecessary services. In this context, medically
    unnecessary services are . . . Choose the answer that best
    completes this sentence.
    A. Those services not warranted by a patient’s documented
    medical condition.
    B. Those services that are not approved by the Health and
    Human Services Department (HHS).
    C. Those services not required for a patient’s survival.
    D. Those services that do not yet have a CPT code.
    E. Services that have not actually been performed on a patient.
A
  1. Answer: A
    Explanation:
    Explanation: Physicians practices should not seek
    reimbursement for a service that is not warranted by a
    patient’s documented medical condition. It is not safe to
    assume that the reason a service is ordered can be inferred
    from chart entries.
    Source: 65 Fed. Reg. at 59439. In order to determine
    whether a service is reasonable and necessary, thephysician
    must apply the appropriate local medical review policy
    (“LMRP”). For more information on LMRPs, go to
    www.lmrp.net.
    Source: Erin Brisbay McMahon, JD, Sep 2005
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9
Q
  1. Which of the following has NOT been identifi ed as a
    major risk area for physician practices?
    A. Coding and billing
    B. Reasonable and necessary services
    C. Documentation
    D. Unqualifi ed personnel
    E. Improper inducements, kickbacks and self-referrals
A
  1. Answer: D
    Explanation:
    The OIG has identifi ed four major risk areas for physician
    practices: 1) coding and billing; 2) reasonable and
    necessary services; 3) documentation; and 4) improper
    inducements, kickbacks and self-referrals.
    Source: 65 Fed. Reg. at 59438.
    Source: Erin Brisbay McMahon, JD, Sep 2005
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10
Q
  1. Health Insurance Portability and Accountability Act
    established the Health Care Fraud and Abuse Control
    Program primarily to . . . Which one of the following
    would not correctly complete this sentence?
    A. Coordinate Federal, state, and local law enforcement efforts
    relating to health care fraud and abuse.
    B. Provide guidance to the health care industry regarding
    fraudulent practices.
    C. Conduct investigations, audits, and evaluations relating
    to delivery and payment for health care around the
    world.
    D. Facilitate enforcement of remedies for health care fraud.
    E. Create a national data bank to report adverse actions
    against health care providers.
A
  1. Answer: C
    Explanation:
    Explanation: Answer (C) should be limited to the United
    States.
    Reference: The Department of Health and Human
    Services and The Department of Justice Health Care Fraud
    and Abuse Control Program Annual Report for FY 2003
    (December 2004).
    Source: Erin Brisbay McMahon, JD, Sep 2005
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11
Q
  1. Which one of the following statements regarding the
    Offi ce of Inspector General (OIG) is FALSE?
    A. The OIG is an implementer of HIPAA’s Health Care
    Fraud and Abuse Program.
    B. The OIG excludes providers from Medicare, Medicaid, and other federal health programs for violating program
    rules and regulations.
    C. The OIG publishes compliance program guidance for
    physicians and small group practices.
    D. Penalties from the OIG may be avoided by the adoption
    of an effective compliance program.
    E. The OIG considers improper inducements, kickbacks
    and self-referrals as the only major risk area for physician
    practices
A
  1. Answer: E
    Explanation:
    Answer (e) is false because the OIG does not consider
    improper inducements, kickbacks and self-referrals as the
    only major risk area for physician practices. The OIG has
    identifi ed four major risk areas for physician practices: 1)
    coding and billing; 2) reasonable and necessary services; 3)
    documentation; and 4) improper inducements, kickbacks
    and self-referrals.
    Source: 65 Fed. Reg. at 59438
    Source: Erin Brisbay McMahon, JD, Sep 2005
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12
Q
  1. Which of the following is NOT one of the seven elements
    of an effective compliance program?
    A. Regular auditing and monitoring
    B. Designation of a compliance offi cer, compliance committee
    or compliance contacts
    C. Retaliation against employees who report legal or ethical
    concerns
    D. Education and training for all personnel in the practice
    E. Written practice standards that include a code or standard
    of conduct
A
  1. Answer: C
    Explanation:
    Although the scope of a compliance program will vary
    according to a practice’s resources, an effective compliance
    program should refl ect the following seven elements: (1)
    regular auditing and monitoring, (2) written practice
    standards that include a code or standard of conduct, (3)
    designation of compliance offi cer, compliance committee
    or compliance contacts, (4) education and training for all
    personnel in the practice, (5) existence of response
    mechanism and corrective action plan, (6) open lines of
    communication, and (7) an enforced and well-publicized
    disciplinary process.
    Answer (c) is not correct because an effective
    communication process is encouraged in a compliance
    program and, to achieve this, the practice must establish a
    procedure for communicating questions or complaints to
    designated compliance personnel without raising concerns
    about retaliation.
    Source: 65 Fed. Reg. 59434.
    Source: Erin Brisbay McMahon, JD, Sep 2005
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13
Q
1922. The designated health services covered by the Stark Law
include eleven categories. Which of the following is not a
DHS category covered by Stark Law?
A. Clinical laboratory services
B. Physical therapy services
C. Radiology services
D. Ophthalmology services
E. Home health services
A
  1. Answer: D
    Explanation:
    The DHS covered by the Stark Law include the following
    eleven categories: clinical laboratory services, physical
    therapy services,occupational therapy and speech language
    pathology services, radiology services, radiation therapy
    services and supplies, durable medical equipment and
    supplies, parenteral and enteral nutrients, equipment and
    supplies, prosthetics, orthotics, and prosthetic devices,
    home health services, outpatient prescription drugs, and inpatient and outpatient hospital services.
    Reference: 69 Fed. Reg. 16054 (2004).
    Source: Erin Brisbay McMahon, JD, Sep 2005
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14
Q
  1. Functions performed by the Practice Management
    Software include the following:
    A. Appointment and procedures scheduling and rescheduling
    B. Management of accounts receivable and collections
    C. Creation of electronic billing
    D. Provider input terminal
    E. Integration
A
  1. Answer: A
    Explanation:
    The function of the Practice Management Software
    includes all aspects of patient management including
    appointment, procedure scheduling, communication,
    creating bills, managing accounts receivable, and creating
    reports. The provider is an important part of the software,
    but more so in the back offi ce. The Practice Management
    Software responsibility is to ensure the vital functions of
    the support system to the provider. This is independent of
    clinical input.
    Source: Hans C. Hansen, MD
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15
Q
  1. A patient develops diffi culty during an interventional
    procedure and the physician discontinues the procedure.
    Identify the modifi er that may be reported by the physician
    to indicate that the procedure was discontinued.
    A. -52 reduced services
    B. -53 discontinued procedure
    C. -73 discontinued outpatient procedure prior to anesthesia
    administration
    D. -74 discontinued outpatient procedure after anesthesia
    administration
    E. -59 distinct procedural service
A
  1. Answer: B
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16
Q
  1. The EMR incorporates different sectional components
    to best manage the practice. The specifi c part of the EMR
    that relates to clinical services, requiring provider input
    is:
    A. The front offi ce
    B. The back offi ce
    C. The integrated pad, or workstation
    D. The server pod
    E. The offi ce input at the front desk
A
  1. Answer: B
    Explanation:
    The back offi ce is associated with the clinical service side
    of the electronic medical record. Input can be from a
    number of sources, being a verbal integration into the
    medical record, dictated and then transcribed cut and
    pasted, data input by keyboard, or touch screen, and even
    possibly by a pad or pen system.The key component of the
    back offi ce, however, is the provider interface.
    Source: Hans C. Hansen, MD
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17
Q
  1. According to ICD-9-CM, which one of the following is a
    mechanical complication of an internal implant?
    A. Erosion of skin by spinal cord stimulator electrodes
    B. Epidural abscess following catheterization
    C. Post lumbar puncture headache after spinal
    D. Side effects of morphine in an intrathecal pump
    E. Accidental injection of phenol into epidural space
A
  1. Answer: A
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18
Q
  1. If one knowingly submits or causes to be submitted
    a false or fraudulent claim for payment to the federal
    government, but with no intent to defraud the
    government, this is a violation of which of the following?
    A. The Criminal False Claims Act
    B. The Civil False Claims Act
    C. Stark Law
    D. Controlled Substances Act
    E. The Federal Anti-Kickback Law
A
  1. Answer: B
    Explanation:
    A. The Criminal False Claims Act makes it a felony to
    make or cause to be made any “false statement or
    representation of material fact in any application for any
    benefi t or payment under a Federal health care program.
    B. The Civil False Claims Act imposes liability if one
    “knowingly” submits or causes to be submitted a false or
    fraudulent claim for payment to the federal government. A
    specifi c intent to defraud is not required.
    C. Stark Law prohibits physicians from making referrals
    for certain designated health services (DHS) to entities in
    which the physician has a fi nancial relationship and the
    service is billed to Medicare or Medicaid.
    D. The Drug Enforcement Agency monitors prescriptions
    of controlled substances pursuant to authority under the
    Controlled Substances Act, Title II of the Comprehensive
    Drug Abuse Prevention and Control Act of 1970.
    E. The Federal Anti-Kickback Law prohibits the offer or
    receipt of anything of value which is intended to inducethe
    referral of a patient for an item of service that is
    reimbursed under a federal health care program, including
    Medicare and Medicaid.
    Source:
    A. 18 U.S.C. § 287, 1001; and 42 U.S.C. § 1320a-7b.
    B. 31 U.S.C. § 3729.
    C. 42 U.S.C. § 1395nn.
    D. 21 U.S.C. § 801 et seq.
    E. 42 U.S.C. § 1320a-7b(b).
    Source: Erin Brisbay McMahon, JD, Sep 2005
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19
Q
  1. One of managed care organizations policies to decrease
    criticism of their one-sided contracts is:
    A. Allowing the provider Medical Directors to determine
    medical necessity.
    B. Moving some of the objectionable provisions from the
    contract to the policy and procedure manuals.
    C. Allowing a vague description of the managed care
    organization’s coding standards.
    D. Adding a “least cost” standard to the contract.
    E. Allowing a very general defi nition of the services to be
    covered.
A
  1. Answer: B
    Explanation:
    They are moving some of the objectionable provisions to
    the policy and procedure manuals, but by reference, these
    become part of the contract.
    Source: Marsha Thiel, RN, MA, Sep 2005
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20
Q
  1. Which of the following would be LEAST likely to
    infl uence the collection ratio
    A. An increase in the practices billing rate
    B. Discounts on payments not being applied properly
    C. An increase in the practices billed amount for procedures
    D. Unaddressed incorrect payments
    E. Uncollected secondary billings.
A
  1. Answer: D
    Explanation:
    While discounts not applied correctly or in a timely
    manner may affect aging they would have a minimal effect
    on the collection ratio which involves dividing the net
    collected amount by gross charges for a particular time
    frame.
    Source: Marsha Thiel, RN, MA, Sep 2005
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21
Q
  1. An internal control weakness would best defi ned as
    a condition in which errors or irregularities are not
    detected within a timely period by:
    A. An independent audit of reports on control procedures
    B. Management when reviewing fi nancial statements
    C. Outside consulting fi rms
    D. Employees in the normal course of performing their
    functions
    E. The fi nancial manager during year end audits
A
  1. Answer: D
    Explanation:
    Checks and balances should be in place to detect errors or
    irregularities by front line employees at the time the
    irregularity occurs. This is the fi rst line of defense for
    managing problems
    Source: Marsha Thiel, RN, MA, Sep 2005
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22
Q
  1. Employers are responsible for completing an Injury
    and Illness Incident Form 301. Sally Jones was injured
    at the clinic on May 10, 2005. Sally reported the injury
    to the Human Resources Department the same day of
    her injury. How many days does the HR staff have to
    complete the Injury and Illness Form 301 in order to be
    compliant?
    A. Two
    B. Seven
    C. Ten
    D. Fourteen
    E. Thirty
A
  1. Answer: B
    Explanation:
    Employers are responsible for completing an Injury and
    Illness Incident Form 301 within seven calendar days after
    receiving information that a recordable work-related
    injury or illness has occurred. An equivalent form can be
    used if that form contains all the information asked for on
    the OSHA 301
    Supporting Documentation:
    http://www.osha.gov/recordkeeping/index.html THEN
    SELECT recording forms then select OPEN FORMS pdf
    PAGE 10 OF 12
    Source: Marsha Thiel, RN, MA, Sep 2005
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23
Q
  1. During a given month, the practice has $30,000 in gross
    charges of which about$15,000 will be written off via
    contract adjustments, collects $40,000 in receipts and
    writes $10,000 in checks to vendors. Under the cash
    method of accounting, what would this practice show as
    net income before taxes?
    A. $5,000
    B. $15,000
    C. $30,000
    D. $20,000
    E. $25,000
A
  1. Answer: C
    Explanation:
    Under the cash method of accounting, revenue is recorded
    when received and expenses recorded when paid.
    Therefore, you would record $40,000 of revenue and
    $10,000 in expenses.
    Source: Marsha Thiel, RN, MA, Sep 2005
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24
Q
  1. A practice has the following: Cash of $40,000; Accounts
    Receivable of $60,000; Equipment of $10,000; Accounts
    Payable of $20,000; Long term debt of $70,000 and
    Capital of $20,000. Assuming the practice uses the accrual
    method of accounting, what would the total assets be?
    A. $40,000
    B. $50,000
    C. $90,000
    D. $110,000
    E. $120,000
A
1933. Answer: D
Explanation:
Cash of $40,000, accounts receivable of $60,000 and
equipment of $10,000 are the assets.
Source: Marsha Thiel, RN, MA, Sep 2005
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25
Q
  1. Which of the following statements pertaining to pricing
    philosophies is not true?
    A. The relative value approach takes into account the cost of
    professional liability insurance
    B. The standard measure used by providers for the relative
    value approach is Medicare’s Relative Value Units
    C. The market-drive approach ties the providers fees to
    those of similar providers in the area
    D. The market-driven approach assumes that the patients
    are price sensitive but unaware of cost differences
    among providers
    E. The Geographic Practice Cost Index is used to convert
    Medicare’s national RVU values to regional values
A
  1. Answer: D
    Explanation:
    The market-drive approach assumes that the patients are
    price sensitive and are also aware of the cost differences
    among providers.
    Source: Marsha Thiel, RN, MA, Sep 2005
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26
Q
  1. Which one of the following statements regarding an
    impact analysis performed by a medical provider is
    correct?
    A. An impact analysis should be done after changes are
    implemented to a providers fee schedule
    B. For an impact analysis to accurately calculate the affect of
    new fees, the historical data should be weighted for the
    types of services performed by the provider
    C. An impact analysis is an excellent method of predicting
    the coming year’s revenue based on a new or revised fee
    schedule
    D. The main purpose of an impact analysis is to calculate
    how much future revenue will be generated by increasing
    the providers charges
    E. An impact analysis is basically a study of the affect a
    decrease in a provider’s fee schedule will have on future
    revenues
A
  1. Answer: B
    Explanation:
    An impact analysis applies the rates in a new or revised fee
    schedule to services provided in the past. This analysis
    will show what total charges would have been in a prior
    period based on a new fee schedule. The historical data
    should be weighted for the types of services provided
    because a large portion of a provider’s charges are often
    from a few key services. The analysis should be done
    before the fee changes are implemented.
    Source: Marsha Thiel, RN, MA, Sep 2005
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27
Q
  1. Budgets are very useful for an organization for all of the following reasons EXCEPT:
    A. Provides a benchmark to compare actual results to
    B. Forces management to plan
    C. Requires all areas of the company to communicate
    D. Provides information on patient fl ow
    E. Provides goals for the company to work toward
A
  1. Answer: D
    Explanation:
    A fi nancial budget provides information regarding
    revenues and expenses and whether or not the company is
    achieving its fi nancial goals. It does not provide clinical
    information on the fl ow of patients through the offi ce.
    Source: Marsha Thiel, RN, MA, Sep 2005
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28
Q
  1. In looking at the fi nancial statements for the period, you
    fi nd that your net collections have been decreasing over
    the last few months. All of the following could be possible
    causes EXCEPT:
    A. Provider productivity
    B. Payer mix
    C. Number of patient visits
    D. Inventory level of supplies
    E. Billing/Collecting process
A
1938. Answer: D
Explanation:
Level of supplies in inventory does not affect net
collections.
Source: Marsha Thiel, RN, MA, Sep 2005
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29
Q
  1. Which of the following is considered a Safe Harbor,
    making it an exception to the Federal Anti-Kickback
    Law?
    A. Gifts offered to a patient that may affect the patient’s
    choice of provider or treatment decisions, as long as
    certain requirements are met.
    B. Compensation arrangements with physicians or other
    practitioners that are based upon the volume or value
    of referrals for services with the practice, as long as certain
    requirements are met.
    C. Free medications given to a patient with the intention of
    inducing the patient to chose a specifi c provider, as long
    as certain requirements are met.
    D. The sale of pharmaceutical samples to benefi ciaries, as
    long as certain requirements are met.
    E. Payments relating to the purchase and sale of physician
    practices, as long as certain requirements are met.
A
  1. Answer: E
    Explanation:
    A. Gifts offered to patients or potential patients that may
    affect the patient’s choice of provider or the treatment
    decision are suspect under the Anti-Kickback Statute.
    B. Compensation arrangements with physicians or other
    practitioners that are based upon the volume or value of
    referrals for services within the practice are suspect under
    the Anti-Kickback Statute.
    C. Giving a patient free medications with the intention of
    inducing the patient to choose a specifi c provider is
    suspect under the Anti-Kickback Statute.
    D. The sale of pharmaceutical samples to benefi ciaries is
    suspect under the Anti-Kickback Statute.
    E. Payments relating to the purchase and sale of physician
    practices are considered one of the exceptions, commonly
    known as a safe harbor, under the Anti-Kickback Statute.
    Source:
    e) 42 CFR 1001.952(e) (1991).
    Source: Erin Brisbay McMahon, JD, Sep 2005
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30
Q
  1. Choose accurate statements about Evidence Based
    Medicine (EBM):
    A. EBM emphasizes examination of evidence for clinical
    research
    B. EBM de-emphasizes systematic collection of clinical
    studies
    C. EBM does not provide a role for synthesis of evidence
    D. EBM emphasizes intuition
    E. EBM depends on unsystematic experience
A
1940. Answer: A
Explanation:
EBM as plausible response
* Emphasizes
- Examination of evidence for clinical research
- Systematic collection of clinical studies
- Synthesis of evidence
* De-emphasizes
- Intuition
- Unsystematic experience
- Biological rationale (surrogates)
Source: Laxmaiah Manchikanti, MD
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31
Q
  1. Choose the accurate statements describing legitimate
    professional courtesy:
    A. When a physician practice waives coinsurance obligations
    or other out-of-pocket expenses for other physicians
    or family members, but only based on their
    referrals.
    B. When a hospital or other institution waives fees for
    services provided to their medical staff, but not employees.
    C. When an organization waives fees based on proportion
    of referrals.
    D. When a physician practice is able to collect full fee, by
    increasing charges proportionately.
    E. When a physician practice waives all or part of a fee for
    services for offi ce staff, other physicians or family members.
A
  1. Answer: E
    Explanation:
    The following are general observations about professional
    courtesy arrangements for physicians to consider:
    * Regular or and consistent extension of professional
    courtesy by waiving the entire fee for services rendered to
    a group of persons (including employees, physicians or
    their family members) may not implicate any of OIG’s
    fraud and abuse authorities if membership in the group
    receiving the courtesy is determined in a way that does not
    take into account directly or indirectly any groupmember’s
    ability to refer to or otherwise generate federal health care
    program business for, the physician.
    * Regular or consistent extension of professional courtesy
    by waiving otherwise applicable copayments for services
    rendered to a group of persons (including employees,
    physicians or their family members), would not implicate
    the Anti-Kickback Statute if membership in the group is
    determined in a way that does not take into account
    directly or indirectly any group member’s ability to refer
    to, or otherwise general federal health care program
    business for, the physician.
    Source: Laxmaiah Manchikanti, MD
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32
Q
1942. Currently, payment to the physician for outpatient
surgery performed on a Medicare patient is based upon
which prospective payment system?
A. DRGs
B. APGs
C. RBRVS
D. ASCs
E. APCs
A
  1. Answer: C

Source: Laxmaiah Manchikanti, MD

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33
Q
1943. Level III Healthcare Common Procedure Coding System
(HCPCS) codes are updated by
A. CMS
B. The fi scal intermediary
C. AMA
D. AHA
E. OIG
A
  1. Answer: B
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34
Q
  1. The medical decision-making is measured by all of the
    following except:
    A. Number of diagnoses/management options
    B. Amount and complexity of data reviewed
    C. Risk of complications
    D. Specialty of the treating physician
    E. Risk associated with diagnostic procedures
A
  1. Answer: D
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35
Q
1945. The Unifi ed Medical Language System (UMLS) is a
project sponsored by the:
A. National Library of Medicine
B. Centers for Medicare and Medicaid
C. World Health Organization
D. Offi ce of Inspector General
E. American Medical Association
A
  1. Answer: A

Source: Laxmaiah Manchikanti, MD

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36
Q
  1. In general, all three critical components (history,
    physical examination, and medical decision making) for
    the Evaluation and Management (E/M) codes in CPT
    should be met or exceeded when
    A. The patient is established
    B. A new patient is seen in the offi ce
    C. The patient is given subsequent care in the hospital
    D. The patient is seen for a follow-up inpatient consultation
    E. the patient is undergoing an interventional procedure
A
  1. Answer: B
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37
Q
  1. The “cooperating party” responsible for maintaining
    the ICD-9-CM Disease classifi cation is the
    A. Centers for Medicare and Medicaid Services (CMS)
    B. National Center for Health Statistics (NCHS)
    C. American Hospital Association (AHA)
    D. American Health Information Management Association
    (AHIMA)
    E. National Institutes of Health (NIH)
A
  1. Answer: B
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38
Q
  1. Select the accurate statement about proper billing ?
    A. Bill for items or services not rendered or not provided
    as claimed
    B. Submit claims for equipment, medical supplies and services
    that are not reasonable and necessary
    C. Double bill resulting in duplicate payment
    D. Bill for non-covered services as if covered
    E. Knowingly do not misuse provider identification numbers, which results in improper billing
A
  1. Answer: E
    Explanation:
    Documentation Summary
    Never:
    Bill for items or services not rendered or not provided
    as claimed
    Submit claims for equipment, medical supplies and
    services that are not reasonable and necessary
    Double bill resulting in duplicate payment
    Bill for non-covered services as if covered
    Knowingly misuse provider identifi cation numbers,
    which results in improper billing
    Unbundle (billing for each component of the service
    instead of billing or using an all-inclusive
    code)
    Upcode the level of service provided
    Source: Laxmaiah Manchikanti, MD
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39
Q
  1. Which of the following is the best predictor for a patient
    with pain becoming violent?
    A. Progressive psychomotor retardation
    B. Prior diagnosis of a Dependent Personality Disorder
    C. Past history of violence or destruction of property
    D. Shouting at the offi ce staff to be seen immediately
    E. Shouting at the physician to change the medical record
A
  1. Answer: C

Source: Cole EB, Board Review 2003

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40
Q
1950. DSM-IV-TR is used most frequently in what type of
health care setting?
A. Work hardening programs
B. Ambulatory surgery centers
C. Home health agencies
D. Behavioral health centers
E. Nursing homes
A
  1. Answer: D
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41
Q
  1. Which of the following is classifi ed as a poisoning in
    ICD-9-CM?
    A. Reaction to contrast administered for epidurogram
    B. Idiosyncratic reaction between various drugs
    C. Carbazeran intoxication
    D. Syncope due to cold medicine and a three martini lunch
    E. Motor paralysis for 2 hours following adhesiolysis
A
  1. Answer: D
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42
Q
  1. Under the RBRVS for physician payments, three (3)
    components are assigned relative value units. These are:
    A. Physician work, experience, and malpractice insurance
    expense
    B. Geographic index, wage index, and cost of living index
    C. Conversion factor, CMS weight, and hospital specifi c
    rate
    D. Physician work, practice expense, and malpractice insurance
    expense
    E. Fee-for-service, per diem payment, and capitation
A
  1. Answer: D
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43
Q
  1. A nomenclature of codes and medical terms which
    provides standard terminology for reporting physicians’
    services for third party reimbursement is:
    A. Current Medical Information and Terminology (CMIT)
    B. Current Procedural Terminology (CPT)
    C. Systematized Nomenclature of Pathology (SNOP)
    D. Diagnostic and Statistical Manual of Mental Disorders
    (DSM)
    E. International Classifi cation of Diseases, Ninth Revision
    (ICD-9)
A
  1. Answer: B
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44
Q
1954.Identify WRONG statement about speciality
designation:
A. 09 = interventional pain management
B. To change designation, fi ll out new 855I provider enrollment
form
C. 72 = pain medicine
D. 10 = anesthesia
E. 14=Neurosurgery
A
1954. Answer: D
Explanation:
Designate Yourself as 09
* 05 = anesthesia
* 72 = pain management
* 09 = interventional pain management
* 14 = Neurosurgery
* To change designation, fi ll out new 855I provider
enrollment form
* Web site to get 855 form:
- cms.hhs.gov/providers/enrollment/forms/
Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
Meeting
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45
Q
  1. Pay for performance is being considered by Medicare
    and third party payors. Identify accurate statements.
    A. Compensation incentives will not induce changes in the
    quality of services
    B. Outcome measures are easy to develop
    C. Compensation incentives rest on the economic fi eld
    of agency theory (method of compensation induces
    conduct)
    D. Quality measures are already in place
    E. It is simple to fi nance incentives
A
1955. Answer: C
Explanation:
Pay for Performance
Compensation incentives rest on the economic fi eld of
agency theory
Method of compensation induces conduct
Compensation incentives will not induce changes in the
quality of services
Issues to Consider in Paying for Performance
How to measure quality
Vehicles for encouraging quality
What to reward
How to fi nance incentives
Source: Laxmaiah Manchikanti, MD
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46
Q

1956.What are the requirements for Past, Family, Social
History documentation?
A. Three items for level 1 & 2 offi ce visits
B. Three items for subsequent hospital care, follow-up,
consultations, subsequent nursing home care
C. None for level 3 offi ce visits
D. One (1) specifi c item from EACH of the three categories
for level 3 offi ce visit
E. One (1) specifi c item from EACH of the three categories
for complete comprehensive service

A
1956. Answer: E
Explanation:
Past, Family, Social History
* None
For Level 1 & 2 offi ce visits
Subsequent Hospital Care, F.U. Consultations,
Subsequent Nursing Home Care
* Pertinent Level 3
One (1) specifi c item from ANY of the three categories
* Complete - Comprehensive
New Service
One (1) specifi c item from EACH of the three categories
Follow-up
One (1) specifi c item from EACH of the two categories
or
Either Update or Repeat all items
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47
Q
  1. Choose the correct statement for History of Present
    Illness:
    A. For level I service, 4 items are documented
    B. For level II service, 4 items are documented
    C. For level III service, 4 items are documented
    D. For level IV service only 3 items are documented
    E. For level V service only 3 items are documented
A
1957. Answer: C
Explanation:
History of Present Illness
* Brief (1-3)
Level 1 & 2
* Extended (4+)
Level 3 and above
or
Status of 3+
multiple chronic conditions
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48
Q
1958. Which of the following is a critical component of
evaluation and management services?
A. Time
B. Counseling
C. Medical decision making
D. Coordination of care
E. Nature of presenting problem
A
1958. Answer: C
Explanation:
The critical components of evaluation and management
services are:
History
Examination
Decision-making
Other four components are:
Counseling
Coordination of care
Nature of presenting problem
Time
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49
Q
  1. Medical record functions include all of the following
    EXCEPT:
    A. Support insurance billing
    B. Provide clinical data for education
    C. Provide clinical data for research
    D. Promote continuity of care among physicians
    E. Reduce quality of care
A
1959. Answer: E
Explanation:
Medical records function to:
keep the practitioner out of the slammer support “medical necessity”
reduce medical errors & professional liability exposure
reduce audit exposure
facilitate claim review
support insurance billing
provide clinical data for education
provide clinical data for research
promote continuity of care among physicians
indicate quality of care
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50
Q
  1. Identify the accurate statement showing the differences
    between consultation and a referral visit:
    A. A problem is well known in both
    B. A patient is referred for evaluation and treatment for a
    consultation
    C. Course of treatment is well known and predetermined
    for a consultation
    D. A patient is treated and followed in a referral visit
    E. No correspondence is required as care is transferred in
    consultation
A
  1. Answer: D
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51
Q
  1. What are the documentation requirements for Review
    of Systems?
    A. Review of one (1) system for problem focused visit
    B. Review of two (2) systems for expanded focused visit
    C. Review of one (1) system for detailed visit
    D. Complete or 10+ systems for comprehensive visit
    E. Complete or 10+ systems for detailed visit
A
  1. Answer: D
    Explanation:
    Review Of Systems
    * Problem-Pertinent
    Positive and negative responses related to problems
    identifi ed in the HPI
    * Extended
    Positive and negative responses related to 2 - 9 systems
    * Complete
    Ten Systems must be reviewed
    or
    In place of documenting negative responses to the
    remaining systems (up to 10), May note all other systems
    negative
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52
Q

1962.Multiple components of proper medical record
documentation DOES NOT include the following:
A. The reason for the patient visit
B. The indication of services provided
C. The location of the services
D. Itemized billing for services
E. Plan of action including return appointment

A
  1. Answer: D
    Explanation:
    Proper medical record documentation includes the
    following:
    Why did the patient present for care?
    What was done?
    Where were the services rendered?
    When is the patient to return or what is the plan of
    action?
    Will there be follow-up tests or procedures ordered?
    Source: Laxmaiah Manchikanti, MD
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53
Q
1963. What are the CPT codes describing new patient offi ce
visits?
A. 99201, 99203, 99204, 99215
B. 99201, 99202, 99203, 99204
C. 99201, 99202, 99214, 99233
D. 99204, 99203, 99221, 99233
E. 99261, 99262, 99252, 99255
A
  1. Answer: B
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54
Q
  1. Prevalence of errors in outpatient settings are common
    in patient encounters. The most common error in the
    outpatient setting is:
    A. Communication error
    B. Prescribing error
    C. Improper diagnosis
    D. Loss of patient data
    E. Improper follow up with abnormal lab result
A
  1. Answer: A
    Explanation:
    Communication error is the most common type of error
    in the outpatient setting. It is then followed by
    discontinuity of care, and then by abnormal lab result
    follow up. The next four errors, although not as common,
    are well suited to the EMR as heralding alerts. These
    include missing values and poor charting, prescribing
    errors of dosage choice, allergy or interaction, clinical
    mistakes of knowledge or skills, which would include
    improper diagnosis, and the ubiquitous “other”. “Other”
    is actually quite high. This would include lost charts,
    improper fi ling, and violation of confi dentiality to name a
    few. At 8%, or 8 out of 100 charts, applying to the typical daily practice seeing 100 patients a day, this category
    “other” is actually a very high and unacceptable number.
    The EMR will assist in reducing this number.
    Source: Hans C. Hansen, MD
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55
Q

1965.The electronic medical record assists the practice
with billing guidelines, CMS guidelines and following
standards of “Incident to” billing. “Incident to” billing
for physician extenders is a CMS guideline detailed in
Statute S2050, which states that:
A. Accountability of supervising physician. The nurse
practitioner, or PA’s can bill at 100% if the physician is
immediately available on-site and involved in medical
decision making
B. The practice may bill the physician extender, nurse practitioner,
or PA at 100% if available by telephone
C. Requires that an 85% allowance of the physician fee is
necessary if the physician only sees the patient every
other visit
D. 100% may be billed by the nurse practitioner or physician
extender if they use their own provider codes
E. The electronic medical record ensures improved data
assessment and decision making, supporting 100%
physician fee by the extender.

A
  1. Answer: A
    Explanation:
    “Incident to” is a concern for CMS, and a potential source
    for fraud and abuse. It is the duty of the practice to
    determine whether the physician extender, nurse
    practitioner, or PA, is meeting the appropriate guidelines
    that CMS requires for “incident to” billing. It is
    incumbent upon the pain management physician to know
    these rules if an extender is being utilized. To bill at 100%
    physician fee,the physician is immediately available onsite,
    intimately involved in medical decision making with
    support of the nurse practitioner and PA in follow up
    visits. The physician will see the patient at fi rst encounter,
    defi ne diagnosis, and course of care. Follow up will
    typically be at the third to fi fth visit by the physician,
    ensuring correct diagnosis and treatment pathway. The
    physician extender may follow up with the patient,assist in
    management of the patient, and bill at 100% if the
    physician is onsite and immediately available. The
    extender should only bill 85% if the physician is not
    immediately available, or is not involved in the initial
    encounter. In all incidences, the physician should be
    involved in medical decision making. Even if the extender
    has their own provider numbers, these “incident to”
    criteria must be met to apply the 100% physician fee. If an
    extender bills under their own provider number, typically
    only an 85% physician fee criteria will be met. Many
    practices adopt the policy of just billing at the straight
    85% fee to avoid regulatory scrutiny, and to avoid the
    pitfalls of non-compliance, particularly during an audit.
    Source: Hans C. Hansen, MD
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56
Q
  1. Dr. Smith requests a consultation from an interventional
    pain physician on a patient in the hospital. The physician
    takes a detailed history, performs a detailed examination,
    and utilizes moderate medical decision-making.
    The physician orders diagnostic tests and prescribes
    medication. He documents his fi ndings in the patient’s
    medical record and communicates in writing with the
    attending physician. The following day the physician
    visits the patient to evaluate the patient’s response to the
    medication, to review results from the diagnostic tests,
    and discuss treatment options. What codes should the
    physician report for the two visits?
    A. An initial hospital visit and follow-up hospital care
    B. An initial inpatient consult and initial hospital care
    C. An initial inpatient consult and follow-up hospital care
    D. An initial inpatient consult and a follow-up consult
    E. An initial inpatient consult for both visits
A
  1. Answer: C
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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57
Q
  1. A system of preferred terminology for naming disease
    processes is known as a :
    A. Set of categories
    B. Diagnostic listing
    C. Classifi cation system
    D. Medical nomenclature
    E. International Classifi cation of Diseases
A
  1. Answer: D
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58
Q
  1. Torts are civil wrongs recognized by law as grounds
    for a lawsuit. These wrongs result in an injury or harm
    constituting the basis for a claim by the injured party.
    The primary aim of tort law is to provide relief for the
    damages incurred and to deter others from committing
    the same harm. Which of the following may the injured
    person not sue for?
    A. Loss of earning capacity
    B. Three times medical expenses
    C. Injunction to prevent release of protected information
    D. Pain and suffering
    E. Actual and potential reasonable medical expenses
A
  1. Answer: B
    Explanation:
    The injured person may sue for an injunction to prevent
    the continuation of the tortuous conduct or for monetary
    damages. Among the types of damages the injured party
    may recover are: loss of earnings capacity, pain and
    suffering, and reasonable medical expenses. They include
    both present and future expected losses.
    There are numerous specifi c torts including trespass,
    assault, battery, negligence, products liability, and
    intentional infl iction of emotional distress. Torts fall into
    three general categories: intentional torts (e.g.,
    intentionally hitting a person); negligent torts (causing an
    accident by failing to obey traffi c rules); and strict liability
    torts (e.g., liability for making and selling defective
    products - See Products Liability). Intentional torts are those wrongs which the defendant knew or should have
    known would occur through their actions or inactions.
    Negligent torts occur when the defendant’s actions were
    unreasonably unsafe. Strict liability wrongs do not depend
    on the degree of carefulness by the defendant, but are
    established when a particular action causes damage. Tort
    law is state law created through judges (common law) and
    by legislatures (statutory law).
    Source: Gurpreet Singh Padda MD MBA
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59
Q
  1. What authority does a Local Medicare Carrier have
    regarding payment for an item or service that is noncovered
    because of a National Coverage Decision (NCD)?
    A. The coverage determination on whether specifi c medical
    items and services are reasonable and necessary under
    Medicare Law is published in the National Coverage
    Manual and Local Carriers do not have the discretion
    to pay for the services
    B. The Medical Director of a Local Carrier has the authority
    to review a comprehensive report and information on
    the item or service sent by the treating physician and
    pay the claim if, in his/her opinion, medical necessity
    has been demonstrated.
    C. The CAC may overturn the NCD and publish a local
    coverage addendum that the specifi c item or service
    may be paid under special circumstances.
    D. The CAC and/or the Carrier Medical Director may
    write to the Medicare Coverage Advisory Committee
    (MCAC) for permission to pay for the item or service;
    E. Medical Director of a Local carrier has overriding authority
    on National coverage policies.
A
  1. Answer: A
    Explanation:
    An NCD is made after a comprehensive evaluation process
    that often includes a technology assessment by anexpert(s)
    outside CMS and/or the CMS Coverage Advisory
    Committee. NCD’s are made according to a process
    detailed in a Federal Register Notice dated April 27, 1999
    (64 FR 22619). An NCD is binding on all Medicare
    carriers, fi scal intermediaries, quality improvement
    organizations, health maintenance organizations
    (Medicare), competitive medical plans and health care
    prepayment plans.
    Source: CMS website www.cms.gov
    Source: Joanne Mehmert, CPC, Sep 2005
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60
Q
  1. How do Local Medicare Contractors that pay claims in
    each state make coverage determinations?
    A. All coverage determinations are updated and sent to the
    Local Contractor by the Centers for Medicare and Medicaid
    Services (CMS) once a year.
    B. The Medical Director at each carrier reviews statistical
    data to determine how much it has paid for each CPT
    procedure code and reduces payments on the most
    frequently paid codes by means of restrictive coverage
    policies
    C. A committee of physician specialists, (Carrier Advisory Committee (CAC)), in the State participates in the development
    of Local Coverage Decisions (LCD).
    D. All claims that have a valid CPT code are paid, there are
    no exceptions.
    E. All interventions without a National coverage policy are
    considered for coverage
A
  1. Answer: C
    Explanation:
    Reference: www.cms.gov; Principles and Practice of
    Documentation, Billing, Coding, and Practice
    Management 2005
    Carriers are required to maintain CAC’s which are
    intended to provide a formal mechanism for physicians in
    the State to be informed and participate in the
    development of coverage decisions in an advisory capacity.
    CMS instructed Medicare Carriers by means of
    Transmittal #106, March 4, 2005, that it is mandatory to
    include Interventional Pain Management Specialists on
    CAC Membership.
    Source: CMS Web site: www.cms.gov; Chapter III
    Manchikanti L, Principles and Practice of Documentation,
    Billing, Coding, and Practice Management 2005
    Source: Joanne Mehmert, CPC, Sep 2005
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61
Q
  1. What level(s) E&M service can a registered nurse (R.N)
    Perform?
    A. If the physician is in the offi ce but does not see the patient,
    and the nurse spends a long time with the patient
    h/she may report a level 3 service: 99213
    B. An R.N. may not report any E&M service codes
    C. The only appropriate level of service for an R.N. to report
    is 99211
    D. An R.N. may report whatever level of service he/she
    provides/documents
    E. Under the advance nurse practitioner act, nurses are entitled
    for equal payment as physicians.
A
  1. Answer: C
    Explanation:
    The description of CPT code 99211 includes the
    statement,“that may not require the presence of a
    physician”. Medicare allows an R.N. to report code 99211
    as an “incident to” service, i.e., the physician must be in the
    offi ce. Services such as an evaluation when a patient
    comesto pick up a prescription refi ll or a patient that
    is seen for a drug screen are clinical examples listed in
    Appendix C of the CPT Manual. Regardless of the extent
    of the R.N.’s service, (work performed, length of time
    spent) the only appropriate code h/she may report is
    a Level I, 99211.
    Source: Medicare Carriers Manual 100-4; CPT Manual
    Source: Joanne Mehmert, CPC, Sep 2005
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62
Q
  1. How do you report the unlisted drug code J3490 so payer
    knows how much to reimburse for the drug?
    A. List the code J3490 in the “procedure code “ fi eld (24D)
    and the amount of the drug given in the number of services
    fi eld, (24G) attach a letter that describes the drug
    B. List code J3490 in 24D and number “1” in the units/
    services fi eld (24G) and list the name of the drug, the
    amount given and the strength in the information fi eld
    (Box 19 on the 1500).
    C. CMS doesn’t pay for unlisted drugs; they should not be
    reported to Medicare
    D. List J3490 in 24D, and the amount used in 24G and
    always send an invoice with the claim for the unlisted
    drug
    E. Collect from the patient.
A
  1. Answer: B
    Explanation:
    Since the drug is “unlisted” the description J3490 does not
    include an amount; therefore the number of services listed
    in 24G is “1”. A complete description of the substance and
    amount administered is listed in the informational fi eld,
    which is Box 19 on a paper claim 1500. The insurance
    payer wants to know what drug and how much of the drug
    was administered.
    An NDC number listed in the “information” fi eld will
    provide an exact description. There are some
    circumstances (compound drugs used in pumps) where
    the invoice may be required or would provide necessary
    information for the payer to determine payment; however
    as a general rule, it is not necessary to attach an invoice.
    Source: Medicare policies; HCPCS Manual
    Source: Joanne Mehmert, CPC, Sep 2005
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63
Q
  1. How do you determine the “number of services/units”
    to list on the CMS 1500 form (or electronic fi eld) for the
    “J” codes?
    A. All “J” codes are reported as “1” unit
    B. List the number of mgs, mls, mcgs, or units that are
    administered to the patient in the “number of services
    fi eld”.
    C. Each “J” code lists a specifi c dosage, such as, “per 10
    mg”.
    D. Convert the amount listed in the “J” code to ml’s and
    calculate the number of ccs were used
    E. All “J” Codes are reported as “10” units.
A
  1. Answer: C
    Explanation:
    The quantity of the “J” codes is listed in various forms that
    must be taken into consideration when calculating the
    number of units/services to report. For example, Depo
    Medrol, a commonly used drug for epidural injections
    comes in 3 different amounts, (J1020, 20 mg, J1030, 40 mg
    and J1040, 80 mg) and is one of the least complicated
    drugs to bill. When 80 mgs of Depo is administered,
    report J1040 x 1 unit.
    Aristocort Forte is described as J3302, per 5 mg. When 40
    mg is administered, the number of units/services will be
    listed as ‘8’ since it will take 8 units of 5 mg each to reach a
    dosage of 40 mg. It is particularly important to coordinate
    with the provider to ensure that h/she documents the
    amount of the drug used and lists the name and amount
    on the charge ticket in such a manner that the coding
    person bills the correct number of units.
    The most straightforward method for most coding/billing
    staff is to describe the drug on the charge ticket using the
    same measurement that is listed in the HCPCS “J” code
    description. The provider’s documentation should state
    the amount given using the same description, (e.g., units,
    cc’s, mg).
    Source: Joanne Mehmert, CPC, Sep 2005
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64
Q
  1. Do non-Medicare payers allow physicians to report nonphysician
    services as “incident to” if they meet the same
    requirements as Medicare?
    A. Yes, all payers recognize the “incident to” billing concept
    B. The term “incident to” is unique to Medicare and “incident
    to” regulations are Medicare regulations.
    C. Non-Medicare payers do not pay for services unless the
    physician is present in the room with the patient during
    the provision of the service
    D. None of the above
    E. All of the above.
A
  1. Answer: B
    Explanation:
    Billing rules for services provided by non-physician
    providers vary from payer to payer. Non-Medicare payers
    may reimburse non-physicians differently. Providers
    should review their participation agreements for all of
    their contracted payers as well as the State laws in which
    they are providing services. In cases where physicians, as
    the collaborating physician, have complete leeway to delegate services that are within the non-physician’s scope
    of practice, the services will generally be reported as if
    rendered by the physician.
    Medicare’s requirement that the physician be “in the
    offi ce”may not pertain to other insurers unless the
    payer specifi es that they apply. Many states allow a
    general delegation of authority with responsibility
    retained by the physician without requiring on-premises
    supervision.
    In situations where the provider is not participating,
    Medicare rules may be the best option for billing nonphysician
    practitioner services.
    Source: “The Ins and Outs of “incident –To
    Reimbursement” by Alice Gosfi eld, J.D., Family Practice
    Management, November/December 2001.
    Source: Joanne Mehmert, CPC, Sep 2005
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65
Q
  1. Drugs and supplies used “incident to” the physician’s
    service paid separately or considered bundled into the
    CPT code for an injection or nerve block because:
    A. All “incident to” items and services should be individually
    reported and are separately paid by Medicare
    B. All “incident to” items and services are considered paid
    for in the payment for only one CPT code, nothing
    should be separately reported
    C. “Incident to” only refers to non-physician practitioners
    and “global” refers to supplies, radiology services and
    drugs
    D. Drugs and supplies are considered “incident to” costs.
    E. If Medicare does not pay “Incident to” items and services
    must be collected from the patient.
A
  1. Answer: D
    Explanation:
    The term “incident to” is primarily a CMS description for
    items and services that are furnished as a part of the
    patient’s normal course of treatment and are incidental
    (contributory or ancillary) to a patient’s care. Drugs that
    cannot be self administered (other than local anesthetics)
    are reported and paid separately, most supplies are
    included in the global payment.
    Source: Medicare Carriers Manual, 100-4, Chapter 12;
    Manchikanti L, Principles and Practice of Documentation,
    Billing, Coding, and Practice Management 2005
    Source: Joanne Mehmert, CPC, Sep 2005
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66
Q
  1. Dr. Bob is on vacation and his patient Mrs. Smith, a
    Medicare benefi ciary, will be seen in the offi ce today by
    the NP. Dr. Bob evaluated Mrs. Smith and initiated Mrs.
    Smith’s treatment plan 3 weeks ago. Dr. Jim, another
    member of the group is seeing patients in the offi ce
    during Mrs. Smith’s visit. Mrs. Smith does not have any
    new complaints; the NP evaluates her and advises Mrs.
    Smith to continue treatment plan that Dr. Bob initiated.
    How is the service reported to Medicare?
    A. Report the service using the NP’s own name and PIN
    number
    B. Report the service as an “incident to” service, using Dr.
    Bob’s name and PIN number
    C. Report the service as an “incident to” service, using Dr.
    Jim’s name and number
    D. Report as an “incident to” service with Dr. Jim’s PIN and
    name. List Dr. Bob’s name and UPIN number as the
    “referring doctor (Boxes 17 & 17a) on a paper form
    or in the corresponding fi eld when the claim is fi led
    electronically.
    E. Report as an “Incident to” service using Dr. Bob’s PIN
    and name.
A
  1. Answer: D
    Explanation:
    Effective May 24, 2004, CMS implemented its clarifi cation
    of the Preamble of the Proposed Rule for the Medicate
    Physician Fee Schedule on November 1, 2001 (66 Fed Reg
    55267) which stated, “The billing number of the ordering
    physician (or other practitioner) should not be used ifthat
    person did not directly supervise the auxiliary personnel.”
    In Question VII above, the doctor that established the
    plan of care (Dr. Bob) is the “ordering provider” and Dr.
    Jim is the “supervising provider”.
    CMS sent Change Request #3138, dated April 23, 2004 to
    Medicare Carriers that further clarifi es where physician’s
    Provider Information Numbers and names should be
    reported when both an ordering provider and a
    supervising provider are involved in a service.
    Source: Medicare Carriers Manual 100-04, Medicare
    Claims Processing; Transmittal 148, April 23, 2004, CMS
    website, Medlearn Matters #MM3138
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67
Q
  1. When a pain specialist performs a 3 level lumbar
    discogram in an outpatient hospital place of service
    (POS) 22, films are taken, and a report is issued what
    radiology code(s) should be reported:
    A. 72295-26 x 3
    B. 72295-26 x 1
    C. 76003-26, 72295-26
    D. 76005, 72295 x 3
    E. 76003 X3, 72295X1
A
  1. Answer: A
    Explanation:
    It is appropriate to report code 72295-26, the and interpretation code, for each level for which a
    diagnostic study is performed, fi lms taken and a report is
    written. The fl uoroscopic guidance code, 76005 is not
    separately reported since fl uoroscopic guidance is
    included in the supervision and interpretation codes
    Source: CPT Assistant: Code and Guideline Changes, A
    Comprehensive Review November 1999; CPT Assistant
    Coding Consultation Questions and Answers, April 2003.
    Source: Joanne Mehmert, CPC, Sep 2005
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68
Q
  1. When a physician loans a C-Arm to an ambulatory
    surgical center, place of service (POS), 24 where h/she
    performs procedures, the correct code to report for
    fl uoroscopic guidance for a facet injection is:
    A. 76005-26
    B. 76003-26
    C. 76005
    D. 76000-26
    E. 76005-TC
A
  1. Answer: A
    Explanation:
    Medicare (and many non-Medicare insurers) pays a global
    facility fee to an ASC that includes fl uoroscopic guidance;
    it would be a duplicate payment if the physician were paid
    a global fee for the fl uoroscopic guidance. When a
    procedure is performed in a facility setting, modifi er -26,
    the professional component, is appended to the
    radiological codes. The physician should lease the
    equipment to the ASC.
    Source: Medicare Contractors Manual, 100-04, Chapter
    14, §10.2
    Source: Joanne Mehmert, CPC, Sep 2005
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69
Q
1979. When an epidurogram is performed in the offi ce, place of service (POS) 11, images are taken and a formal
radiologic report is issued, the physician should report
code(s):
A. 76005 and 72275
B. 76003 and 72275-26
C. 72275
D. 76005-26 and 72275-TC
E. 72275 and 76003 TC
A
  1. Answer: C
    Explanation:
    Code 72275, is a supervision and interpretation code that
    includes code 76005. The use of fl uoroscopy (76005) is
    included in the supervision and interpretation codes and
    should not be separately reported
    Source: CPT coding Manual; Manchikanti L, Principles
    and Practice of Documentation, Billing, Coding, and
    Practice Management 2005
    Source: Joanne Mehmert, CPC, Sep 2005
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70
Q
  1. Which of the following is a properly designed control
    procedure for internal control of accounts receivables?
    A. Lag time on billing charges should be closely watched
    B. Protocol for authorizing write-offs and discounts should
    be established
    C. Prior authorizations should be obtained before services
    rendered if you think they won’t be paid
    D. Patient statements are mailed on a monthly basis
    E. Insurance requests for medical records should be logged
    and dated
A
  1. Answer: B
    Explanation:
    Management of contractual discounts and bad-debt
    write-offs ensure that they are legitimate and maintain the
    integrity in AR reports.
    Source: Marsha Thiel, RN, MA, Sep 2005
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71
Q
  1. Which of the following may report a physician to the
    National Practitioner Data Bank?
    A. A plaintiff ’s attorney after fi ling a successful claim.
    B. A professional society.
    C. A judge imposing sanctions.
    D. A state licensing board, that receives an allegation.
    E. A professional society that conducts formal peer review.
A
  1. Answer: E
    Explanation:
    The National Practitioner Data Bank (NPDB) was
    established under Title IV-B and B of Public Law 99-660,
    42 U.S.C. Section 11101-11152, “The Health Care Quality
    Improvement Act of 1986.” The NPDB, which is
    maintained by the Department of Health and Human
    Services (DHHS), contains a record of adverse clinical
    privileging, licensure, and professional society
    membership actions taken primarily against physicians
    and dentists, and medical malpractice payments made on
    behalf of all health care practitioners who hold a license or
    other certifi cation of competency. Groups that have access
    to the NPDB include hospitals, other health care entities
    that conduct peer review and provide or arrange for care, state boards of medical or dental examiners, and other
    health care practitioner state boards. Individual
    practitioners are also able to self-query the NPDB. The
    reporting of information to the NPDB is restricted to
    medical malpractice payers, state licensing medical boards
    and dental examiners, professional societies that conduct
    formal peer review, and hospitals and health care entities.
    Source: Gurpreet Singh Padda MD MBA
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72
Q

1982.There are currently how many levels of appeal/review
available when a provider and/or Medicare benefi ciary
disagrees with Medicare’s initial determination of claim
payment/denial?
A. There is no opportunity to ask for a review, the Carrier
or Fiscal Intermediary determination is fi nal
B. Three levels of appeal all at the Carrier level
C. Five levels of appeal; the fi nal level is a judicial review in
U.S. District Court
D. Four levels of appeal, the fi nal level is the Administrative
Law Judge (ALJ)
E. Six levels, the fi nal level is the review by secretary of
HHS.

A
  1. Answer: C
    Explanation:
    The fi ve levels of review are: 1) appeal to the Medicare
    contractor for a re-consideration of the initial
    determination, 2) Qualifi ed Independent Contractor
    (“QIC”) or Hearing Offi cer employed by the Carrier, 3)
    ALJ hearing which can be held by videoconference where
    the technology is available, 4)Departmental Appeals Board
    review (“DAB”), and 5) Judicial review in U.S. District
    Court.
    Source: Manchikanti L, Principles and Practice of
    Documentation, Billing, Coding, and Practice
    Management 2005. Federal Register March 25, 2005 and
    June 30, 2005.
    Source: Joanne Mehmert, CPC, Sep 2005
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73
Q
  1. While waiting to operate, a surgeon asks a physician
    colleague what the best antibiotic to use for surgical
    implants. The colleague states she always uses Antibiotic
    G. The patient is prescribed Antibiotic G by her surgeon
    and is found to be allergic two days later, but suffers no
    injury. Who is negligent?
    A. The colleague
    B. The surgeon
    C. The pharmacist
    D. No one.
    E. The patient
A
  1. Answer: D
    Explanation:
    The legal criteria for determining negligence require all of
    the following:
  2. the professional must have a duty to the affected party
  3. the professional must breach that duty
  4. the affected party must experience a harm; and
  5. the harm must be caused by the breach of duty.
    Curbside consultation creates no physician patient
    relationship.
    Source: Gurpreet Singh Padda MD MBA
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74
Q
  1. A patient undergoes an intrathecal pump implantation
    procedure, and develops a deep tissue infection because
    the instrument pack was not sterilized. Negligence
    occurred in the following circumstance?
    A. The operating room nurse failed to notify the surgeon
    that the instrument pack was not appropriately sterilized.
    B. The operating surgeon did not verify that the instrument
    pack was appropriately sterilized.
    C. The pump manufacturer failed to obtain a consent for
    the implanted device.
    D. The patient’s alienated spouse was not contacted by the
    physician after the infection was discovered.
    E. The wrong antibiotic was prescribed by the operative
    physician.
A
  1. Answer: A
    Explanation:
    In common language, we consider it negligence if one
    imposes a careless or unreasonable risk of harm upon
    another. The legal criteria for determining negligence are
    as follows:
  2. the professional must have a duty to the affected party
  3. the professional must breach that duty
  4. the affected party must experience a harm; and
  5. the harm must be caused by the breach of duty.
    This principle affi rms the need for medical competence. It
    is clear that medical mistakes occur, however, this
    principle articulates a fundamental commitment on the
    part of health care professionals to protect their patients
    from harm.
    Source: Gurpreet Singh Padda MD MBA
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75
Q
1985. All of the following are major principles of medical
ethics, except?
A. the principle of respect for autonomy
B. the principle of nonmalefi cence
C. the principle of benefi cence
D. the principle of justice
E. the principle of egalitarianism
A
  1. Answer: E
    Explanation:
    A. Respect for Autonomy means that the patient has the
    capacity to act intentionally, with understanding, and
    without controlling infl uences that would mitigate against
    a free and voluntary act. This principle is the basis for the
    practice of “informed consent” in the physician/patient
    transaction regarding health care
    B. The Principle of Nonmalefi cence requires of us that we
    not intentionally create a needless harm or injury to the
    patient, either through acts of commission or omission.
    C. The Principle of Benefi cence is the duty of health care
    providers to be of a benefi t to the patient, as well as to take
    positive steps to prevent and to remove harm from the
    patient.
    D. The Principle of Justice is usually defi ned as a form of
    fairness, or as Aristotle once said, “giving to each that
    which is his due.” This implies the fair distribution of
    goods in society and requires that we look at the role of
    entitlement. The question of distributive justice also seems
    to hinge on the fact that some goods and services are in
    short supply, there is not enough to go around, thus some
    fair means of allocating scarce resources must be
    determined.
    E. Egalitarianism is the basis of the French Constitution.
    Source: Gurpreet Singh Padda MD MBA
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76
Q
  1. A study involving a new pain medication is being
    proposed. Which of the following is not required in the
    informed consent?
    A. The names of the Insitutional Review Board board members
    who approved the study
    B. The aims of the study
    C. The anticipated benefi ts of the study
    D. The potential hazards of the study
    E. The discomforts of participating in the study
A
  1. Answer: A
    Explanation:
    In any research on human beings, each potential subject
    must be adequately informed of the aims, methods,
    anticipated benefi ts and potential hazards of the study and
    the discomfort it may entail. He or she should be informed
    that he or she is at liberty to abstain from participation in
    the study and that he or she is free to withdraw his or her
    consent to participation at any time. The physician should
    then obtain the subject’s freely-given informed consent,
    preferably in writing.
    Source: Gurpreet Singh Padda MD MBA
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77
Q
  1. In human subject research, who is required to obtain
    consent?
    A. The nurse checking the patient in.
    B. The primary investigator.
    C. A designated properly trained person who is knowledgeable
    about the study and able to answer questions.
    D. The patient should read the consent independent of any
    third party and have a witness sign the consent before
    discussing the research procedure.
    E. The competent patient’s family members should obtain
    the consent and sign as witnesses.
A
  1. Answer: C
    Explanation:
    The person who conducts the consent interview should be
    knowledgeable about the study and able to answer
    questions. FDA does not specify who this individual
    should be. Some sponsors and some IRBs require the
    clinical investigator to personally conduct the consent
    interview. However, if someone other than the clinical
    investigator conducts the interview and obtains consent,
    this responsibility should be formally delegated by the
    clinical investigator and the person so delegated should
    have received appropriate training to perform this activity.
    Source: Gurpreet Singh Padda MD MBA
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78
Q
  1. Research informed consent may not be obtained?
    A. In person from a competent subject
    B. By telephone only from a legally authorized representative
    C. In person from a competent subject, who cannot write
    his full name
    D. In a language other than English with an approved
    translation.
    E. A member of the research team, other than the primary
    investigator
A
  1. Answer: C
    Explanation:
    A verbal approval does not satisfy the 21 CFR 56.109(c)
    requirement for a signed consent document, as outlined in
    21 CFR 50.27(a). However, it is acceptable to send the
    informed consent document to the legally authorized
    representative (LAR) by facsimile and conduct the consent
    interview by telephone when the LAR can read the consent
    as it is discussed. If the LAR agrees, he/she can sign the
    consent and return the signed document to the clinical
    investigator by facsimile.
    Source: Gurpreet Singh Padda MD MBA
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79
Q
  1. Presumed or implied consent for a chest tube after
    pneumothorax is valid in which of the following
    circumstances?
    A. The patient is transported to the Emergency Room in
    shock and obtunded.
    B. The patient is transported to the Emergency Room, is
    short of breath but competent and does not want a
    procedure.
    C. The patient is in the ICU, is short of breath but competent competent
    and does not want a procedure.
    D. The patient is in the ICU and has made his decision
    against interventional treatment abundantly clear previously,
    signing a DNR, but is now obtunded.
    E. The patient’s legal guardian is in the ICU, with the obtunded
    patient, indicating that the patient would never
    consent to a chest tube and has signed a DNR, which is
    not taped to the front of the chart.
A
  1. Answer: A
    Explanation:
    Is there such a thing as presumed/implied consent?
    The patient’s consent should only be “presumed”, rather
    than obtained, in emergency situations when the patient is
    unconscious or incompetent and no surrogate decision
    maker is available. In general, the patient’s presence in the
    hospital ward, ICU or clinic does not represent implied
    consent to all treatment and procedures. The patient’s
    wishes and values may be quite different than the values of
    the physician’s. While the principle of respect for person
    obligates you to do your best to include the patient in the
    health care decisions that affect his life and body, the
    principle of benefi cence may require you to act on the
    patient’s behalf when his life is at stake.
    Source: Gurpreet Singh Padda MD MBA
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80
Q
  1. In obtaining clinical informed consent how much
    information is considered “adequate”?
    A. The currently available literature regarding the specifi c
    procedure.
    B. The same information that a fellow physician would
    expect.
    C. What this specifi c patient needs to know and understand
    in order to make an informed decision.
    D. The top fi ve risks associated with this procedure.
    E. What a reasonable physician would tell her patient
A
  1. Answer: C
    Explanation:
    How do you know when you have said enough about a
    certain decision? Most of the literature and law in this area
    suggest one of three approaches:
    * reasonable physician standard: what would a typical
    physician say about this intervention? This standard allows
    the physician to determine what information is
    appropriate to disclose. However, it is probably not
    enough, since most research in this area shows that the
    typical physician tells the patient very little. This standard
    is also generally considered inconsistent with the goals of
    informed consent as the focus is on the physician rather
    than on what the patient needs to know.
    * reasonable patient standard: what would the average
    patient need to know in order to be an informed
    participant in the decision? This standard focuses on
    considering what a patient would need to know in order to
    understand the decision at hand.
    * subjective standard: what would this patient need to
    know and understand in order to make an informed
    decision? This standard is the most challenging to
    incorporate into practice, since it requires tailoring
    information to each patient.
    Most states have legislation or legal cases that determine
    the required standard for informed consent. The best
    approach to the question of how much information is
    enough is one that meets both your professional obligation to provide the best care and respects the patient as a
    person with the right to a voice in health care decisions.
    Source: Laxmaiah Manchikanti, MD
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81
Q
  1. What are the elements of full informed consent?
    A. The name of the procedure, written in lay language
    B. Written list of alternative treatments
    C. Signature of patient documenting consent
    D. A witness signature
    E. The patient have an opportunity to be an informed participant
    in his health care.
A
  1. Answer: E
    Explanation:
    The most important goal of informed consent is that the
    patient have an opportunity to be an informed participant
    in his health care decisions. It is generally accepted that
    complete informed consent includes a discussion of the
    following elements:
    * the nature of the decision/procedure
    * reasonable alternatives to the proposed intervention
    * the relevant risks, benefi ts, and uncertainties related to
    each alternative
    * assessment of patient understanding
    * the acceptance of the intervention by the patient
    Source: Gurpreet Singh Padda MD MBA
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82
Q
  1. What is informed consent?
    A. Telling the patient he needs to have done.
    B. Letting the patient ask what needs to be done.
    C. Telling the patient about the options of treatment, which
    may include no treatment.
    D. An ongoing interactive process by which a patient understands
    his choices regarding healthcare, not necessarily
    written.
    E. A comprehensive list of written risks associated with
    a specifi c procedure, provided to the patient prior to
    initiating the procedure.
A
  1. Answer: D
    Explanation:
    Explanation: Informed consent is the process by which a
    fully informed patient can participate in choices about his
    health care.It originates from the legal and ethical right the
    patient has to direct what happens to his body and from
    the ethical duty of the physician to involve the patient
    in his health care.Although written consent in a clinical
    situation is recommended, it is not required.For example:
    consent to examine by taking a patient history.
    Source: Gurpreet Singh Padda MD MBA
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83
Q
  1. Identify accurate statements: When a health care
    provider fails to honor a patient’s written request for an
    itemized statement of items or services within 30 days,
    what penalties may the provider face from the HHS Offi ce
    of Inspector General (OIG)?
    A. Exclusion from Medicare program
    B. Civil monetary penalty of $5,000
    C. Civil monetary penalty and exclusion
    D. Civil monetary penalty of $100 for each unfi lled request
    E. Criminal penalty with 6 month prison time.
A
  1. Answer: D
    Explanation:
    D. Under the Social Security Act (SSA) Medicare patients
    have the right to submit a written request for an itemized
    statement to any physician, provider, supplier, or any other
    health care provider for any item or service provided to the
    patient by the provider.
    After receiving a request, the provider has 30 days to
    furnish an itemized statement describing each item or
    service provided to the patient. Providers that fail to
    honor a request may be subject to a civil monetary penalty
    of $100 for each unfulfi lled request. In addition, the
    provider may not charge the benefi ciary for the itemized
    statements.
    Source: Laxmaiah Manchikanti, MD
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84
Q

1994.What are the accurate statements about billing and
compliance?
A. A physician may mark up durable medical equipment
items under the Stark Physician Self-referral in-offi ce
ancillary services exception.
B. If a practice which does not have a compliance plan discovers
a billing error, it is not necessary for this practice
to make a voluntary disclosure and a refund of the
overpayment.
C. When a provider receives a payment from Medicare that should have gone to the patient, the provider should
keep the payment.
D. Direct supervision is defined as “The physician is responsible
overall, but is not necessarily present at the
time of procedure.”
E. If an employee files a qui tam (whistleblower) suit against
his or her employer, the employer may ask the employee
to stay out of the work place and refrain from speaking
to his or her co-workers until a full investigation has
taken plan.

A
  1. Answer: A
    Explanation:
    A. The DME must meet six requirements in order to be
    billed as in-offi ce ancillary services:
  2. It is needed by the patient to move or leave the
    doctor’s offi ce, or is a blood glucose monitor.
  3. It is provided to treat the condition that brought the
    patient to the physician and in the “same building”
  4. It is given by the physician or another physician or
    employee in a group practice.
  5. The physician or group practice meets all DME supplier standards
  6. The arrangement doesn’t violate any billing laws or
    the Anti-Kickback Statute.
  7. All other in-offi ce ancillary requirements are met.
    B. Providers only need to self disclose to OIG in certain
    situations. They do not need to self disclose every time
    they receive an overpayment from Medicare. However,
    every provider must learn when OIG views an
    overpayment as a deliberate attempt to defraud Medicare
    instead of the result of a harmless error.
    If the circumstances surrounding the billing error
    resemble any of the situations described below, consider
    voluntary disclosure and return of the over payment.
    Otherwise, a refund may be suffi cient.
    * The situation is the result of a willful disregard for fraud
    and abuse laws.
    * The situation is a systematic problem that occurred over
    a long period of time.
    * The provider has not such mechanisms as a compliance
    plan in place.
    * The provider took no action once the problem was
    discovered.
    C. Once a provider realized that he or she has received an
    overpayment, the provider is statutorily obligated to
    return it to Medicare. This includes instances where the
    provider receives an overpayment due to an unintended
    mistake on their part.
    D. According to the Centers for Medicare & Medicaid
    Services (CMS), there are three levels of supervision.
    General supervision means the procedure is furnished
    under the physician’s overall direction and control, but the
    doctor’s presence is not required during the procedure.
    (The physician remains responsible for training nonphysician
    personnel and for maintaining all necessary
    equipment and supplies.)
    Direct supervision means the physician must be present in
    the offi ce suite and immediately available to furnish
    assistance and direction throughout the performance of a
    procedure. It does not mean that the physician must be
    present in the room when the procedure is performed.
    Personal supervision means a physician must be in
    attendance in the room during the performance of the
    procedure.
    E. Whistleblowers who are discharged, demoted,
    suspended with or without pay, threatened, harassed or in
    any other manner discriminated against by their
    employers in the terms and conditions of employment are
    entitled to relief. That includes reinstatement with the
    same seniority,two times the amount of back pay, interest
    on the back pay and compensation for any damages,
    including attorney’s
    fees.
    Source: Laxmaiah Manchikanti, MD
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85
Q
  1. When a physician performs a facet joint nerve injection
    using fluoroscopic guidance in an office setting, place of
    service (POS) 11, he/she should report what code(s):
    A. 76000-26
    B. 76005
    C. 76005-26-TC
    D. 76003
    E. 76003-26
A
  1. Answer: B
    Explanation:
    In the provider’s offi ce (POS 11), h/she owns/leases the
    radiological equipment and is entitled to the global
    payment (professional and technical components). The
    CPT code is submitted without a modifi er to indicate that
    the provider is entitled to the global reimbursement.
    Source: CPT Coding Manual, CPT Coding Conventions;
    Manchikanti L, Principles and Practice of Documentation,
    Billing, Coding, and Practice Management 2005
    Source: Joanne Mehmert, CPC, Sep 2005
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86
Q
  1. A patient is admitted to the hospital by a general surgeon.
    The pain physician is requested to see the patient for
    the purpose of providing whatever pain treatment was
    necessary during the hospital stay. Regarding the pain
    physician’s initial visit, made for the purpose of assessing
    a course of treatment, that visit should be coded as
    follows:
    A. An inpatient initial hospital care code
    B. A subsequent hospital care code
    C. An inpatient consult
    D. An outpatient consult
    E. A confi rmatory consult
A
  1. Answer: B
    Explanation:
    Many physicians incorrectly bill an initial hospital care
    code for the fi rst time they see the patient during ahospital
    stay. However, only the admitting physician, in this case
    the surgeon, can bill an initial hospital care code. If the
    pain physician is not the admitting physician,he must bill
    a subsequent hospital care code, unless he can bill an
    inpatient consult. In the above scenario, an inpatient
    consult is not billable because the factual scenario
    stipulates that the surgeon referred the patient for
    treatment, not for an opinion from the pain physician. A
    consult cannot be billed unless the patient is referred for
    an opinion.
    CPT 2005, p. 12, Professional Edition.
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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87
Q

1997.The senior physician notices that a new physician
routinely fails to code all required diagnoses and
procedures for a patient encounter. This indicates that
there is a problem with:
A. Accuracy
B. Validity
C. Billing and coding
D. Timeliness
E. Reliability

A
  1. Answer: C
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88
Q

1998.True statements about IDET coding include all of the
following, EXCEPT:
A. A new code was established in 2005
B. IDET codes are 0062T (0063T is add’l level)
C. Both are temporary, Category III codes
D. Fluoro is not bundled
E. If a temporary code is available, you must use it instead
of unlisted Category I code

A
  1. Answer: D
    Explanation:
    IDET
    * New code for 2005
    * 0062T (0063T is add’l level)
    * Temporary, Category III codes
    * Fluoro bundled
    * CPT Code says that if a temporary code is available, you
    must use it instead of unlisted Category I code
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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89
Q

1999.The Institute of Medicine defi ned core features in the
electronic medical record (EMR) .These include:
A. Patient notifi cation of abnormal laboratory data
B. Decision support
C. Alert reminders and practice tools
D. Allowing payer sources to have access to the medical record,
and payer sources’ attorneys and interested third
parties’ access to the medical record
E. Reporting electronic data storage using uniform data
standards, allowing physician’s offi ces to comply with
federal, state and private reporting requirements.

A
  1. Answer: C
    Explanation:
    The electronic medical record is a secure record that does
    not allow access to unregistered or unnecessary personnel,
    payor sources, or other entities that could disturb a HIPAA
    compliant environment. Policy and procedures should be in place with each electronic medical record to assure that
    no breach of confi dentiality is realized.
    Source: Hans C. Hansen, MD
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90
Q
  1. A pain physician receives a referral from an orthopedic
    surgeon who has recently performed back surgery on a
    patient whom the pain physician has never seen. The
    orthopedic surgeon has done all he can do for this
    particular patient. The pain physician performs the
    requirements for a level 4 patient encounter, but decides
    during the encounter that the patient would benefi t
    from a lumbar epidural steroid injection. The physician
    dictates a report to the referring surgeon and mails it to
    him. This patient encounter should be coded as:
    A. 62311 – Bill only the procedure code because the E&M
    service is bundled
    B. 62311 and 99244-25 – Bill the procedure and a level 4
    consult. A consult is billable even when treatment is
    administered
    C. 62311 and 99204-25 – Bill both the procedure and a level
    4 new patient code. You can’t bill a consult because the
    referring physician has done all he can for the patient,
    so he is referring the patient for treatment and hasn’t
    requested an opinion.
    D. 62311 or 99204-25 – Bill either the procedure or the
    new patient code because you can’t bill both on the
    same date of service
    E. 62311 or 99244-25 – Bill either the procedure or the consult
    code because you can’t bill both on the same date of
    service
A
  1. Answer: C
    Explanation:
    The general rule is that a physician can bill both a
    procedure and either a new patient visit or a consult on
    the same date of service. In this case, the issue is whether
    the E&M code is a consult or a new patient visit. Because
    the referring physician had done all he could for the
    patient, he really isn’t interested in the pain physician’s
    opinion; he just wants the pain physician to treat the
    patient. Therefore, the hallmark of a consult, i.e., a
    request for an opinion, is not present. Thus, a new patient
    visit must be coded.
    Medicare Claims Processing Manual, Chapter 12, Section
    30.6.10.A.
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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91
Q
  1. A pain physician sees a Medicare pain patient in the
    offi ce for the pre-procedure visit relating to a scheduled
    epidural that day. The patient has been complaining of
    radicular back pain. On the date of the procedure, the
    patient also complains of headaches that have become
    unmanageable by over-the-counter medications. The
    physician performs a level 3 E&M service for the headache.
    The physician also performs a brief E&M service for the
    back to insure that the clinical indications still warrant
    the epidural. The physician prepares one dictation, in
    which he includes the patient’s headaches, the low back
    pain, and the lumbar epidural injection for that day. The
    physician prescribes narcotics for the headaches. This
    patient encounter should be coded as:
    A. 62311 – Bill only the procedure code because the E&M
    services are bundled
    B. 99215 – Combine the two E&M services into the highest
    E&M code because 99215 pays more than a lumbar
    epidural in the offi ce
    C. 62311 and 99213-25 – Bill both the procedure and the
    E&M code for the headaches, provided that the level of
    the E&M code relates solely to the headaches and not
    the back
    D. 62311 and 99215-25 – There are two separate E&M services,
    one for the headaches and one for the low back;
    combine the two E&M services (levels 3 and 2) to bill
    one level 5 E&M code.
    E. 62311 and 99211-25 – The failure of the physician to dictate
    a separate note on a separate piece of paper for the headaches reduces the work value of the level 3 E&M
    code to level 1.
A
  1. Answer: C
    Explanation:
    The 25 modifi er is defi ned as a signifi cant and separately
    identifi able E&M service above and beyond or separate
    and distinct from the usual pre-procedure visit that is
    related to the procedure. In this case, the headaches
    are different from the low back procedure.
    While we encourage the physician to dictate a separate
    note for the separate E&M service for the headaches - so
    as to differentiate it from the low back complaint that is
    bundled into the procedure - there is no requirement for a
    separate dictation. The E&M code would have a headache
    diagnosis, not a low back diagnosis.
    Source: CPT 2005, p. 401, Professional Edition
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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92
Q
  1. A pain physician performs a procedure on a non-
    Medicare inpatient for the implantation of a femoral
    nerve catheter for continuous infusion. As is typical of
    indwelling catheters, the pain physician rounds on the
    patient for 3 days and then discontinues the catheter. The
    daily pain rounds should be coded as:
    A. 99231 – A level 1 subsequent hospital care code
    B. 01996 – Catheter management is coded with 01996
    C. No code – This service is bundled into payment for the
    placement of the catheter
    D. 99231-58 – The 58 modifi er is for staged procedures or
    services, and it is contemplated that catheter management
    constitutes a different stage of the service from
    the procedure.
    E. 01996-59 – The 59 modifi er indicates that the post-op
    rounds were a distinct and separate service from the
    insertion of the catheter. Since this is not a Medicare
    patient, the usual bundling rules do not apply.
A
  1. Answer: C
    Explanation:
    The CPT Code, which is applicable to all payers, defi nes
    code 64447 as “including daily management for anesthetic
    agent administration.” Therefore, when billing 64447, you
    are already billing for the post-op rounds,and no separate
    code can be billed. Medicare’s Physician’s Fee Schedule
    contains a 10 day global for this and all other continuous
    catheter codes, other than a continuous epidural catheter,
    which does not have global period.
    CPT 2005, p. 250, Professional Edition; Medicare’s
    Physician’s Fee Schedule, 2005
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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93
Q
  1. A pain physician performs surgery on a Medicare patient
    for the percutaneous implantation of neurostimulator
    electrodes. Thirty days later, the patient is complaining
    of pain in the area of the electrode implantation. The
    physician sees the patient to rule out infection or other
    complications. The physician takes an expanded problem
    focused history, performs an expanded problem focused
    exam, and engages in low medical decision making. This
    patient encounter should be coded as:
    A. 99213 – An expanded problem focused history and
    exam, together with low medical decision making are
    exactly the requirements for 99213.
    B. 99212 – Inspection of a surgical site which does not result
    in any surgical revision is coded as a level 2.
    C. No code – The physician cannot bill this code because
    it relates to a complication for which a return to the
    operating room is not necessary, and occurs within the
    90-day Medicare global for electrode implants.
    D. 99213-25 – Use the 25 modifi er to indicate the visit is
    separately billable.
    E. 63660-52 – Bill the code for the revision of the electrodes
    with the 52 modifi er for reduced services since the
    E&M is not billable.
A
  1. Answer: C
    Explanation:
    The Medicare Global Surgical Package bundles E&M
    services relating to a complication that does not result in return to the operating room, if those services occur
    during the global period for that code. The code for
    percutaneous implantation of electrodes, 63650, has a 90-
    day global, so a visit for complications from the surgery is
    bundled into the surgical payment and is not billable.
    Medicare Claims Processing Manual, Chapter 12, Section
    40.1.A.
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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94
Q
  1. A pain physician sees an established patient who speaks
    very poor English. The patient brings his wife, but her
    English isn’t much better. The patient’s neck pain has
    recently gotten worse, but there hasn’t been any new
    incident to cause it. The physician takes a expanded
    problem focused interval history, and performs an
    expanded problem focused exam. Medical decision
    making is low. There was no time spent counseling.
    Nevertheless, the physician spends 45 minutes face to face
    with the patient due to communication problems with
    the patient and his wife. This patient encounter should
    be coded as:
    A. 99213 – An expanded problem focused history and
    exam, together with low medical decision making are exactly the requirements for 99213. The physician cannot
    bill for the extra interpretation time.
    B. 99214 – The physician increases the normal level of
    99213 by 1 level to accommodate for the increased
    interpretation time.
    C. 99215 – The physician spent 45 minutes with the patient,
    and a level 5 typically involves 40 minutes, so the physician
    can code a level 5.
    D. 99213 and 99354 – The physician bills the correct E&M
    code for the services performed, and then captures the
    additional 30 minutes with the prolonged services code,
    99354.
    E. 99215 and 99211-25 – The physician spent 45 minutes
    with the patient; 5 minutes is equivalent to 99211, and
    40 minutes is equivalent to 99215.
A
  1. Answer: B
    Explanation:
    You don’t code the underlying E&M code with time as the
    primary ingredient because there was no counseling. So,
    you code the underlying E&M code as per the
    documentation requirements. An expanded problem
    focused history and exam, together with low medical
    decision making is 99213. However, as long as the
    additional 30 minutes is spent face to face with the
    patient, the CPT Code allows the billing of an “add-on”
    E&M code, 99354, provided that the physician spends
    at least 30 extra minutes in excess of the time
    usually accorded to the underlying E&M code (15 minutes
    for 99213). In this case,the physician spent 45 minutes
    which equates to 998213 & 99354.
    CPT 2005, pp. 27-28, Professional Edition; Medicare
    Claims Processing Manual, Chapter 12, Section 30.6.15.1.
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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95
Q

2005.

A

.

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96
Q

2006.

A

.

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97
Q
  1. A pain physician sees an established patient. The
    patient’s complaint is the same as in prior visits, i.e.,
    moderate back pain, which is controlled by prescription
    medication, which the physician refi lls in the same
    dosage and drug type as he had in the past. Nevertheless,
    the physician performs a comprehensive history, a
    comprehensive exam, and low medical decision making.
    There was no time spent counseling. This patient
    encounter should be coded as:
    A. 99211 – a nurse could have performed this visit, so 99211
    is the correct code
    B. 99212 – this is a typical medication management visit,
    with no change in medication, and there was no medical
    necessity for a comprehensive exam, and as such,
    one should code only what was medically necessary,
    which is a level 2
    C. 99213 – A detailed history warrants a level 3 under any
    circumstances
    D. 99214 – The combination of a comprehensive history
    and comprehensive exam, even with low medical decision
    making warrants a level 4
    E. 99215 – An established patient visit only needs two of
    the three elements of an evaluation and management
    code, so the comprehensive history and comprehensive
    exam are enough to warrant a level 5, regardless of the
    low medical decision making
A
  1. Answer: B
    Explanation:
    Overriding the technical documentation requirements for
    E&M coding is medical necessity. If an established
    patient’s complaints are the same as in his prior visits, and
    those complaints are controlled with medication,and
    there is no change in the medication, which is refi lled with
    the same drug and dosage, and there is no counseling, this
    is a classic level 2 offi ce visit, which should take no longer
    than 10 minutes. If the physician voluntarily, in order to
    increase billing, performs an unnecessary comprehensive
    exam, the exam will be disregarded on audit. 42 U.S.C.
    1395y excludes from Medicare coverage services which
    “are not reasonable and necessary for the diagnosis or
    treatment of illness or injury or to improve the
    functioning of a malformed body member.”
    42 U.S.C. 1395y.
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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98
Q
  1. A pain physician receives a request from a referring
    surgeon to perform a series of 3 epidural steroid
    injections on a patient the pain physician has not seen
    before. In order to ascertain whether the referring
    surgeon’s ordered treatment is the correct treatment, the
    pain physician performs a level 4 H&P. After performing
    the H&P, the physician performs a lumbar epidural
    injection. This patient encounter should be coded as:
    A. 62311 – the visit is not billable because it is bundled into
    the procedure
    B. 62311and 99244 – the procedure and a level 4 consult are
    both billable
    C. 62311 and 99204 – the procedure and a level 4 new patient
    visit are both billable
    D. 99204 – a level 4 new patient visit only because the procedure
    is bundled into the visit
    E. 99244 – a level 4 outpatient consult only because the procedure is bundled into the visit
A
  1. Answer: C
    Explanation:
    Although a procedure and a consult can be billed on the
    same date, a consult is not billable in this case because the
    referring physician did not request the pain physician’s
    opinion, rather, he referred the patient for treatment.
    Therefore, the new patient visit and the epidural are both
    billed. They can both be billed because a new patient visit
    can be billed in addition to a procedure on the same date.
    CPT 2005, pp. 12, 16, 18, Professional Edition.
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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99
Q
  1. What is the primary purpose of the National Correct
    Coding Initiative? (NCC)
    A. For every third party payer to use in claims processing
    B. To control improper coding (unbundling of CPT codes)
    that leads to inappropriate payment in Part B claims.
    C. To ensure that medical providers adhere to appropriate
    coding standards of specialty societies
    D. For use by Local Medicare Carriers when paying claims
    if they don’t have their own program to identify improper
    code submission by providers, i.e., bundled
    codes
    E. To facilitate up coding by physicians to third party payers
    other than Medicare to make up for loss of income.
A
  1. Answer: B
    Explanation:
    The NCCI was fi rst published in 1996 and is updated by
    AdminiStar Federal every quarter. The purpose of the
    NCCI is to identify and isolate inappropriate coding,
    unbundling and other improper coding. Carriers must
    incorporate the NCCI into their claims processing; they do
    not have discretion to pay services that the NCCI
    identifi es as “bundled” unless an applicable modifi er is
    appended.
    Source: Manchikanti L, Principles and Practice of
    Documentation, Billing, Coding, and Practice
    Management 2005.
    Source: Joanne Mehmert, CPC, Sep 2005
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100
Q
  1. A pain physician receives a consult request from a
    referring orthopedic surgeon requesting the pain
    physician’s opinion as to what course of treatment is
    preferable for an inpatient. Upon entering the room, the
    pain physician realizes that he has seen the patient in his
    own practice during the past year. The pain physician
    documents a consult and puts it in the medical chart.
    This service should be coded as follows:
    A. An initial hospital care code because this is the fi rst time
    the physician has seen the patient during this hospital
    stay
    B. A subsequent hospital care code because this is an established
    patient, thereby precluding either an initial
    hospital care code or a consult
    C. An inpatient consult
    D. An outpatient consult
    E. A confi rmatory consult
A
  1. Answer: C
    Explanation:
    An inpatient consult code can be billed even if the
    physician has previously seen the patient in his own
    practice. A consult, whether inpatient or outpatient is not
    dependent on whether the patient is a new or established
    patient. A consult is dependent on a referring physician
    requesting an opinion from the consulting physician.
    CPT 2005, p. 14, Professional Edition.
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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101
Q
  1. How does a physician practice determine that a private
    payer is bundling its claims?
    A. When the practice manager reports that the revenue is
    lower during the first quarter of the current year than it
    was last year during the fi rst quarter
    B. When the monthly charges increase and the income
    from insurance payers remains the same
    C. When the staff that analyzes the explanation of benefi ts
    (EOB) by comparing the claims to the original claims
    submission and reports that there are consistent denials
    for a specifi c type of service
    D. When a patient calls to advise that his/her insurance
    company denied a claim because the physician billed
    too many services in one day
    E. When patient complains that practice is over charging.
A
  1. Answer: C
    Explanation:
    Private payers’ bundling of claims will have a negative
    effect on the practice revenue stream over a period of time;
    however, it is often so subtle that it is unlikely to be
    recognized until the bundling has been going on for a long
    time. The only effective means to stay tuned to payer
    payment/bundling patterns is by continuous monitoring
    of the reason for claim denials. Billing personnel should
    look for an ambiguous reason for non-payment such as
    “when you report multiple related services on the same
    day for a patient, insurer bases benefi t payments on the
    primary service”.
    Source: American Medical Association Model Managed
    Contract: Supplement 6, “Downcoding and Bundling of
    Claims: What Physicians Need to Know About These
    Payment Problems
    Source: Joanne Mehmert, CPC, Sep 2005
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102
Q
  1. A physician receives a call to the emergency room at
    11:30 p.m. to see a Medicare patient whom he admits
    to the hospital at 12:30 a.m. The physician performs an
    emergency H&P and then documents an inpatient H&P.
    These services are coded as follows:
    A. An inpatient initial hospital care code only
    B. Both an inpatient initial hospital care code and an emergency
    department visit code
    C. An inpatient consult only
    D. An outpatient consult only
    E. Both an emergency department visit and a subsequent
    hospital care code
A
  1. Answer: B
    Explanation:
    Two E&M services may be billed on different dates of service, even if less than 24 hours have transpired between
    the services. The initial inpatient hospital care code is
    used,rather than the subsequent hospital care code,
    because the emergency room is an outpatient setting, so
    the admit to the hospital is the initial inpatient service.
    Chapter 12, Medicare Claims Processing Manual, Section
    30.6.9.1.B.
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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103
Q
  1. A physician receives a call to the emergency room to
    see a Medicare patient whom he admits to the hospital
    that same date of service. The physician performs an
    emergency H&P and then documents an inpatient H&P.
    These services are coded as follows:
    A. An inpatient initial hospital care code only
    B. Both an inpatient initial hospital care code and an emergency
    department visit code
    C. A hospital inpatient consult only
    D. A hospital outpatient consult only
    E. Both an emergency department visit and a subsequent
    hospital care code
A
  1. Answer: A
    Explanation:
    All E&M services on a date of admission of a patient to
    inpatient status are billed as part of the inpatient admit
    service, including a prior emergency room visit that leads
    to the admission of the patient to inpatient status.
    Chapter 12, Medicare Claims Processing Manual, Section
    30.6.9.1.A.
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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104
Q
  1. An established patient last seen in January 2002,
    presents for a visit in June 2005. Based on the length of
    time between visits, the physician performs a complete
    H&P, including a detailed history, a comprehensive exam,
    accompanied by moderate medical decision making. On
    the same visit, the physician decides to perform a lumbar
    epidural steroid injection since a prior set of injections
    had worked in 2002. These services are coded as follows:
    A. 99204 – level 4 comprehensive new patient visit
    B. 99214 – level 4 established patient visit
    C. 62311 – epidural only; the visit is not billable since the
    visit is related to the procedure
    D. 62311 and 99204 -25 – due to the length of time between
    visits, the visit qualifi es as a new patient visit, which is
    billable with a procedure because a new patient visit is
    typically above and beyond the usual pre-procedure
    visit bundled into the procedue
    E. 62311 and 99214-25 – Once an established patient,
    always an established patient, but since the visit was a
    complete H&P, it is billable in addition to the procedure.
A
  1. Answer: D
    Explanation:
    A new patient visit occurs if the patient has not been seen
    in 3 years by the physician or anyone in his group. A
    complete H&P is separately billable since it was above and
    beyond the usual pre-procedure visit that is bundled into
    the procedure.
    Chapter 12, Medicare Claims Processing Manual, Section
    30.6.7.
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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105
Q
  1. Do all of the NCCI bundling edits correspond with
    CPT coding conventions and the instructions in the CPT
    Manual?
    A. Administar Federal, the contractor that develops the
    edits coordinates with the CPT Editorial staff before
    quarterly updates are published
    B. There is not always an NCCI edit t that corresponds
    precisely to CPT coding conventions and instructions;
    however AMA/CPT coding conventions do have a prevailing
    infl uence on coding edits
    C. CMS local carrier decisions are the only policies that
    Administar Federal considers when revising the edits
    D. Administar Federal relies solely on specialty society
    manuals and communication from physicians to update
    the edits
    E. NCCI edits are solely determined by CMD of Administer
    Federal.
A
  1. Answer: B
    Explanation:
    CCI edits are developed around CPT/AMA coding
    conventions and instructions; however not all of the CPT
    instructions and/or coding conventions are set forth in
    NCCI. Administar Federal looks at several factors when
    updating the NCCI.
    Source: National Correct Coding Initiative,current update
    effective July 1, 2005-September 30, 2005.
    Source: Joanne Mehmert, CPC, Sep 2005
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106
Q
  1. What advantage does pre-approval or pre-authorization
    by “other” third party payers, meaning payers other than
    Federal programs, i.e., Medicare and Medicaid give a
    provider?
    A. Pre approval means that when a provider is told that
    a specifi c item or service is “authorized” payment is
    guaranteed
    B. Payers always give pre-approval in writing and this will
    guarantee payment
    C. Obtaining pre-approval offers providers a “safety-net”, it
    does not guarantee payment
    D. Pre approval is not effective unless the physician personally
    makes the request
    E. Pre approval must be always obtained by the patient.
A
  1. Answer: C
    Explanation:
    Generally, once a claim is pre-authorized/pre-approved,
    especially when the pre-approval is obtained in writing, a
    physician has an effective argument if the insurer changes
    its mind. Payers seldom, if ever, guarantee payment when
    they authorize treatment.
    Source:Manchikanti L, Principles and Practice of
    Documentation, Billing, Coding, and Practice
    Management 2005.
    Source: Joanne Mehmert, CPC, Sep 2005
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107
Q
  1. What are the accurate statements of the Medicaid review
    process compared to Medicare?
    A. Yes, the Medicaid review process is mandated by CMS
    and it has the same steps
    B. No, the Medicaid process has only four steps where
    Medicare claims have fi ve
    C. It is similar with the exception of the amount of time a
    provider is allowed to fi le a claim
    D. Medicaid has no established federal review process, it is
    State specifi c
    E. Medicaid will lose Federal Grants if they do not follow
    Medicare review process.
A
  1. Answer: D
    Explanation:
    Medicaid may deny a service stating that it is not medically
    necessary and where Medicare has a statutory appeals
    process that a provider can follow step by step, Medicaid is
    State specifi c. There is no “standard” Medicaid review
    process.
    Source: Manchikanti L, Principles and Practice of
    Documentation, Billing, Coding, and Practice
    Management 2005. Federal Register March 25, 2005 and
    June 30, 2005.
    Source: Joanne Mehmert, CPC, Sep 2005
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108
Q
  1. The timely fi ling limits for each level of appeal are?
    A. The provider has 120 days to fi le an initial appeal and
    60 days to fi le an appeal following each level where an
    unfavorable decision is rendered
    B. All appeals must be resolved within 120 days
    C. There are no timely fi ling limits relative to request for
    appeal of a Medicare claim denial
    D. The provider has 120 days to appeal a denial at each
    level
    E. The Provider appeal may fi le at any time after one year.
A
  1. Answer: A
    Explanation:
    When the Carrier sends its initial determination, a
    provider or benefi ciary has 120 days to fi le a request for
    reconsideration. After each subsequent unfavorable
    determination is received, the provider has 60 days to
    request a review at the next level.
    Manchikanti L, Principles and Practice of Documentation,
    Billing, Coding, and Practice Management 2005. Federal
    Register March 25, 2005 and June 30, 2005.
    Source: Joanne Mehmert, CPC, Sep 2005
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109
Q
  1. Which of the following would be most likely to
    precipitate an inaccurate decrease in accounts receivable
    aging numbers?
    A. Contractual discounts on payments not being made in a
    timely manner
    B. Uncollectible debts not being written off
    C. Delays in claim submissions
    D. Delays in refunding overpayments
    E. Delayed patient collections
A
  1. Answer: D
    Explanation:
    Delays in processing refunds will artifi cially increase the
    payments recorded and in turn cause aging numbers to
    remain steady or even decrease.
    Source: Marsha Thiel, RN, MA, Sep 2005
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110
Q
  1. A pain physician receives a consult request from a
    referring surgeon for an inpatient. After the initial
    consult, the pain physician continues to make additional
    visits to the patient to monitor the course of treatment.
    These additional visits should be coded as:
    A. Subsequent hospital care visits
    B. Inpatient consults
    C. Follow-up inpatient consults
    D. Confi rmatory consults
    E. Outpatient consults
A
  1. Answer: A
    Explanation:
    While a physician can bill a follow-up inpatient consult, in
    order to do so, the physician must be requested to provide
    another consult by the referring physician. Unless the
    physician receives a second consult request, follow-up
    visits for inpatients are coded as subsequent hospital care
    codes. A confi rmatory consult is generally for second
    opinions.
    CPT 2005, pp. 12, 16, 18, Professional Edition.
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
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111
Q
2026. PRO is a term used to describe:
A. Performance Reporting Organization
B. Peer Research Organization
C. Peer Review Organization
D. Professional Review Operations
E. Professional Review Organization
A
  1. Answer: C
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112
Q
  1. A 32-year-old female was seen in interventional pain
    management for persistent phantom sensations after
    traumatic amputation. The physician evaluates the
    patient and advises with regards to appropriate treatment
    and communicates with the referring physician. What is
    the proper coding for this evaluation and management
    service?
    A. 99241, new or established patient initial offi ce consultation,
    with a problem focused history and focused examination
    with straightforward medical decision making
    B. 99242, new or established patient offi ce consultation,
    with expanded problem focused history and examination
    with straightforward medical decision making
    C. 99243, new or established patient offi ce consultation,
    with detailed history and examination with medical
    decision making of low complexity
    D. 99244, new or established patient offi ce consultation,
    with comprehensive history and examination with
    moderate complexity medical decision making
    E. 99245, new or established patient offi ce consultation,
    with comprehensive history and examination with high
    complexity medical decision making
A
  1. Answer: B

Source: Laxmaiah Manchikanti, MD

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113
Q
  1. In the pain management facility, labeling is required
    for contained regulated waste. Labels are not required
    when:
    A. Red bags with biohazard labeling are used.
    B. On refrigerators that contain labeled blood components.
    C. If less than 15 cc of blood 5 g of tissue is placed in a
    sealed plastic bag to be transported to a dumpster.
    D. When an authorized biohazard transport company will
    be handling the waste
    E. If policy defi nes the biohazard as benign
A
  1. Answer: A
    Explanation:
    Labeling requires fl uorescent orange and red warning
    labels are attached to waste, or other containers that may
    contain potentially infectious materials and includes
    blood,blood products, tissue, serum, or body fl uids.
    Universal/standard precautions implies that all blood is
    infected with HIV or HBV and requires proper labeling.
    Labels are not required when,
    Blood components are labeled with their contents, and
    specifi ed for transfusion
    Blood or infectious materials are placed in a labeled
    container for transport and disposal.
    When biohazard bags are used. The bags should not leak,
    and they are free of sharps and the bag is sealed.
    Placing materials of an infectious nature in a facility or
    disposal container, such as a dumpster, without labeling
    should not be done.
    Source: Hans C. Hansen, MD
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114
Q

2029.Record keeping in the pain management facility is
required for proper OSHA documentation. After a
needle stick injury, the length a record must be retained
for retrieval:
A. 5 years
B. 10 years
C. 15 years
D. 20 years
E. 30 years

A
  1. Answer: E

Source: Hans C. Hansen, MD

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115
Q
  1. When a physician is uncomfortable treating a patient
    due to religious or sexual nature, it is best to:
    A. Openly discuss with the patient as to why the relationship
    will not continue.
    B. Allow for orderly transfer to another physician.
    C. State to the patient that lifestyle preference will not yield
    a solid patient-physician relationship.
    D. Follow specifi c policy as to types of patients that the physician
    will follow, and defi ne them with the staff.
    E. Avoid charges of discrimination by treating the patient as
    any other, irrespective of lifestyle or religious activity
A
  1. Answer: E
    Explanation:
    This is a somewhat diffi cult area for a physician to grasp.
    A patient who expresses a lifestyle contradictory to what
    the physician would consider conducive to a patientphysician
    relationship, does not necessarily mean that the
    physician is allowed to drop the patient. Antidiscrimination
    suits have been settled against the practice
    based on personal views of the physician, irrespective of
    the fact that the physician had given names of other
    physicians that would treat the patient. The ACLU Chief
    Council Michael Small states “discrimination, whether it
    in the workplace or in the doctor’s offi ce, can never be
    tolerated”. All businesses open to the public must treat
    their clients/patients equally without regard to race, sexual
    orientation, or gender.
    Source: Hans C. Hansen, MD
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116
Q
  1. A 62-year-old patient of yours has refused to pay on a
    $427.00 balance. You have researched your compliance
    plan, and your auditor’s recommendations. You have
    offered the patient multiple choices to pay over time,
    and the patient refuses because you are “not doing
    anything”. The patient continually asks for narcotics in
    a higher dose, and you have refused, placing the patient
    on a pharmacokinetically long-acting drug which is
    unsatisfactory to the patient’s demands. The patient
    expects to be seen monthly for her medication, but states
    that she is not going to pay you. Your next step is to:
    A. Discontinue the patient/physician relationship due to
    noncompliance of payment.
    B. State to the patient that you will refer her to another provider
    who may be more amenable to her wishes.
    C. Send the patient to collections, and discharge the patient,
    after informing her of your intention in writing.
    D. Do nothing, continue to see the patient as you are
    concerned about abandonment, and you write off the
    balance.
    E. You inform the patient, both verbally and in writing, that
    you are unable to continue to treat her without a demonstration
    of her responsibility to pay some or all of her
    bill.
A
  1. Answer: E
    Explanation:
    When a patient becomes noncompliant, care must be
    exercised to avoid abandonment. At no time should the
    patient feel that care will be withdrawn inappropriately or
    that they are going to have an inadequate period of time to
    fi nd another treating physician, typically 30-days. It might
    be wise to use a third party, such as a business manager to
    sit in a non-confrontational environment with the patient
    discussing more than one option, avoiding
    embarrassment. Another strategy might be to give the
    patient time to contemplate options and availability of
    other treatment physicians. It might be that you are the
    best choice, which would suggest payment compliance is a
    better option than no treatment whatsoever.
    Finally,when controlled substances are involved, abrupt
    discontinuation in an age group that could be considered
    at risk for adverse event or poor outcome should be
    avoided.Consider the appearances to referral sources or
    the community of an older or elderly individual, refused
    access to medications, which resulted in an adverse event
    Perceptions are sometimes far more costly than a few
    dollars on a bill, particularly if this bill can be negotiated.
    The caveat would of course be a managed care plan, or a
    compliance violation when lack of collection could come
    back with frequent write-offs, or lack of collection
    resulting in a professional sanction. If good will is the
    theme of the day, this is unlikely.
    Source: Hans C. Hansen, MD
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117
Q
  1. A patient who comes to you on a regular basis for
    controlled substance management has been found to be
    doctor shopping. This information was relayed to you
    by a reliable pharmacist, stating the patient is known in
    the community to divert medications. If you decide to
    terminate the relationship, and the patient declares that
    he is going to sue you for abandonment, he has done it
    before and he will win again. Your next step would be:
    A. Negotiate a reasonable termination plan, with a medication
    taper and assistance in fi nding another physician.
    B. Immediate termination, irrespective of the threat.
    C. Developing an immediate referral so there is no interruption
    in treatment.
    D. Consider the threat incredulous and avoid confrontation,
    informing the patient that 30-days of medication
    will be prescribed and then you are done with him.
    E. Inform the patient of your policy to continue emergency
    care for 30-days, and offer detoxifi cation, then assure
    continuity, both verbally and in writing.
A
  1. Answer: E
    Explanation:
    Patients threatening lawsuit should not alter appropriate
    medical care,and judgment should not be impaired by
    fear.Proper medical care supersedes baseless threats,
    particularly when legitimate prescribing practices are
    followed. When a patient / physician relationship must be
    terminated, appropriate cautions and policies are in place
    to avoid being accused of abandonment. Abandonment is
    when a patient might result in injury or has been injured
    by a physician’s refusal to treat, defi ned. Usually by 30-
    days, a patient must be given a reasonable amount of time
    to fi nd a substitute to care provide her; otherwise, there is
    a breachof duty, which is the foundation of medical
    malpractice.
    The duty of treatment is defi ned by community standard,
    and that of the profession and not at the physician’s
    discretion. The patient’s overall health status should be
    addressed, and alternatives to care, appropriate to a
    treatment course for best outcome must to be
    acknowledged. This is where offering detoxifi cation may
    be this patient’s only choice.
    Prescribing medications for any length of time in a patient
    that is suspected or known of a diversion is an
    inappropriate patient for a controlled substance.
    Providing a controlled substance to a person known to
    divert his contributory to traffi cking, and places the
    physician at risk.
    Source: Hans C. Hansen, MD
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118
Q
  1. A 47-year-old patient complaining of low back pain is an
    established patient with the clinic. It becomes apparent,
    however, that her brother who was recently treated by
    you is fi ling a lawsuit against you because he allegedly
    returned to work prematurely from a Workman’s
    Compensation injury, re-injuring himself.The proper
    approach to dealing with the sister of the plaintiff is to:
    A. Withdraw care and discharge from the clinic.
    B. State to the sister that your partner will continue to treat
    her, but you will not be treating her due to confl ict of
    interest.
    C. Continue to treat the sister as every other patient, because
    the lawsuit does not involve her or action against you personally.
    D. Consider it wise to discontinue treatment and provide
    orderly transfer to another physician of equal competence
    informing the patient, both verbally and by
    registered letter.
    E. Transfer care to a university based system that is immune
    from liability concerns.
A
  1. Answer: D
    Explanation:
    There is really nothing legally that would prohibit a
    physician from treating a family member of a plaintiff, but
    it is a risky decision. Comments might be made that could
    be misconstrued or constructed to be deleterious to the
    physician during the upcoming action. Furthermore, it
    may be possible that the family member legitimately or
    illegitimately develops a complication in attempts to
    establish a pattern. Collusion cannot be ruled out, which
    places the physician in an awkward position of constantly
    second guessing each visit. Furthermore, the family
    member could testify about offi ce policy procedure,
    experiences, and behavior patterns of the physician.
    Universities are not immune from lawsuits and patient
    dumping can be considered abandonment.
    It is best to probably severe ties with the patient that has a
    family member involved in litigation with you or a partner.
    Source: Hans C. Hansen, MD
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119
Q
  1. A non-Medicare inpatient underwent extensive knee
    surgery. The anesthesiologist placed a femoral catheter
    for continuous infusion to control her pain. Another
    anesthesiologist, who is the pain specialist in the group
    rounds on the patient for 3 days. The fi rst day the
    patient had increased pain and the doctor performed an
    expanded problem focused interval history and exam and
    made some adjustments in the medication. The patient’s
    pain improved and visits on the 2nd and 3rd days were
    problem focused. The daily visits are reported using what
    codes:
    A. 99232x1 and 99231 x 2 - Subsequent care codes;
    B. 01996-52 - Daily hospital management of an epidural
    or subarachnoid continuous drug administration with
    a modifi er -52 since the catheter is not in the epidural
    or subarachnoid space;
    C. 99232-25 x 1 and 99231-25 x 2 - The daily visits require a
    modifi er -25 to indicate that the care is over and above
    placement of the catheter after surgery;
    D. No follow up days are billed because the code 64448
    specifi cally “includes daily management”
A
  1. Answer: D
    Explanation:
    CPT instructions specifi cally preclude the reporting of any
    daily care when code 64448 is reported. The descriptions
    and instructions in the CPT Manual for this code and the
    other continuous catheters for pain control are clearly
    stated.
    Source: CPT Coding Manual
    Source: Joanne Mehmert, CPC
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120
Q
  1. A new Medicare patient comes in to an interventional
    pain specialist’s offi ce for the fi rst time complaining of
    low back pain which started when she bent over to lift a
    box 2 days ago. The physician proceeds to examine the
    patient to determine a course of treatment. Based on
    the history & exam which takes about 15 minutes, the
    doctor decides to perform an ESI. The physician recently
    converted to an electronic medical record (EMR) that
    operates on a palm pilot. He has found that with the
    use of this palm and the EMR’s E&M templates he can
    perform a comprehensive visit and exam in 15 minutes.
    After completing the exam, he performs the lumbar ESI.
    The encounter is coded:
    A. 99202 and 62311-25 - It was medically necessary to
    perform a history and exam to determine the course of
    treatment and a modifi er -25 should be appended to
    the ESI code to bypass Medicare’s bundling edit;
    B. 99202 and 62311 - The new patient history and exam resulted
    in the doctor’s decision to perform the injection.
    It is appropriate to report both codes, modifi er –25 is
    usually not required for a new patient and a minor
    procedure;
    C. 99204 and 62311 - Since the EMR provided the physician
    with the information that he needed to document
    a higher level of service, the level documented should be
    reported regardless of the time he spent;
    D. 99203-25 and 62311 -The use of the EMR resulted
    in a comprehensive visit and exam, the decision was
    straightforward.Based on the time and medical decision
    making, the doctor compromised between a level 3 and level 4 and added modifier -25
A
  1. Answer: B
    Explanation:
    Explanation: The government has prosecuted physicians
    for routinely coding double the typical time for the level of
    E&M service. Medical necessity is the overriding
    consideration. Regardless of the amount of documentation
    an EMR generates, if the need isn’t there and the physician
    spent half of the usual time,it is not appropriate to report
    a higher level of service. Modifi er 25 should not be
    required for a Medicare claim for a new patient visit when
    a procedure is performed. In December 2005, the Offi ce of
    Inspector General (OIG) released a report that indicated
    that modifi er –25 was used (in 2002) unnecessarily on a
    large number of claims where it did not result in improper
    payments; however, it did not meet program
    requirements. There may be exceptions to this principle
    since Part B Carriers do not always program the same
    claim edits.
    Source: Code of Federal Regulations 42 U.S.C., 1395y;U.S.
    v Mayer (U.S. District TN 2000)
    Source: Joanne Mehmert, CPC
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121
Q
  1. An established Medicare patient who is on opioids
    comes in for a prescription refi ll. The physician has
    an interactive patient questionnaire that takes about
    10 minutes to complete which he reviews with patients
    on narcotic management to comply with his strict
    controlled substance policy. The patient is stable and
    is taking the medication as prescribed. No change in
    dosage is necessary. The doctor also uses electronic
    records complete with E&M templates. The doctor
    uses the E&M template to perform and document the
    necessary elements to complete a comprehensive history
    which took him another 10 minutes, for a total time of 20
    minutes with the patient. The visit is reported as:
    A. 99211 - A level one visit because the offi ce nurse could
    have asked the patient the questions and fi lled out the
    questionnaire;
    B. 99212 - No change in the patient’s status does not warrant
    a comprehensive history, this is a problem focused
    history and straightforward medical decision making;
    C. 99213 - A detailed history is reported since the visit was
    not 25 minutes which is the threshold time for a level
    4;
    D. 99214 - Management of a patient taking opioids is high
    risk and regardless of the time spent, always warrants
    a level 4;
    E. 99212-22 - The visit should be modifi ed to show the
    payer that the physician is entitled to more than level 2
    reimbursement for opioid management
A
  1. Answer: B
    Explanation:
    The overriding principle is medical necessity. The patient
    is described is stable, with his pain well controlled, and is
    taking the medication as prescribed. The doctor did not
    change dosage, the patient had no complaints, and the
    doctor did not spend time counseling. The comprehensive
    history was not medically necessary for this patient at this
    time; the physician used the template to increase the level
    of service.
    Source: Code of Federal Regulations 42 U.S.C. 1395y
    excludes from Medicare coverage services which “are not
    reasonable and necessary for the diagnosis or treatment of
    illness or injury or to improve the functioning of a
    malformed body member”.
    Source: Joanne Mehmert, CPC
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122
Q
  1. A 42-year-old female patient presents with intractable
    chest wall pain following a radical mastectomy
    performed 8 months ago for carcinoma of the breast. A
    comprehensive history and examination was performed.
    Physician communicates with referring physician and
    provides medical decision making which was of moderate
    complexity. How would you code this visit?
    A. 99241, new or established patient initial offi ce consultation,
    with a problem focused history and focused examination
    with straightforward medical decision making
    B. 99242, new or established patient offi ce consultation,
    with expanded problem focused history and examination
    with straightforward medical decision making
    C. 99243, new or established patient offi ce consultation,
    with detailed history and examination with medical
    decision making of low complexity
    D. 99244, new or established patient offi ce consultation,
    with comprehensive history and examination with
    moderate complexity medical decision making
    E. 99245, new or established patient offi ce consultation,
    with comprehensive history and examination with high
    complexity medical decision making
A
  1. Answer: D

Source: Laxmaiah Manchikanti, MD

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123
Q
  1. Mr. Spencer, a Medicare patient, has been treated for
    back pain radiating down his legs over the past 5 years.
    During that time he has undergone injections, lysis of
    epidural adhesions, physician therapy, bio-feedback,
    and medication management, none of which have been
    effective. Dr. Jackson who has been treating Mr. Spencer
    requests an opinion from Dr. Michael, an Interventional
    Specialist that uses spinal cord stimulation for a number
    of his own patients. Dr. Michael talked with Dr. Jackson
    at length about the patient and spends 20 minutes
    reading the notes Dr. Jackson sent before he goes into
    see Mr. Spencer. Dr. Michael spent 30 minutes taking
    an expanded problem focused history and doing an
    expanded problem focused examination; however Mr.
    Spencer was very apprehensive and wanted to know in
    great detail how SCS works, what he could expect, etc. Dr.
    Michael spent another 45 minutes explaining SCS. Dr.
    Michael documented all elements of the visit including
    his discussion and the time he spent explaining SCS to
    Mr. Spencer. The visit should be reported as:
    A. 99244 - A level 4 consultation requires a comprehensive
    history, exam and medical decision of moderate complexity
    and the typical time is 60 minutes;
    B. 99243 - A level 3 consultation requires a detailed history,
    detailed exam, medical decision making of low complexity
    and the typical time is 40 minutes
    C. 99245 - Counting the time that Dr. Michael spent reviewing
    the notes before he went into see Mr. Spencer,
    he spent the typical time for a level 5 consult, 80 minutes;
    D. 99242 - A level 2 consultation requires an expanded
    problem focused history, an expanded problem focused
    exam and straightforward medical decision making; the
    typical time is 30 minutes
A
  1. Answer: A
    Explanation:
    Dr. Michael spent over 50% of the typical time for a level 4 consultation explaining the patient’s treatment
    option. Regardless of the extent of the history, exam and
    medical decision making, when a physician spends (and
    documents time and discussion points) over 50% of the
    typical time for the visit, time can be the determining
    factor in choosing a code. Medicare does not allow time
    spent reading the records to be used to determine a code
    level. Time must be spent face-to-face with a patient in the
    offi ce.
    Source: CPT Manual, E&M Coding Guidelines
    Source: Joanne Mehmert, CPC
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124
Q
  1. A 34-year-old patient, with post-cervical laminectomy
    syndrome, presents with severe neck pain associated with
    depression and drug dependency for your consultation.
    Physician spends approximately 1½ hours with
    comprehensive history and examination. What is the
    appropriate coding for this visit?
    A. 99241, new or established patient initial offi ce consultation,
    with a problem focused history and focused examination
    with straightforward medical decision making
    B. 99242, new or established patient offi ce consultation,
    with expanded problem focused history and examination
    with straightforward medical decision making
    C. 99243, new or established patient offi ce consultation,
    with detailed history and examination with medical
    decision making of low complexity
    D. 99244, new or established patient offi ce consultation,
    with comprehensive history and examination with
    moderate complexity medical decision making
    E. 99245, new or established patient offi ce consultation,
    with comprehensive history and examination with high
    complexity medical decision making
A
  1. Answer: C

Source: Laxmaiah Manchikanti, MD

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125
Q
  1. A patient that is well known to the clinic because of a
    very successful lysis of epidural adhesions procedure
    3 years ago, calls for an appointment. The patient
    explained that she moved out of the area shortly after her
    lysis procedure and has been doing well. She moved back
    to the city a week ago and while moving she hurt her back.
    She is experiencing signifi cant pain and would like to see
    the same physician that treated her 3 years ago. The
    physician notes that he called in a prescription for the patient 2 years and 10 months ago, just before she moved
    out of the area. When the patient comes in, the physician
    performs and documents a Level 3 E&M service. This
    visit should be reported as:
    A. 99203 - A level 3 new patient visit is the appropriate code
    to report for this encounter
    B. 99213-22 - An established patient visit should be reported;
    however, the physician should append a modifi
    er -22 (unusual procedure service) and charge more
    than his usual fee since he had not seen the patient in
    almost 3 years;
    C. 99203-52 - Since the doctor called in a prescription for
    the patient 2 years and 10 months ago, a new patient
    with a “reduced services” modifi er should be reported;
    D. 99215-52-The physician appends the modifi er -52 to
    indicate that the services were reduced because the
    documentation does not support a level 5 visit.He feels
    that he should be paid more than the level 3 established
    patient visit
A
  1. Answer: A
    Explanation:
    Prior to the year 2000, CPT defi ned a “new patient” as one
    that had not had any professional services in the past 3
    years. In the 2000 CPT Manual a signifi cant change was
    made in the description of a “new patient” and this change
    is also refl ected in the Medicare Claims Processing
    Manual. CPT 2000-2006, which defi nes: “professional
    services” as, “those face-to-face- services rendered by a
    physician and reported by a specifi c CPT code”. Since
    calling in a prescription is not a service for which a
    physician reports a CPT code, a new patient visit is
    reported.
    Source: Medicare Claims Processing Manual, 100-04
    Chapter 12 Physicians/Non-physician Practitioners
    §30.6.7A and CPT Coding Manual E&M Services
    Guidelines Page 1.
    Source: Joanne Mehmert, CPC
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126
Q
  1. An established Medicare patient comes to the offi ce
    to have the second in a planned series of three lumbar
    epidural steroid injections.The physician takes a focused
    interval history asking the patient about the effect of the
    fi rst epidural and to ensure that she discontinued her
    daily aspirin as instructed. Based on his interview with
    the patient, he proceeds with the injection. The physician
    dictates a meticulous note. The encounter should be
    reported as:
    A. 99213-25, 62311-The epidural and the visit were medically
    necessary and both should be billed using the
    modifi er -25 to ensure that the claim passes the payer’s
    bundling edit;
    B. 62311 - A procedure includes a reasonable amount of
    pre and post procedure work which is bundled into the
    payment for the injection;
    C. 99215 - The physician has a choice of reporting a procedure
    or an E&M visit and chooses to report a level 5
    E&M service;
    D. 99213, 62311 - The physician realizes that the offi ce
    visit is not above and beyond the usual work that he
    performs when he does a procedure; however, he still
    wants to bill an offi ce visit just in case the Carrier will
    reimburse without the -25 modifi er.
A
  1. Answer: B
    Explanation:
    The visit is not above and beyond the usual pre operative
    work. The physician’s note is good medical practice and
    documents the medical necessity of performing the second
    injection with the primary benefi t that it provides a high
    qualify medical record for his patient. The answer
    described in “C” bears no resemblance to a true statement
    and “D” is a deliberate attempt to obtain payment to
    which one is not entitled.
    Source: CPT Coding Guidelines
    Source: Joanne Mehmert, CPC
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127
Q
  1. A patient comes into the offi ce to pick up a prescription
    for medication refi ll. The new receptionist takes the
    patient’s chart into the doctor and the doctor looks at
    the medication record, writes a prescription and gives it
    to the receptionist to give to the patient. The receptionist
    hands the patient the prescription and tells the patient to
    have a nice day. This encounter should be reported to the
    insurance company as:
    A. 99211 - An incident to service because the receptionist is
    employed by the physician and the doctor looked at the
    chart and wrote the prescription;
    B. 99212 - The physician should report a level two office
    visit because the physician looked at the patient’s medication
    record and made a medical decision to write the
    prescription;
    C. No charge should be submitted because the receptionist
    is not qualifi ed to perform, and did not perform an offi
    ce visit and the doctor did not see the patient;
    D. 99213 - Anytime a physician writes a prescription, it is
    considered a management decision that justifi es a level
    3 offi ce visit.
A
  1. Answer: C
    Explanation:
    The receptionist did not perform an offi ce visit and the
    physician did not have any contact with her patient. The
    CPT codes assume that a qualifi ed person will perform
    and document a service and while an employee does not
    necessarily have to be a nurse or clinician to report a 5
    minute offi ce visit, the employee should have enough
    training to perform and document a minimal service. In
    the circumstance described above, an office visit was not performed by the doctor.
    Source: CPT Coding Instructions
    Source: Joanne Mehmert, CPC
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128
Q
  1. A hospital in-patient in the advanced stages of lung
    cancer is suffering from intractable pain and a pain
    specialist has been asked to consult for pain control.
    The consultant begins his interview and exam of the
    patient which takes 50 minutes and fi nds it necessary
    to review radiology fi lms that are at the nursing station.
    Additionally, he spends 45 minutes at the nursing station
    discussing the patient’s hospital course to date with the
    charge nurse, reviewing the patient’s electronic record,
    and talking with the patient’s oncologist and surgeon. By
    the time he has completed his consultation, he performed
    a level 2 history and examination (99252) and spent an
    additional 45 minutes reviewing records, consulting
    with other professionals and coordinating the patient’s
    care. The physician’s total time was 95 minutes. The
    appropriate code is:
    A. 99254 because the time spent is the threshold for a level
    4 consult even though the doctor only performed and
    documented an H&P to qualify for a level 2 consultation,
    he can add the extra time to report a higher level;
    B. 99252 and 99356, prolonged care, requiring direct (faceto-
    face) patient contact beyond the usual service, fi rst
    hour, because the doctor spent a total of 95 minutes on
    the patient consult;
    C. 99252, 99356, 99357, since the threshold time for the
    consult (40 minutes) and the fi rst prolonged care time
    (1st hour) were both exceeded, the physician should
    report an additional 30 minutes of prolonged care
    D. 99252, A level two consultation code, prolonged care can
    not be reported because the physician was not at the
    patient’s bedside for the entire 95 minutes.
A
  1. Answer: B
    Explanation:
    In the hospital, unlike in the offi ce, time spent on the
    fl oor/unit reviewing records and coordinating the care can
    be considered as long as it is spent exclusively on the
    patient. At least 15 minutes must be spent in addition to
    the fi rst hour of prolonged care to report the second 30
    minutes, 99357.
    Source: Joanne Mehmert, CPC
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129
Q
  1. An inpatient is 4 days post knee surgery and the surgeon
    has been managing his pain control with injections and
    oral medication. Since the pain is not being satisfactorily
    controlled with the surgeon’s current regimen, he asks a
    pain management specialist to perform a femoral nerve
    block. The specialist spends a few minutes talking to the
    patient and agrees that the femoral nerve block is likely
    to be the best course of treatment at this time. The pain
    specialist reports:
    A. CPT codes 99255-25 and 64447 Level 5 consultation
    with modifi er -25 to show a service above and beyond
    the usual pre/post operative work and a femoral nerve
    block, single
    B. CPT code 64447
    C. CPT codes 99231-25 and 64447 Level 1 subsequent care
    hospital visit
    D. CPT codes 99231-57 and 64447 Modifi er 57 should be
    appended to the hospital visit since a procedure was
    performed
A
  1. Answer: B
    Explanation:
    The surgeon did not request an evaluation or ask for the
    pain specialist’s opinion or advice. He simply requested
    that the pain physician perform a femoral nerve block. The
    only appropriate code to report in this circumstance is the
    injection code.
    Source: Medicare Claims Processing Manual, 100-04
    Chapter 12 Physicians/Nonphysician Practitioners -
    Consultations
    Source: Joanne Mehmert, CPC
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130
Q
  1. A Medicare benefi ciary underwent an epidural lysis of adhesions (10 day global) on February 1, and returns to
    the offi ce for a follow-up visit on February 8, the doctor
    noted that the patient has a slight redness around the
    site where the catheter had been inserted and applied
    antibiotic ointment. He recommended that the patient
    apply antibiotic ointment for the next 3-4 days to prevent
    infection. During the visit, the patient also complains of
    a dull, aching pain in her left knee that started when she
    twisted her knee while going downstairs to do laundry 2
    days ago. After a visit that included a problem focused
    exam and straightforward medical decision making
    (Level 2), the physician should:
    A. Report code 99212-24 (E&M for an unrelated condition
    during the global period)
    B. Report code 99212(No modifi er is necessary since the
    ICD-9 code will be different than the code for the procedure
    performed on February )
    C. The doctor can’t report any services during the 10-day
    global period
    D. Report code 99213-24(The doctor treated the small
    wound to prevent infection and took care of a new
    complaint which adds up to a higher level of service)
A
  1. Answer: A
    Explanation:
    All additional medical or surgical services required of the
    surgeon during the postoperative period of the surgery
    room are included in the global fee for the surgery. Thus,
    the treatment of the surgical wound to prevent infection is
    included in the global fee. It is appropriate to report an
    E&M code for a condition that is not related to the
    condition for which the surgery was performed. Modifi er
    -24 is required to bypass the global surgery edit.
    Source: Medicare Claims Processing Manual, 100-04
    Chapter 12 Physicians/Nonphysician Practitioners §40.1A
    Source: Joanne Mehmert, CPC
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131
Q
  1. Dr. Harris, a specialist in the treatment of cancer pain,
    provided a consultation service on March 5, for a patient
    who is in the hospital for treatment of Chondrosarcoma
    in her pelvis. Dr. Harris wrote a consultation note
    and recommended a treatment plan to the referring
    oncologist; however, he did not assume care of the pain
    condition. On March 8, the patient’s oncologist asked
    Dr. Harris to provide a follow-up consultation since
    the treatment that Dr. Harris recommended was not
    providing adequate pain control and the patient was
    experiencing a signifi cant amount of breakthrough pain.
    Dr. Harris saw the patient performed a visit that would
    qualify for a level 2 service. Dr. Harris should report the
    March 8 visit as:
    A. 99252-76 (Level 2 initial consultation and 76 to indicate
    repeat procedure by same physician)
    B. 99252-32 (Modifi er for mandated services)
    C. 99232 (Subsequent hospital care, level 2)
    D. 99232-32
A
  1. Answer: C
    Explanation:
    Only one initial consultation code should be reported per
    a patient’s hospital stay. The AMA instructs providers to
    report subsequent care hospital visit codes when a followup
    consultation is performed since the follow-up
    consultation codes were deleted effective 1/1/06.
    Source: CPT Changes 2006
    Source: Joanne Mehmert, CPC
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132
Q
  1. After unsatisfactory pain control has been achieved
    with injections, physical therapy and oral medication,
    a patient that is covered by Health Plus has been told
    by his pain management specialist that a spinal cord
    stimulator (SCS) is the next option. Before Health Plus
    will approve a trial and subsequent permanent SCS
    stimulator, it requires a confirmatory consultation from
    another chronic pain specialist. The consultant performs
    a level 4 consultation service and sends a report to Health
    Plus. CPT guidelines instruct the provider to report this
    service:
    A. 99204-25 (New patient visit & Modifi er -25, separately
    identifi able E&M service)
    B. 99244-32 (Consultation & Mandated services)
    C. 99204-32
    D. 99244-25
A
  1. Answer: B
    Explanation:
    CPT Changes 2006: An Insider’s View (pg. 4), states:
    “When a consultation is mandated by a third-party payer,
    modifi er -32 should be appended to the level of
    consultation code reported.” Medicare does not recognize modifi er -32 as a payment modifi er or cover a second
    opinion evaluation visit required by a third party payer.
    Source: Joanne Mehmert, CPC
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133
Q
  1. Dr. Cruise wrote a letter to his Part B Medicare carrier
    asking for the correct method to report bilateral intraarticular
    facet blocks. His carrier was paying the correct
    amount for the fi rst level; however, when he reported one
    or two additional, bilateral levels [using modifi er -50] his
    claims were either denied or paid incorrectly. In his letter,
    he provided accurate and complete information along
    with examples showing CPT coding instructions and his
    exact charges. A year after receiving [and implementing]
    the Carrier’s written instructions, the Carrier determined
    that Dr. Cruise had been overpaid due to his billing
    method and asked for a refund. The Carrier also added
    interest and penalty to its demand. Dr. Cruise refunded
    the overpayment; however, after Dr. Cruise presented
    more information, the Carrier waived the penalty. The
    reason the Carrier waived the penalty is:
    A. Dr. Cruise received and followed erroneous written guidance
    from a representative acting within the scope of
    the contractor’s Medicare contract authority
    B. Dr. Cruise was a very infl uential physician in the community
    and the Carrier Medical Director did not want
    to risk any backlash from other physicians
    C. Dr. Cruise did not have any other negative audit outcomes
    D. None of the above
A
  1. Answer: A
    Explanation:
    CMS published Transmittal 731, [61 pages] dated 11/1/05
    which addresses only the penalty provision.
    CMS published §903(c) of the Medicare Prescription
    Drug, Improvement and Modernization Act of 2003
    (MMA), which amended §1871(e) of the Social Security
    Act (the Act), establishes a basis for waiving the penalty in
    certain circumstances. Specifi cally, §903(c) establishes
    that, subject to certain conditions, a provider or supplier
    shall not be subject to any penalty under an authority of
    Title XVIII of the Act or under an authority of Title XI of
    the Act (that relates to Title XVIII) if the basis for the
    penalty that would have otherwise been applicable was
    that the provider or supplier acted in accordance with
    erroneous guidance from the Medicare program.
    This statutory amendment also provides for waiving
    interest if the overpayment that is the basis for assessing
    such interest resulted from the provider or supplier acting
    in accordance with erroneous guidance from the Medicare
    program.
    Source: Joanne Mehmert, CPC
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134
Q
  1. An MSDS is:
    A. Mandatory manual of current OSHA affairs
    B. A medical waste discharge plan
    C. The materials list of ingredients, and chemical composition
    D. Documentation procedures of blood borne pathogens
    E. A component of the hazardous waste spill kit.
A
  1. Answer: C
    Explanation:
    The materials list of ingredients, and chemical
    composition.
    The Material Safety Data Sheets, MSDS, are mandatory for
    medical offi ces and should be displayed, or found by
    employees on demand, usually kept in a binder. These lists
    are frequently printed by the company, and labeled on the
    device or container for quick reference. An example might
    be a cleaning solvent, or a container with potentially
    dangerous organic content, such as insecticide.
    Source: Hans C. Hansen, MD
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135
Q
  1. An electronic medical record vendor approaches you
    stating that the electronic medical record will increase
    productivity, and allow the physician to capture an
    elevated evaluation and management code by enhanced
    documentation. The vendor goes on to relate that the
    electronic medical record efficiently documents a higher
    code and can increase the practice bottom line. Your
    correct response is:
    A. Ask the vendor to show you the vendor support for the
    electronic medical record.
    B. Demonstrate an amortization schedule to justify cost of
    the unit.
    C. Ask for a demonstration of workfl ow and enhanced operational
    components to justify a higher E/M.
    D. Ignore the vendor, but ask for a demonstration.
    E. Consider the vendor as relating a common sales pitch,
    and examine the input output effi ciency of the electronic
    medical record independently.
A
  1. Answer: E
    Explanation:
    Vendors, have a fi nancial motive to demonstrate a benefi t
    to the practice. It is easy for a vendor to show templated
    output documents, that may justify a CPT Level 4, and
    entice the physician to consider up-coding the work
    performed. It is incumbent upon the physician, that only
    work performed is documented. Templates are met with a
    high level of scrutiny during an audit. Do all of the
    templates appear the same? Were you sold a system that
    effi ciently up-codes, and hence a revenue generating tool,
    as opposed to a work fl ow tool? The physician will in time
    meet salespeople who really have nothing to lose but
    everything to gain, and the digital sales industry has no
    regulation. The physician, however, is in one of the most
    regulated environments in business, and has everything to
    lose. The best approach with any vendor is to listen,
    review the system, but verify, and apply principals of a valid compliance program to assess the fl exibility of the
    electronic medical record. The medical record should be
    fl exible enough to offer many templates, refl ecting only the
    work performed, and not a standard, regurgitated
    document, which will fall into question should an audit
    occur.
    Source: Hans C. Hansen, MD
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136
Q
  1. “Incident To” billing for physician extenders under CMS
    guidelines Statute S2050 is used to defi ne services of midlevel
    practitioners such as physician assistants and nurse
    practitioners. The supervising physician, immediately
    available by phone is consulted by the nurse practitioner
    regarding a patient. The electronic medical record will support:
    A. 100% of charged capture because the physician is immediately
    available
    B. 85% charge capture of the physician’s fee
    C. Defi ned by the electronic medical record, if CPT guidelines
    are met, 100% capture defi ned by complexity, and
    medical decision-making.
    D. The practice is unable to bill for the nurse practitioner’s
    services.
    E. The nurse practitioner may bill under his or her provider
    number 100% of the fee, irrespective of conversation
    with the physician.
A
  1. Answer: B
    Explanation:
    The nurse practitioner may work independently and bill
    under his or her provider number, but obtain only 85% of
    the fee. The electronic medical record is irrelevant. If the
    physician is immediately available, onsite, and the nurse
    practitioner is present examining the patient in a
    collaborative environment with the physician, then the
    physician’s services may be billed at 100% “Incident To” .
    If the physician is not immediately available to the site,
    irrespective of telephone conversations, the practice may
    bill 85% of the physician’s fee. The electronic medical
    record will (or should) account for incident to,
    documenting when the physician is present and when not
    in the presence when a physician extender is utilized.
    Source: Hans C. Hansen, MD
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137
Q
  1. An interventional pain specialist is called by an internist
    to consult on an in-patient that is complaining of severe
    neck pain. When the specialist goes into the patient’s
    room, she realizes that she has treated the patient in
    her offi ce for low back pain a year ago. The specialist
    performs a consultation, and dictates a note along with
    her recommendations. The correct coding for this
    encounter is:
    A. An initial hospital care code because this is the fi rst time
    the specialist has seen the patient during this hospital
    stay;
    B. A subsequent hospital care code because the specialist
    treated this patient in her offi ce within the past 3 years;
    C. An inpatient consultation
    D. An outpatient consultation
A
  1. Answer: C
    Explanation:
    A consult does not depend on whether the patient is a new
    or established patient. A consult depends on whether the
    doctor is currently treating the patient for the condition
    and whether the referring doctor requests an opinion or
    advice from the specialist. There is no “initial hospital
    visit” code.
    Source: Source: Medicare Claims Processing Manual,
    100-04 Chapter 12 Physicians/Non-physician
    Practitioners §30.6.7 and 1995 or 1997 E&M Coding
    Guidelines.
    Source: Joanne Mehmert, CPC
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138
Q
  1. True statements about Chief Compliance Offi cer include
    the following:
    A. Totally independent position
    B. Access to all staff, but not to C.E.O.
    C. Assign the compliance plan to supervisor in reception
    department
    D. Generally a compliance committee will assist
    E. Operates independently and confi dentially without informing
    board of directors
A
2053. Answer: D
Explanation:
Chief Compliance Offi cer
*Access to the top
*Oversee and monitor the compliance plan
*Generally a compliance committee to assist
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139
Q
  1. Which of the following is not a work practice control
    required by the regulation governing occupational
    exposure to bloodborne pathogens?
    A. Not eating or drinking in work areas
    B. Not smoking in work areas
    C. Not storing food in the same refrigerator as blood is
    stored
    D. Recapping needles using both hands.
    E. Washing hands after removing gloves
A
  1. Answer: D
    Explanation:
    Source: 29 CFR 1910.1030(d)(2).
    Source: Erin Brisbay McMahon, JD
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140
Q
  1. Which one of the following is not a major component
    of the regulation governing occupational exposure to
    bloodborne pathogens?
    A. Exposure Control Plan
    B. Hepatitis B Vaccinations
    C. Testing Employees for Infectious Diseases
    D. Post-Exposure Evaluation and Follow-Up
    E. Recordkeeping
A
  1. Answer: C
    Explanation:
    Source:29 CFR 1910.1030.
    Source: Erin Brisbay McMahon, JD
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141
Q
2056. Which of the following is a designated health service
subject to the Stark law?
A. Ambulatory surgery
B. Outpatient prescription drugs
C. Services paid at a composite rate
D. Sleep lab services
E. Cardiac catheterization
A
  1. Answer: B
    Explanation:
    Source:42 USC §1395nn(h)(6)
    Source: Erin Brisbay McMahon, JD
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142
Q
  1. The Level II (national) codes of the Healthcare Common
    Procedure Coding System (HCPCS) coding system are
    maintained by the
    A. American Medical Association
    B. CPT Editorial Panel
    C. Local fi scal intermediary
    D. Centers for Medicare and Medicaid Services
    E. International Classifi cation of Diseases, Ninth Revision
    (ICD-9 CM)
A
  1. Answer: D
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143
Q
  1. A physician performed an outpatient surgical procedure
    on the disc of a Medicare patient. Upon searching the
    CPT codes and consulting with the physician, the coder is
    unable to fi nd a code for the procedure. The coder should
    assign:
    A. An unlisted Evaluation and Management code from the
    E & M section
    B. A HCPCS Level Two (alphanumeric) code
    C. An anesthesia treatment service code
    D. A code which is closest to the description
    E. An unlisted procedure code located in the nervous system
    section
A
  1. Answer: E
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144
Q
  1. Multiple functions of a medical record include all
    EXCEPT:
    A. Support “medical necessity”
    B. Reduce medical errors & professional liability exposure
    C. Reduce audit exposure
    D. Facilitate claims review
    E. Facilitate upcoding
A
2059. Answer: E
Explanation:
Medical records function to:
keep the practitioner out of the slammer
support “medical necessity”
reduce medical errors & professional liability exposure
reduce audit exposure
facilitate claim review
support insurance billing
provide clinical data for education
provide clinical data for research
promote continuity of care among physicians
indicate quality of care
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145
Q
2060. What are state laws affecting medical practices?
A. Balanced Budget Act
B. Medical records confi dentiality laws
C. OSHA
D. Needle stick safety
E. Privacy
A
2060. Answer: B
Explanation:
State Laws
* Medical records confi dentiality laws
* Medical records access laws
* HIV/AIDs
* Mental health
* Genetic testing/anti-discrimination
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146
Q
  1. What are the ramifi cations of anti-kickback statute on
    your practice?
    A. It is a felony - 10 years imprisonment
    B. It is a crime to offer, solicit, pay, or receive remuneration,
    in cash or in kind, directly or indirectly, for referrals
    under a federally-funded health care program
    C. Civil penalties - $500,000 per violation
    D. “Multipurpose” Rule
    E. No safe harbors
A
  1. Answer: B
    Explanation:
    Anti-Kickback Statute
    * A crime to offer, solicit, pay, or receive remuneration, in
    cash or in kind, directly or indirectly, for referrals under a
    federally-funded health care program
    - Felony - 5 years imprisonment
    - Civil Penalties - $50,000 per violation
    - “One Purpose” Rule
    - Safe Harbors
    Source: Laxmaiah Manchikanti, MD
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147
Q
  1. Administrator of a pain center identifi ed some risks of
    non-compliance. Which one of these is legitimate?
    A. An increase in the cost of an investigation and audit
    B. No risk of exclusion from government health care programs.
    C. Criminal and civil penalties
    D. No risk of termination of private managed care and
    insurance contracts
    E. Reduction in fee schedule
A
  1. Answer: C
    Explanation:
    RISKS OF NON-COMPLIANCE:
    Criminal and civil penalties
    The cost of an investigation and audit
    Exclusion from government health care programs
    including Medicare, Medicaid, and Tricare
    Possible termination of private managed care and
    insurance contracts
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148
Q
  1. What are true statements about regular and effective
    compliance training?
    A. Includes all department heads
    B. Includes all employees and vendors
    C. Initial training is provided only if employee wants to
    learn
    D. Regular ongoing training is expensive and not an essential
    component
    E. In response to identifi ed problem to the particular employee
A
2063. Answer: B
Explanation:
Regular and Effective Training
Who?
All employees and vendors
What?
Initial training
Regular ongoing training
In response to identifi ed problem
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149
Q
  1. The training requirements of needle stick safety include
    all of the following EXCEPT:
    A. Work hours
    B. 90 days after initial assignment
    C. At a cost to employee
    D. Within 365 days after effective date of standard
    E. Within 10 years of previous training.
A
2064. Answer: C
Explanation:
Training
* No cost to employee
* During work hours
* At time of initial assignment
* Within 90 days after effective date of standard
* Within 1 year of previous training
* Shift in occupational exposure
Source: Laxmaiah Manchikanti, MD
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150
Q
  1. You were requested to provide a consultation on a 38-
    year-old male with low back pain with radiation into
    lower extremity. MRI fi ndings were unequivocal. Physical
    examination was normal. Nerve conduction studies were
    negative. You advise the patient with regards to future
    treatment and communicate with the referring physician.
    In this evaluation a detailed history and examination was
    carried out. Medical decision making included advice
    to refer the patient to physical therapy. What is the
    appropriate coding for this evaluation and management
    service?
    A. 99241, new or established patient initial offi ce consultation,
    with a problem focused history and focused examination
    with straightforward medical decision making
    B. 99242, new or established patient offi ce consultation,
    with expanded problem focused history and examination
    with straightforward medical decision making
    C. 99243, new or established patient offi ce consultation,
    with detailed history and examination with medical
    decision making of low complexity
    D. 99244, new or established patient offi ce consultation,
    with comprehensive history and examination with
    moderate complexity medical decision making
    E. 99245, new or established patient offi ce consultation,
    with comprehensive history and examination with high
    complexity medical decision making
A
  1. Answer: C

Source: Laxmaiah Manchikanti, MD

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151
Q
  1. Accurate examples of abuse are identifi ed as follows:
    A. Occasionally submitting duplicate claims
    B. Intentional upcoding
    C. Unbundling using appropriate modifi ers
    D. Using modifi er-25 to charge for separate, identifi able
    E/M service, on the same day as procedure
    E. Collecting approved amount from the patient
A
2066. Answer: B
Explanation:
Examples of Abuse are:
Collecting more from the patient than you should
Routinely submitting duplicate claims
Upcoding
Unbundling
Wrong modifi ers
Modifi er 59
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152
Q
  1. The Electronic Medical Record defi nes critical areas of
    development. These include:
    A. System back offi ce management
    B. Document management
    C. HIPAA control constraints
    D. Data input, decision support, system data and development
    of new protocol
A
  1. Answer: C

Source: Hans C. Hansen, MD

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153
Q
2068. For a service to be reasonable and necessary it must be:
A. Safe
B. Experimental
C. Investigational
D. Patient can afford to pay
E. Furnished only in an hospital
A
  1. Answer: A
    Explanation:
    Service must be:
    Safe and effective
    Not experimental or investigational
    Appropriate, including the duration and frequency that is
    considered appropriate for the service, in terms of whether
    it is:
    - Furnished in accordance with accepted standards of
    medical practice for the diagnosis or treatment of the
    patient’s condition or to improve the function
    - Furnished in a setting appropriate to the patient’s
    medical needs and condition
    - Ordered and/or furnished by qualifi ed personnel
    - One that meets, but does not exceed, the patient’s
    medical need.
    Source: Laxmaiah Manchikanti, MD
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154
Q
  1. An established patient for neck pain and headaches
    returns with a new onset low back pain which started
    following motor vehicle injury. Pain also radiates
    into lower extremity associated with numbness and
    tingling. Patient is evaluated with a detailed history,
    and physical examination. Appropriate management
    included evaluation with an MRI, physical therapy and
    nonsteroidal anti-infl ammatory drug therapy. How
    would you code this visit?
    A. 99211, established patient, offi ce or other outpatient visit
    (time 5 minutes), no physician presence is required
    B. 99212, established patient, offi ce or other outpatient
    visit, problem focused
    C. 99213, established patient, offi ce or other outpatient
    visit, expanded problem focused
    D. 99214, established patient, offi ce or other outpatient
    visit, detailed visit
    E. 99215, established patient, offi ce or other outpatient
    visit, comprehensive
A
  1. Answer: D

Source: Laxmaiah Manchikanti, MD

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155
Q
  1. An established, 43-year-old female patient, with
    frequent intermittent, moderate to severe episodes of
    low back pain, requiring transforaminal epidural steroid
    injections, hydrocodone therapy, presents with continued
    low back and lower extremity pain requiring her to miss
    work, presents for a follow-up visit,. Physician takes
    history, performs a detailed examination, and changes
    medical therapy. At this time it was also decided that
    patient will be referred for a neurosurgical consultation.
    How would you code this visit?
    A. 99211, established patient, offi ce or other outpatient visit
    (time 5 minutes), no physician presence is required
    B. 99212, established patient, offi ce or other outpatient
    visit, problem focused
    C. 99213, established patient, offi ce or other outpatient
    visit, expanded problem focused
    D. 99214, established patient, offi ce or other outpatient
    visit, detailed visit
    E. 99215, established patient, offi ce or other outpatient
    visit, comprehensive
A
  1. Answer: D

Source: Laxmaiah Manchikanti, MD

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156
Q
  1. A 46-year-old female, established patient, who is
    experiencing increased symptoms while in a pain
    management treatment program involving interventional
    techniques and medication management with exercise
    program, presents for reassessment and counseling.
    Interventional pain physician takes a detailed history, conducts an examination and provides the patient with
    counseling, instructing in an exercise program and
    refers the patient to physical therapy and psychology.
    Identify the appropriate coding for this evaluation and
    management visit.
    A. 99211, established patient, offi ce or other outpatient visit
    (time 5 minutes), no physician presence is required
    B. 99212, established patient, offi ce or other outpatient
    visit, problem focused
    C. 99213, established patient, offi ce or other outpatient
    visit, expanded problem focused
    D. 99214, established patient, offi ce or other outpatient
    visit, detailed visit
    E. 99215, established patient, offi ce or other outpatient
    visit, comprehensive
A
  1. Answer: D

Source: Laxmaiah Manchikanti, MD

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157
Q
  1. A 44-year-old male, established patient, with chronic
    myofascial pain syndrome, effectively managed by
    desipramine, gabapentin, and oxycodone 10/325 three
    times daily presents with new onset of urinary hesitancy.
    Physician performs a problem focused history with low
    complexity of medical decision making. Physician refers
    the patient to an urologist. What is the appropriate EM
    code for this visit?
    A. 99211, established patient, offi ce or other outpatient visit
    (time 5 minutes), no physician presence is required
    B. 99212, established patient, offi ce or other outpatient
    visit, problem focused
    C. 99213, established patient, offi ce or other outpatient
    visit, expanded problem focused
    D. 99214, established patient, offi ce or other outpatient
    visit, detailed visit
    E. 99215, established patient, offi ce or other outpatient
    visit, comprehensive
A
  1. Answer: C

Source: Laxmaiah Manchikanti, MD

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158
Q
  1. A patient with established diagnosis of refl ex sympathetic
    dystrophy, with signifi cant improvement after
    sympathetic blocks, presently maintained on medical
    therapy with gabapentin and desipramine, presents for
    an offi ce visit. Physician spends approximately 5 minutes
    with the patient with focused history and straight forward
    medical decision making. What is the appropriate coding
    for this evaluation and management visit?
    A. 99211, established patient, offi ce or other outpatient visit
    (time 5 minutes), no physician presence is required
    B. 99212, established patient, offi ce or other outpatient
    visit, problem focused
    C. 99213, established patient, offi ce or other outpatient
    visit, expanded problem focused
    D. 99214, established patient, offi ce or other outpatient
    visit, detailed visit
    E. 99215, established patient, offi ce or other outpatient
    visit, comprehensive
A
  1. Answer: B

Source: Laxmaiah Manchikanti, MD

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159
Q
  1. A 44-year-old white female, an established patient
    experienced reoccurrence of knee pain after she
    discontinued Naprosyn for gastric irritation. She presents
    for alternate therapy. Physician provides a 6 minute
    visit with problem focused history and examination
    and prescribes Mobic® 7.5 mg twice daily. What is the
    appropriate coding for this visit?
    A. 99211, established patient, offi ce or other outpatient visit
    (time 5 minutes), no physician presence is required
    B. 99212, established patient, offi ce or other outpatient
    visit, problem focused
    C. 99213, established patient, offi ce or other outpatient
    visit, expanded problem focused
    D. 99214, established patient, offi ce or other outpatient
    visit, detailed visit
    E. 99215, established patient, offi ce or other outpatient
    visit, comprehensive
A
  1. Answer: B

Source: Laxmaiah Manchikanti, MD

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160
Q
  1. As part of interventional pain management, you are
    providing a patient with quarterly testosterone injections.
    Patient returns for a testosterone injection and was seen
    by an RN and the injection was provided. How would you
    code this evaluation and management visit?
    A. 99211, established patient, offi ce or other outpatient visit
    (time 5 minutes), no physician presence is required
    B. 99212, established patient, offi ce or other outpatient
    visit, problem focused
    C. 99213, established patient, offi ce or other outpatient
    visit, expanded problem focused
    D. 99214, established patient, offi ce or other outpatient
    visit, detailed visit
    E. 99215, established patient, offi ce or other outpatient
    visit, comprehensive
A
  1. Answer: A

Source: Laxmaiah Manchikanti, MD

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161
Q
  1. A 68-year-old male presents with severe neck and
    bilateral shoulder pain. His complaints included stress
    incontinence. His physical examination was with brisk
    deep tendon refl exes. The physician evaluation included
    comprehensive history, comprehensive examination and
    medical decision making of moderate complexity. Select
    the appropriate coding for this initial offi ce visit?
    A. 99201, new patient offi ce or other outpatient visit, problem
    focused history and examination with straightforward
    medical decision making
    B. 99202, new patient offi ce or other outpatient visit,
    requiring an expanded problem focused history and
    examination with straightforward medical decision
    making
    C. 99203, new patient offi ce or other outpatient visit,
    requiring detailed history and examination with low
    complexity medical decision making
    D. 99204, new patient offi ce or other outpatient visit, with
    comprehensive history and examination with moderate
    complexity medical decision making
    E. 99205, new patient offi ce or other outpatient visit, with
    comprehensive history, examination and high complexity
    medical decision making
A
  1. Answer: D

Source: Laxmaiah Manchikanti, MD

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162
Q
  1. A 21-year-old football player presents with fi ve day old
    injury complaining of severe low back pain and right
    knee pain. The right knee is associated with swelling and
    discoloration. What is the appropriate code for this initial
    offi ce visit?
    A. 99201, new patient offi ce or other outpatient visit, problem
    focused history and examination with straightforward
    medical decision making
    B. 99202, new patient offi ce or other outpatient visit,
    requiring an expanded problem focused history and
    examination with straightforward medical decision
    making
    C. 99203, new patient offi ce or other outpatient visit,
    requiring detailed history and examination with low
    complexity medical decision making
    D. 99204, new patient offi ce or other outpatient visit, with
    comprehensive history and examination with moderate
    complexity medical decision making
    E. 99205, new patient offi ce or other outpatient visit, with
    comprehensive history, examination and high complexity
    medical decision making
A
  1. Answer: C

Source: Laxmaiah Manchikanti, MD

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163
Q
  1. A long-term patient of yours brings her 12-year-old
    daughter with progressive scoliosis. You take a detailed
    history and conduct a detailed examination, advise the
    patient with regards to further management. What is the
    appropriate coding for this visit?
    A. 99201, new patient offi ce or other outpatient visit, problem
    focused history and examination with straightforward
    medical decision making
    B. 99202, new patient offi ce or other outpatient visit,
    requiring an expanded problem focused history and
    examination with straightforward medical decision
    making
    C. 99203, new patient offi ce or other outpatient visit,
    requiring detailed history and examination with low
    complexity medical decision making
    D. 99204, new patient offi ce or other outpatient visit, with
    comprehensive history and examination with moderate
    complexity medical decision making
    E. 99205, new patient offi ce or other outpatient visit, with
    comprehensive history, examination and high complexity
    medical decision making
A
  1. Answer: C

Source: Laxmaiah Manchikanti, MD

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164
Q
  1. A 42-year-old male patient presents with localized low
    back pain which started a week ago following strain.
    There was no history of any medical problems. There
    were no radicular symptoms. Patient had only local
    tenderness without alteration of refl exes or sensation,
    etc. What is the appropriate coding for this evaluation
    and management service visit?
    A. 99201, new patient offi ce or other outpatient visit, problem
    focused history and examination with straightforward
    medical decision making
    B. 99202, new patient offi ce or other outpatient visit,
    requiring an expanded problem focused history and
    examination with straightforward medical decision
    making
    C. 99203, new patient offi ce or other outpatient visit,
    requiring detailed history and examination with low
    complexity medical decision making
    D. 99204, new patient offi ce or other outpatient visit, with
    comprehensive history and examination with moderate
    complexity medical decision making
    E. 99205, new patient offi ce or other outpatient visit, with
    comprehensive history, examination and high complexity
    medical decision making
A
  1. Answer: B

Source: Laxmaiah Manchikanti, MD

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165
Q

2080.What are the accurate statements about federal
regulations?
A. They are promulgated by Congress, CMS, and OIG.
B. They are promulgated by the Department of Justice
(DOJ), Federal Bureau of Investigations (FBI) and Offi
ce of Inspector General (OIG).
C. Courts may not promulgate any regulations, as it is the
duty of Congress and Administration.
D. They are enforced by Congress.
E. They are enforced by local Medicare Carriers

A
  1. Answer: A
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166
Q

2081.A compliance offi cer should report credible evidence
of violation of criminal, civil or administrative law to
appropriate federal and state authorities under OIG
Compliance Guidance:
A. Immediately
B. Within 30 days
C. Within 45 days
D. Within 60 days
E. Never

A
  1. Answer: D
    Explanation:
    If a compliance offi cer, compliance committee or other
    management offi cial discovers credible evidence of
    misconduct from any source and, after a reasonable
    inquiry, has reason to believe that the misconduct may
    violate criminal, civil or administrative law, the provider
    promptly should report the existence of misconduct to the
    appropriate federal or state authorities within a reasonable
    period, but not more than 60 days after determining that
    there is credible evidence of violation to appropriate
    federal and state authorities.
    A. OIG states that some violations may be serious that they
    warrant immediate notifi cation to government authorities
    prior to, or simultaneous with, commencing an internal
    investigation. Examples include the following:
    ¨A clear violation of criminal law.
    ¨Has a signifi cant adverse effect on the quality of care
    provided to program benefi ciaries (in addition to any
    other legal obligations regarding quality of care).
    ¨Indicates evidence of a systemic failure to comply with
    applicable laws, rules or program instructions or an
    existing corporate integrity agreement regardless of the
    fi nancial impact on federal health care programs.
    OIG states that all providers, regardless of size, should
    ensure that they are reporting the results of any
    overpayments or violations to the appropriate entity.
    B. Violations need to be reported in 60 days.
    C. Violations need to be reported in 60 days.
    D. Violations need to be reported in 60 days.
    E. Violations need to be reported in 60 days.
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167
Q
  1. A provider should make the same effort to collect the
    amount owed by a non-Medicare patient as s/he does
    from a Medicare patient because
    A. All non-Medicare payers have a stipulation in the Agreement
    that the provider signs that stipulates as stated
    above
    B. The doctor’s name is likely to wind up in a newspaper
    article or “Letter to the Editor” if he doesn’t make equal
    collection efforts for all patients
    C. Medicare wants parity in the treatment of Medicare and
    non-Medicare patients
    D. The AMA published a mandate that collection efforts are
    to be the same for all patients, regardless of insurance
    coverage
A
  1. Answer: C
    Explanation:
    While it is possible that a patient may fi nd out if a doctor
    doesn’t make equal collection efforts and write to the
    newspaper. A primary reason to make equal collection
    effort for all patients is that, according to Herb Kuhn,
    Director Center for Medicare Management Centers for
    Medicare and Medicaid Services, “Medicare wants parity
    to protect the program and all patients, not just our
    benefi ciaries”.
    The above quote is an excerpt from Mr. Kuhn’s testimony
    before the House Energy & Commerce Subcommittee on
    Oversight & Investigations June 24, 2004,
    Source: Joanne Mehmert, CPC
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168
Q

2083.Two of the most frequently and improperly used
modifi ers that providers use to bypass National Correct
Coding (NCCI) code edits are:
A. Modifi er 57 (Decision to do surgery) and modifi er 24
(Unrelated E&M by the same physician during a postoperative
period
B. Modifi er 58 (Staged or related procedure/service by the
same physician during the postoperative period and
modifi er 24
C. Modifi er 25 (Signifi cant, separately identifi able E&M by
the same physician on the same day of the procedure
or other service) and modifi er 59 (Distinct procedural
service such as different anatomic sites or different patient
encounter)
D. Modifi er 76 (Repeat procedure by the same physician)
and modifi er 25

A
  1. Answer: C
    Explanation:
    A recently released Offi ce of the Inspector General (OIG)
    inspection report found that 40 percent of code pairsbilled
    with modifi er 59 in fi scal year 2003 did not meet program
    requirements, resulting in an estimated $59 million in
    improper payments.
    The report also said that 35 percent of claims for E/M
    services allowed by Medicare in 2002 did not meet
    program requirements, resulting in $538 million in
    improper payments. Modifi er 25 was also used
    unnecessarily on a large number of claims, and while such
    use may not lead to improper payments, it fails to meet
    program requirements.
    Source: News Release issued by the Inspector General
    December 12, 2005
    Source: Joanne Mehmert, CPC
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169
Q
  1. Dr. Smith has a contractual agreement with United
    Health Care (UHC) and wants to perform an occipital
    nerve block (ONB) for a patient who suffers from cluster
    headaches. After he performed an ONB for a UHC
    patient 3 months ago, he discovered that UHC considers
    ONB’s investigational and does not cover the service. The patient is willing to pay for the injection.
    A. Dr. Smith can have the patient sign an ABN form and
    substitute UHC for the word ‘Medicare” in the form
    B. Collect cash from the patient without a written notice
    since the patient said she was willing to pay for the
    service
    C. He knows that his contract requires that he provide
    his patient with a written notice before he provides a
    non-covered service.He has a form for UHC patients
    explaining that it doesn’t cover occipital nerve block
    and asks his patient to pay for procedure
    D. Dr. Smith cannot collect from the patient since he is a
    contracted provider. He can perform the ONB for free
    or send the patient to someone else
A
  1. Answer: C
    Explanation:
    ABN’s are designed for use with Medicare benefi ciaries
    only, including those who are dually-eligible Medicare and
    Medicaid. ABN’s are not for use with patients who are not
    Medicare benefi ciaries. A provider should be familiar
    with the terms of his/her contractual agreements relative to charging a patient for a non-covered service. Just as a
    patient is “allowed” to pay and receive a cosmetic
    procedure, they should also be able to pay for and receive a
    non-covered therapeutic procedure. Usually this
    provision is in the provider’s contractual agreement.
    Source: Medicare Transmittal AB-02-114, July 31, 2002
    Source: Joanne Mehmert, CPC
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170
Q
  1. What item(s) listed below does Medicare consider
    “incident to” a physician’s service and may be reported
    and paid separately when services are provided in an
    offi ce setting, POS 11?
    A. Needles and syringes used to perform an injection/nerve
    block
    B. A substance such as Depo Medrol that is injected when a
    lumbar epidural steroid injection is performed
    C. Lidocaine that is used to anesthetize the area
    D. Pulse oximetry
A
  1. Answer: B
    Explanation:
    Needles, syringes, and local anesthetic (lidocaine), are
    supplies that are bundled into the majority of the surgical
    procedure codes. Supplies are considered to be included in
    the payment for the procedure, i.e., the “global surgical
    fee”.
    Pulse oximetry is pre, intra, and post operative care that is
    bundled into the procedure, i.e., paid in the global fee.
    A drug or substance (Depo Medrol) that a patient cannot
    self administer is separately paid and is considered
    “incident to” the physician’s service.
    Source: Medicare Carrier Manual, 100-4, Chapter 12
    Source: Joanne Mehmert, CPC
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171
Q
  1. Working in his offi ce, Dr. Ledger is going to inject 2500
    units of Myobloc (J0587, per 100 units) in a patient’s
    cervical spinal muscles. He used needle EMG guidance
    to obtain the precise muscle and injection location (CPT
    95874). The procedure included injections into the right
    sternocleidomastoid, splenius capitis, posterior scalene,
    and oblique capitis inferioris muscle. An injection was
    also made in the left semispinalis capitis. In addition to
    CPT code 64613 for the injection procedure, what codes
    should Dr. submit?
    A. 95874 x 5, J0587 x 1
    B. 95874 x 1, J0587 x 25
    C. 95874 x 1, J0587 x 1
    D. 95874-50, J0587 x 2500
A
  1. Answer: B
    Explanation:
    Needle EMG localization is reported one time per session
    according to CPT coding conventions. Likewise the
    injection code 64613 is reported one time per session
    regardless of the number of injections or number of
    muscles injected. J0587 is listed per 100 mg, to determine
    the number of units to report, divide the amount injected
    by the listed dosage: 2500/100 = 25
    Source: Joanne Mehmert, CPC
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172
Q
2089. Steps that a practice can take to minimize theft and fraud
include:
A. Internal audits
B. External audits
C. Segregation of duties
D. Competitive bidding for purchases
E. All of the above
A
  1. Answer: E
    Explanation:
    It is essential to have controls and then audit to make sure
    that the controls are working. Segregation of duties allows
    a “check and balance”to be implemented to minimize
    theft and fraud. Competitive bidding will eliminate the
    opportunity for “kick back”and allow the best price to be
    obtained.
    Source: Trent Roark,MBA
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173
Q
2090. Ways to build revenue include:
A. Recall and no show contact
B. Mine charts, screenings, seminars
C. Pay for referrals
D. A and B only
E. A, B and C only
A
  1. Answer: D
    Explanation:
    recall and no show patients need to be contacted to
    reschedule the appointment. Going through charts to
    contact patients who have not returned for some time is
    another opportunity. Screenings and seminars allow for
    the introduction of the practice to the community. Having
    these programs in your practice allows the participant to
    fi nd your location and be impressed by your practice
    environment. Paying for referrals is illegal and carries
    civil and criminal penalties.
    Source: Trent Roark,MBA
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174
Q
  1. Three keys of success have been identifi ed.These are:
    A. Staffi ng, fi nancial and profi tability
    B. Staffi ng, measuring and patient satisfaction
    C. Physician, fi nancial and practice growth
    D. Number of procedures, profi tability and staffi ng
    E. Marketing, physician and profi tability
A
  1. Answer: B
    Explanation:
    Having the right trained staff and number of staff,
    including physicians will help you meet the patient
    demand. Measuring the effi ciency, growth, and fi nancial
    results is essential to determining if changes need to be
    made. Patient satisfaction is essential to grow a practice.
    Word of mouth is the number one referral source of
    patients.
    Source: Trent Roark,MBA
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175
Q
  1. Modern organization structure requires input and
    output between:
    A. CEO/Administrator, physicians, patients, clinic and
    fi nance
    B. CEO/Administrator, Board, and physicians.
    C. Physicians to the CEO/Administrator.
    D. Physician to CEO/Administrator, clinic and fi nance.
    E. Finance to the Physician and CEO/Administrator.
A
  1. Answer: A
    Explanation:
    Open communication to and from all areas of the practice
    allow for more accurate information, shared responsibility
    and better decision making. One group pushing their own
    agenda down to another group will result in resentment,
    less motivation, less openness, and worse decision making.
    Source: Trent Roark,MBA
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176
Q
  1. An offi ce billing employee reports to the physician that
    a template has been developed for each of the separate
    providers to expedite billing processing and reporting.
    The template is compliant, and ensures a Level 3 new,
    consultative, and return patient, as determined by the
    American Medical Association 1997 CPT guidelines. The
    content will be placed in the electronic medical record
    and accessed by keystroke. The physician’s response is
    to:
    A. Accept the template as an important time conserving
    element in the practice.
    B. Consider the templates as an important component of
    effi ciency and compliance.
    C. Review the template to determine a true Level 3 reporting,
    CPT guidelines.
    D. Discard the template.
    E. Ask the other members of the tier team to provide input
    and favored dialogue to the template.
A
  1. Answer: D
    Explanation:
    It is incumbent upon the physician’s practice to be
    compliant. A troubling feature of the electronic medical
    record is the ease of standard templates to emerge as a one
    and only approach to billing and coding. Just as the billing
    sheet contains all levels of code, and not pre-selected 2, 3,
    or 4, for example, a template created by a non-physician,
    applicable to all patients, and all providers, has no validity
    in a true compliance plan. A physician is only allowed to
    bill for elements that they are personally involved in, and a
    template does not always refl ect true work performed.
    Unfortunate up-coding or down-coding may occurplacing
    the practice at risk.
    Source: Hans C. Hansen, MD
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177
Q
  1. The correct defi nition of CPT-4 is:
    A. Inpatient and outpatient diagnosis classifi cation system
    and an inpatient procedure classifi cation system
    B. Systematic listing of procedures and services performed
    by physicians
    C. Uniform method for healthcare providers and medical
    suppliers to code professional services and procedures
    D. Inpatient coding system for tracking time and supplies
    consumed per procedure
    E. Classifi cation system developed by CMS for providers to
    code services and procedures for billing purposes
A
2094. Answer: B
Explanation:
A.Incorrect. Description of ICD-9
B.Correct.
C.Incorrect. Description of HCPCS
D.Incorrect
E.Incorrect. CPT-4 was not developed by CMS.
Source: Marsha Thiel, RN, MA
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178
Q
  1. You just went to a seminar that extolled the virtues of
    having an employee handbook to minimize the risk of
    employment suits and claims. If you want to minimize
    your liability, which of the following is the best way to
    proceed?
    A. Delegate the task of drafting and implementing a handbook
    to your offi ce staff, and appoint your offi ce manager
    as chairman of the committee
    B. Instruct your offi ce manager to download a handbook
    from an internet site and distribute it to the staff
    C. Your divorce attorney owes you money so just ask him to
    draft something for you
    D. Disregard the advice you heard in the seminar handbooks
    can cause more problems than they solve, and
    implementing one will cause morale problems– the less said, the better
    E. None of the above
A
  1. Answer: E
    Explanation:
    Handbooks are a very valuable part of a well-run offi ce,
    and can help you minimize liability and maximize
    employee morale. But having a poorly drafted handbook is
    worse than not having one at all. Don’t download a
    generic handbook from the internet it may not comply
    with applicable laws. Use an experienced employment
    lawyer to draft a handbook appropriate to your offi ce, your
    practice, and your state laws
    Source: Judith Holmes
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179
Q
  1. A local clinical laboratory provides a phlebotomist
    free of charge to a doctor’s offi ce. The phlebotomist
    takes specimens from the physician’s offi ce to the lab.
    When the phlebotomist is not busy drawing blood, the
    phlebotomist assists the doctor/s offi ce personnel with
    fi ling of records and other clerical duties. What aspects of
    this scenario, if any, implicate the anti-kickback laws?
    A. Provision by the clinical lab of a phlebotomist free of
    charge to the physician.
    B. Performance by the phlebotomist of clerical duties in the
    physician’s offi ce.
    C. Phlebotomist taking specimens from physician’s offi ce
    to the lab
    D. All of the above.
    E. None
A
  1. Answer: B
    Explanation
    Don’t accept anything from a clinical lab that you didn’t
    pay fair market value for.
    OIG indicated it was aware of a number of deals between
    clinical labs and providers that could implicate the antikickback
    statute. When a lab offers or gives a referral
    source anything of value without receiving fair market
    value it can be viewed as an inducement to refer. It’s also
    true when a potential referral source receives anything of
    value from the lab.
    When permitted by state law, a lab can make available to a
    physician’s offi ce a phlebotomist who collects specimens
    from patients for testing by the outside lab. Although the
    simple placement of a lab employee in the physician’s
    offi ce isn’t by itself necessarily an inducement forbidden
    by the Anti Kickback Statute, the statute does come into
    play whenthe phlebotomist performs additional tasks that
    are normally the responsibility of the physician’s offi ce
    staff. These tasks can include taking vital signs or other
    nursing functions, testing for the physician’s offi ce lab, or
    performing clerical services.
    When the phlebotomist performs clerical or medical
    functions that aren’t directly related to the collection or
    processing of lab specimens,OIG makes the deduction that
    the phlebotomist is providing a benefi t in return for the
    physician’s referrals to the lab. In this case, the physician,
    the phlebotomist and the lab may have exposure under the
    Anti-kickback Statute. This analysis also applies to the
    placement of phlebotomists in other health care settings,
    including nursing homes, clinics and hospitals.
    OIG also points out that the mere existence of a contract
    between a lab and a health care provider that prohibits the
    phlebotomist from performing services unrelated to
    specimen collection does not eliminate the concern over
    possible abuse, particularly if it’s a situation where the
    phlebotomist is not closely monitored by his or her
    employer or where the contractual prohibition is not
    rigorously enforced.
    Source: Laxmaiah Manchikanti, MD
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180
Q
  1. A hospital wishes to lease space in its building to a group
    of Interventionalists. Choose the correct statement.
    A. The hospital may charge the physicians less than the
    property’s general market value if they agree not to
    refer patients elsewhere.
    B. Hospital may provide bonus of $100 for each interventional
    procedure.
    C. Hospital may share 50% of gross revenues from physical
    therapy services, with physicians
    D. Hospital may provide administrative and nursing services
    at no cost to physicians, and physicians get reimbursed
    for these services.
    E. Hospital wants to lease the space for the value paid in
    their market for like property.
A

.2097. Answer: E
Explanation:
According to the fi nal stark II regulations, fair market
value is the price that an asset would bring by bona fi de
bargaining between well-informed buyers and sellers who
are not in a position to generate business for the other
party in an arms-length transaction, consistent with the
price the asset would bring on the general market. Fair
market price is the price paid in a particular market for
assets of like type, quality and quantity at the time of the
acquisition For rentals and leases, fair market value is the value of
rental property without taking into account the property’s
intended use. This means the space’s general market value,
unadjusted for the additional value of the space’s
convenience or proximity to the renter if the landlord is a
potential source of referrals to the renter

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181
Q
2098. A patient can appoint all of the following as their
surrogate decision-maker EXCEPT:
A. Spouse
B. Friend
C. Their physician
D. Non-traditional signifi cant other
E. Relative
A
  1. Answer: C

Source: Weinberg M, Board Review 2004

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182
Q

2099.Developing Quality Assurance and clinical practice
affects outcome driven mechanisms by which of the
following :
A. Reassuring patients of high level of expectation.
B. Considering outcome management an institutional issue
and outside of the reasonable accountability of a private
clinical practice.
C. Excluding the patient from medical decision-making
relying on objective interpretation of the physician.
D. Developing questionnaires, mechanisms to address complaints,
and adhering to necessary compliance plan for
best treatment management.
E. Holding staff meetings to improve collections

A
  1. Answer: D

Source: Hans C. Hansen, MD

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183
Q
  1. An anesthesiologist performs a caudal epidural and
    two lumbar interlaminar epidural steroid injections at
    different levels in a patient with chronic non-specifi c low
    back pain. The accurate coding for these procedures is
    A. CPT 62311 – lumbar /caudal epidural steroid injection
    B. CPT 62310 – cervical/thoracic epidural steroid injection
    C. CPT 62311 x 3 – lumbar/caudal epidural steroid injections
    D. CPT 62311 and 62311 x 2 – lumbar or caudal epidural
    steroid injections
    E. CPT 62311 and 64483 & 64484 – caudal or lumbar
    epidural and lumbar transforaminal epidural steroid
    injections
A
  1. Answer: A
    Explanation:
    Administration of multiple epidural injections during the
    same session is not only unusual but also is considered as
    abuse. As a general rule, a physician is not reimbursed for
    more than one epidural steroid injection for the region
    (i.e., lumbar/sacral).
    Source: Laxmaiah Manchikanti, MD
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184
Q
  1. A surgery center is surveyed for accreditation by:
    A. Joint Commission on Accreditation of Healthcare Organizations
    (JCAHO).
    B. American Cancer Society
    C. Commission on Accreditation of Rehabilitation Facilities
    (CARF)
    D. Offi ce of Inspector General (OIG)
    E. American Hospital Association
A
  1. Answer: A

Source: Laxmaiah Manchikanti, MD

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185
Q
  1. A direction to “Code fi rst underlying disease” should be
    considered
    A. Mandatory dependent upon the code selection
    B. A mandatory instruction
    C. Only when coding inpatient records
    D. A suggestion only
    E. Applies only for worker’s compensation patients
A
  1. Answer: B
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186
Q
  1. A patient had lumbar disc decompression with 90-
    day global period and presents one month later for an
    unrelated Evaluation and Management (E/M) service.
    Indicate the modifi er that should be attached to the E/M
    code for the service provided.
    A. -24 unrelated evaluation and management service by the
    same physician during a postoperative period
    B. -79 unrelated procedure or service by the same physician
    during the postoperative period
    C. -59 distinct procedural service
    D. -25 signifi cant, separately identifi able evaluation and
    management service by the same physician on the same
    day of the procedure or other service
    E. -58 staged or related procedure or service by the same
    physician during the postoperative period
A
  1. Answer: A
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187
Q

2104.In evaluating quality and compliance with coding,
the degree to which the same results (same codes) are
obtained by different coders or on multiple attempts by
the same coder generally refers to:
A. Validity
B. Completeness
C. Timeliness
D. Reliability
E. Accuracy

A
  1. Answer: D
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188
Q

2105.The Correct Coding Initiative (CCI) edits contain a
listing of codes under two columns titled “comprehensive
codes” and “component codes.” According to the CCI
edits, a provider must bill Medicare for a procedure with
the following:
A. Only the component code
B. Only the comprehensive code
C. Both the comprehensive code and the component code
D. Comprehensive code and component code with modifi
er -59
E. Comprehensive code and component code with modifi er
-51

A
  1. Answer: B

Source: Laxmaiah Manchikanti, MD

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189
Q
2106. Tachycardia after taking a correct dosage of prescribed
oxycodone would be reported as (an):
A. Drug interaction
B. Adverse reaction to a drug
C. Poisoning
D. Late effect of an adverse reaction
E. Late effect of a poisoning
A
  1. Answer: B
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190
Q
2107. Dizziness and blurred vision following ingestion of
prescribed hydrocodone and three glasses of wine at
dinner would be reported as a:
A. Poisoning
B. Adverse reaction to a drug
C. Late effect of a poisoning
D. Late effect of an adverse reaction
E. Drug interaction
A
  1. Answer: A
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191
Q
2108. Practice patterns and medical protocol should be the
responsibility of:
A. The CEO/Administrator.
B. Committee of employees.
C. The Medical Director.
D. The clinical staff.
E. Each physician.
A
  1. Answer: C
    Explanation:
    the Medical Director. It is important to have a peer who
    can address productivity issues and protocols with the
    medical staff. Anyone else does not have a medical license.
    All medical issues should be addressed by the Medical
    Director once input is received from the medical staff,
    clinical staff (if appropriate) and administration.
    Source: Trent Roark,MBA
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192
Q
  1. Your clinic is placing an advertisement for a new
    receptionist. You want to make sure the offi ce projects
    a professional, cool-with-it-now image so you place
    an ad that states: Help Wanted: Female, age 25-35, for
    receptionist position. Must have front offi ce appearance,
    and must speak English without accent. Great job
    security. Send photo with resume. Which of the following
    is true?
    A. An unsuccessful applicant may fi le an EEOC charge
    against the clinic for discrimination based on age
    B. An unsuccessful applicant may fi le an EEOC charge
    against the clinic for discrimination based on race or
    national origin
    C. An unsuccessful applicant may fi le an EEOC charge
    based on disability discrimination
    D. A successful applicant who is later terminated may have
    a breach of implied contract
    E. All of the above
A
  1. Answer: E
    Explanation:
    The ad discriminates on the basis of age and the
    requirement to speak without accent discriminates against
    race and national origin. The words front offi ce
    appearance have been held to discriminate against those
    with visible disabilities. The ad also promises job
    security, allowing a terminated employee to have a claim
    against the clinic for breach of implied contract of
    continued employment. Employers are at a decided disadvantage
    Source: Judith Holmes
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193
Q
  1. Which of the following is not something a physician
    practice’s policies and procedures concerning OIG
    compliance needs to address?
    A. Medical directorships
    B. Offi ce and equipment leases
    C. Gift-giving
    D. Publishing
    E. Financial arrangements with outside entities to whom
    the practice may refer federal health care program business
A
2110. Answer: D
Explanation:
Explanation: Publishing is not an issue addressed in the
OIG compliance materials.
Source: 65 Fed. Reg. at 59,440-41.
Source: Erin Brisbay McMahon, JD
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194
Q
  1. It is recommended that the Sharps container be emptied
    when it is:
    A. Full
    B. 3/4 full
    C. Half full
    D. Monthly
    E. When you are no longer able to close the lid
A
  1. Answer: B

Source: Hans C. Hansen, MD

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195
Q
2112. The Quick Ratio is a measurement of:
A. Current Assets to Current Liabilities
B. Current Liabilities to Current Assets
C. Profi tability
D. Assets
E. Owners Equity
A
  1. Answer: A
    Explanation:
    ratio of Current Assets to Current Liabilities. This ratio
    will tell you if you have enough current assets to cover
    your current liabilities. Current means that the asset or
    liability can be sold or paid within a year.
    Source: Trent Roark,MBA
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196
Q
2113. Data to evaluate for each doctor monthly includes:
A. new patients and no charge patients
B. established patients
C. procedures
D. A and C only
E. A, B and C
A
  1. Answer: E
    Explanation:
    tracking the physician productivity is essential to compare
    the productivity of one physician to another. Once done, a
    decision needs to be made as to whether a physician is
    under-producing compared to the other physicians so that
    correction can be made.If a physician has a high rate of
    no-charge patients, the physician is not covering their
    overhead. Again, correction can then be taken.
    Source: Trent Roark,MBA
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197
Q
2114. Medicare can pay a “clean” claim no sooner than:
A. 10 days of receipt
B. 5 days of receipt
C. 30 days of receipt
D. 15 days of receipt
E. 2 days of receipt
A
  1. Answer: A
    Explanation:
    under law, Medicare cannot pay a “clean” claim within 10
    days of receipt. This means that it is essential to fi le the
    claim as soon as possible to start the pay clock running. If
    it takes a practice 2 days to fi le a claim, that meanspayment
    will not be received, at best, until 12 days after service. The
    goal should be to fi le the claim the next morning to
    improve cash fl ow.
    Source: Trent Roark,MBA
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198
Q
2115. Aged Accounts Receivable report should be run monthly.
The goal is to have 90 days and less balance be greater
than:
A. 90%
B. 60%
C. 80%
D. 95%
E. 50%
A
  1. Answer: C
    Explanation:
    management of the accounts receivable is essential to
    maintain good cash fl ow. In keeping the total balance of
    accounts greater than 80% means that the accounts are
    being managed and properly worked. Any lower
    percentage would indicate that the accounts receivable are
    not being managed.
    Source: Trent Roark,MBA
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199
Q
  1. The OIG does not have to exclude an individual from
    participation in federal healthcare programs in cases
    where:
    A. The individual is convicted of a criminal offense related
    to the delivery of an item or service under Medicare or
    Medicaid.
    B. The individual is convicted of a criminal offense related
    to the neglect or abuse of a patient in connection with
    the delivery of a health care item or service.
    C. The individual is convicted of any misdemeanor under
    federal or state law relating to the unlawful manufacture,
    distribution, prescription, or dispensing of a controlled
    substance.
    D. The individual is convicted of any felony relating to
    fraud, theft, embezzlement, breach of fi duciary responsibility,
    or other fi nancial misconduct under federal or
    state law relating to health care fraud.
    E. The individual is convicted of any felony under federal
    or state law relating to the unlawful manufacture, distribution,
    prescription, or dispensing of a controlled
    substance.
A
  1. Answer: C
    Explanation:
    The OIG’s mandatory exclusionary authority does not
    extend to misdemeanors relating to controlled substances
    crimes.
    Source: 42 U.S.C. § 1320a-7(a).
    Source: Erin Brisbay McMahon, JD
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200
Q

2117.OIG must exclude providers from Medicare and
Medicaid participation if they have been convicted of
certain criminal offenses. Which of the following is not
considered a conviction for the purposes of deciding
whether to exclude a provider from participation in
Medicare and Medicaid?
A. judgments entered by a court.
B. pleas of guilty accepted by a court.
C. pleas of nolo contendre or no contest accepted by a
court.
D. participation in a fi rst offender program where judgment
has been withheld pending completion of the
program.
E. a hung jury.

A
  1. Answer: E
    Explanation:
    A hung jury does not result in a conviction under the
    exclusionary statute; all of the other answers listed above
    are considered a conviction under that statute.
    Source:42 U.S.C. § 1320a-7(i).
    Source: Erin Brisbay McMahon, JD
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201
Q
  1. Under Stark Law, what is acceptable from medical
    representatives?
    A. Golf balls and sports bag
    B. Free meal of more than modest value and is not accompanied
    by exchange of information
    C. Free stethoscope
    D. Lunch for staff not connected to an information presentation
    E. Gift certifi cate from a bookstore
A
  1. Answer: C
    Explanation:
    WHAT’S ACCEPTABLE
    - Free stethoscope
    - Free meal, if it is “modest by local standards,” and
    accompanied by educational or scientifi c exchange
    - Lunch for staff, if provided during an information
    presentation
    - Free medical books, provided the cost is not substantial
    - Modest buffet meal accompanying scientifi c or
    educational meeting
    WHAT’S NOT
    - Golf balls and sports bag
    - Free meal, if it’s of more than modest value and is not
    accompanied by exchange of information
    - Lunch for staff, if not connected to an information
    presentation
    - Gift certifi cate from a bookstore
    - Scientifi c or educational meeting held before an athletic
    event or entertainment performance
    - Reimbursement for gasoline expenses
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202
Q
  1. What is Medicare’s defi nition of reasonable and
    necessary medical services?
    A. Services necessary to improve the health of a patient
    B. Services for the diagnosis or treatment of an illness or
    injury or to improve the functioning of a malformed
    body member
    C. Services for the diagnosis or treatment of an illness or
    injury.
    D. Services to improve the functioning of a malformed
    body member
    E. Services for the treatment of a patient or to improve the
    functioning of a malformed body member
A
  1. Answer: B
    Explanation:
    Source:42 USC § 1395y(a)(1)(A).
    Source: Erin Brisbay McMahon, JD
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203
Q
  1. Which of the following is not a required administrative
    safeguard under the HIPAA Security Rule?
    A. The appointment of a security offi cer.
    B. A risk analysis.
    C. The development of policies and procedures
    D. Password management
    E. Data backup plan
A
  1. Answer: D
    Explanation:
    Password management is an addressable administrative
    safeguard under 45 CFR 164.308; all of the rest of these are
    required administrative safeguards under that rule.
    Source: 45 CFR 164.308
    Source: Erin Brisbay McMahon, JD
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204
Q

2121.Which one of the following is not an electronic
transaction governed by the HIPAA Transactions and
Codes Sets Rule?
A. sending a patient’s electronic health record
B. health care claims
C. checking on a patient’s eligibility for health plan
D. coordination of benefi ts
E. requesting a preauthorization

A
  1. Answer: A
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205
Q
  1. Do all of the National Correct Coding Initiative (CCI)
    bundling edits correspond with CPT coding conventions
    and the instructions in the CPT Manual?
    A. Yes, Administar Federal, the contractor that develops the edits coordinates with the CPT Editorial staff before
    quarterly updates are published
    B. There is not always an NCCI edit t that corresponds
    precisely to CPT coding conventions and instructions;
    however AMA/CPT coding conventions do have a prevailing
    infl uence on coding edits
    C. No, CMS local carrier decisions are the only policies that
    Administar Federal considers when revising the edits
    D. Administar Federal relies solely on specialty society
    manuals and communication from physicians to update
    the edits
A
  1. Answer: B
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206
Q
  1. One of your nurse practitioners just told you that the
    new physician you hired last month is already known
    as the offi ce super-fl irt and that he has declared he will
    conquer every nurse in the offi ce by year’s end. The most
    appropriate course of action you can take is:
    A. Don’t get involved. It’s not any of your business and it
    would be an invasion of your staff ’s privacy to inquire
    further
    B. You have an obligation to go to your nurse practitioner
    and warn her not to spread rumors, and to refrain from
    discussing issues relating to co-workers
    C. You should institute an internal investigation to determine
    whether or not the allegations have merit
    D. You should talk privately to your new physician and
    remind him of your offi ce policies prohibiting inappropriate
    conduct in the offi ce. You should then make
    sure he has signed your anti-harassment policy, and you
    should then keep a very close eye on him
    E. Fire him he’s bad news and you are just buying trouble
    keeping him around
A
  1. Answer: D
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207
Q
  1. True statement applicable to a patient request for a copy
    of his or her record :
    A. The physician is not required to give the patient any
    records that were not created or generated by the practice.
    B. The provider is required to give a copy of all the records.
    C. Designated records set includes only the medical records
    generated by the provider
    D. Medical records may be released only after patient has
    paid his bill in full.
    E. Patient’s access is limited to only certain areas of medical
    record
A
  1. Answer: B
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208
Q
  1. A nurse practitioner employed by your clinic has fi led a
    harassment claim against your clinic, claiming a hostile
    work environment has been created because the male
    physicians and staff members regularly tell off color
    jokes. Which of the following are viable defenses:
    A. The jokes did not affect the work environment and were
    not offensive to a reasonable person
    B. The jokes were not offensive to the nurse practitioner
    because she laughed too and she told similar jokes
    C. The conduct was not harassment because no one else
    minded
    D. All of the above may be raised as defenses but they may
    not work
    E. None of the above2125. A nurse practitioner employed by your clinic has fi led a
    harassment claim against your clinic, claiming a hostile
    work environment has been created because the male
    physicians and staff members regularly tell off color
    jokes. Which of the following are viable defenses:
    A. The jokes did not affect the work environment and were
    not offensive to a reasonable person
    B. The jokes were not offensive to the nurse practitioner
    because she laughed too and she told similar jokes
    C. The conduct was not harassment because no one else
    minded
    D. All of the above may be raised as defenses but they may
    not work
    E. None of the above
A
  1. Answer: D

Explanation:

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209
Q
  1. You are the sole owner of your medical clinic. Your
    transcriptionst has fi led a sexual harassment claim against
    your clinic, claiming a hostile work environment because
    one of your male employees made a lewd comment as he
    touched her inappropriately when she was in the break
    room. The incident occurred fi ve months before she fi le
    her claim with the EEOC, but she made no mention of it
    to anyone at your clinic prior to her claim. Which of the
    following is true?
    A. Your clinic has a defense because you have adopted a
    comprehensive policy prohibiting harassment and all
    of your employees have signed the policy agreeing to
    abide by it. You have also provided comprehensive offi
    ce training on discrimination and harassment
    B. Your clinic has a defense because you have a policy requiring
    employees to act in compliance with the clinic’s
    written complaint procedure and the transcriptionist
    failed to make a complaint in accordance with that offi
    ce policy
    C. Your clinic has a defense because the incident was an
    isolated incident and was not severe or pervasive
    D. All of the above
    E. None of the above. Your clinic is strictly liable for all
    harassment occurring at your clinic
A
  1. Answer: D
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210
Q
  1. You are the sole owner of your medical clinic. One
    of your employees is Dr. West, a female physician. For
    several months, she dated your offi ce manager, a male,
    one of the employees she supervised. Immediately after
    the offi ce manager broke off the relationship, Dr. West
    demoted him to receptionist and cut his pay in half. She
    is also threatening to fi re him if he does not resume the
    relationship with her. Your offi ce manager has fi led sexual
    harassment and retaliation claims against your clinic
    because of Dr. West’s conduct. Which of the following
    is true?
    A. Your clinic is safe a male cannot fi le harassment and retaliation
    claims against a femaleand that her wheelchair
    may be a downer for some patients
    B. Your clinic is safe the offi ce manager cannot fi le a claim
    if the relationship had been voluntary and he is not a
    minor
    C. Your clinic is safe you were not aware that they had been
    dating and you were not aware that Dr. West reduced
    his pay and position
    D. Your clinic is safe you have a policy against harassment
    and retaliation and Dr. West signed an agreement to be
    bound by that agreement.
    E. Your clinic is in trouble
A
  1. Answer: E
    Explanation:
    This is a classic example of economic harassment. Dr
    West is the offi ce manager’s supervisor. She reduced the
    offi ce manager’s pay and demoted him as a result of his
    refusal to continue a personal relationship. It only takes
    one incident to create liability and it the clinic is strictly
    liable even if there is a policy in place and even if the clinic
    owner does not know it has occurred. It does not matter
    that the supervisor is a female
    Source: Judith Holmes
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211
Q
  1. Your file clerk, a hispanic woman in her 50’s has been
    with you for a year, but during that year she has been a terrible employee. There have been several significant problems that have been caused by her misfiling of records, she is chronically late, and several patients have
    complained about her abrupt manner of speaking to
    them. You have never warned her about her behavior,
    and you have never noted any performance defects in her
    employment fi le. Your new offi ce manager has decided
    he wants to get rid of her. He devises a plan to make
    her employment life unbearable by ignoring her, giving
    her weekend assignments, and giving her the dreaded
    telephone duty. After several weeks of this treatment,
    your nurse quits. Which of the following statements are
    correct:
    A. Your offi ce manager’s plan worked like a charm so you
    give him a raise and vow to use the technique in the
    future
    B. You breathe a sigh of relief because you know the clerk
    can’t sue you because she quit and was not fi red
    C. The clerk can sue for constructive discharge based on
    race and/or age if she can establish that the employer
    made conditions so intolerable that any reasonable person
    would have been forced to quit
    D. The clerk can sue for constructive discharge based on
    race or age only if she can demonstrate that her replacement
    was less qualifi ed to perform the job duties.
    E. You are immune from suit because she was a bad employee
A
  1. Answer: C
    Explanation:
    Assuming she can establish the elements of a racial and/or
    age discrimination claim, the clerk could also allege
    constructive discharge based upon the facts presented. A
    constructive discharge claim exists:
    a)when an employer makes conditions so intolerable that
    it would force a reasonable employee to resign her
    employment and
    b)the employer either created the conditions or knew
    about them and permitted them to continue.
    Important note: You would have a better defense to a
    potential lawsuit if you could produce documentation of
    not only her performance defi ciencies, but also your
    repeated warnings to her that she must improve.
    Testimony of poor performance withoutcontemporaneous
    documentation is often not effective.
    Americans with Disabilities Act (ADA)
    Overall learning points:
    Although the ADA is a federal Act that applies only to
    employers with 50 or more employees, physicians
    practicing in groups of all sizes must know the general
    ADA requirements for two reasons. First, most states have
    laws very similar to the ADA and apply to employers with
    far fewer employees. Second, the actions of physicians in a
    clinic or hospital setting may subject that facility to
    liability based on the physician’s conduct - DEFINITELY a
    CLM (Career Limiting Move).
    Source: Judith Holmes
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212
Q

2129.Which of the following are guidelines for good
evaluations?
A. Be familiar with company policies and procedures.
B. Avoid generalities, ambiguities, and sarcasm.
C. Make the time necessary to compose the evaluation.
Avoid poor English and typographical errors.
D. Ensure that there are no surprises, by providing the
employee with effective feedback during the entire
evaluation period
E. All of the above

A
  1. Answer: E
    Explanation:
    All of those elements convey to the employee the
    importance you place on the evaluation process and on the
    information and direction you are imparting.
    Source: Judith Holmes
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213
Q
  1. Which of the following are components of an effective
    performance evaluation narrative?
    A. Include your own subjective feelings regarding the employee’s
    performance. It is only fair that he/she receive
    some insight into the effects that his/her performance
    has had on you.
    B. Be willing to consider and memorialize mitigating circumstances
    that excuse defi ciencies in the employee’s
    performance, and provide suggestions for improvement
    C. Include all information available from any source that
    is in any way related to the employee’s performance.
    You have no way of knowing what information will be
    pertinent later in the defense of a grievance, claim or
    lawsuit
    D. All of the above
    E. None of the above
A
  1. Answer: E
    Explanation:
    In fact, the possible answers given are exactly how NOT to
    write a performance evaluation. You should document
    facts, not conclusions. Avoid judgments. You should be
    able to establish a written pattern of performance. Avoid argumentative statements, excuses, and directions that fail
    to direct.
    Source: Judith Holmes
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214
Q
  1. Which of the following promotes effective evaluation
    meetings?
    A. Have an agenda, encourage feedback, and listen.
    B. Include a third-party witness in your meeting.
    C. Be hospitable: offer coffee and doughnuts before the
    meeting to break the ice.
    D. A and B.
    E. All of the above.
A
  1. Answer: A
    Explanation:
    There is generally no need for a witness in an evaluation
    meeting unless you anticipate the employee to become
    confrontational. In general, the manager should have been
    providing feedback during the entire evaluation period
    andso the employee should have no surprises during the
    evaluation meeting. (Coffee and doughnuts are a nice
    touch but optional).
    Source: Judith Holmes
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215
Q
  1. What is the most important element of an employee evaluation?
    A. A statement from the employee expressing his or her
    opinions
    B. A description of available resources at the disposal of
    the employee in attempting to meet the performance
    requirements
    C. A narrative summary of the employee’s work history,
    clearly setting forth past performance defi ciencies
    D. A clear and unambiguous description of the disciplinary
    or corrective action to be taken if performance requirements
    are not met within the mandated time period
    E. Specifi cation of exact tasks to be performed and reasonable
    time frames, in clear, unambiguous language
A
  1. Answer: E
    Explanation:
    Use clear unambiguous language so that you and the
    employee have objective standards by which to measure
    successful performance
    Source: Judith Holmes
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216
Q
  1. Which of the following statements is true?
    A. As of 2004, nearly every employer in the United States
    has mandatory employment law training obligations
    B. Failure to provide adequate employment law training on
    harassment, discrimination and safety issues exposes
    the employer to signifi cant risk of lawsuits, as well as
    government charges and penalties
    C. Training pays for itself
    D. It is important to have a written record of what was covered
    in the training sessions, and who attended
    E. All of the above.
A
  1. Answer: E
    Explanation:
    Physician employers are required to comply with many
    state and federal safety and employment-related laws.
    Effective compliance requires adequate staff training.
    Failure to do so, in the words of one court, is an
    extraordinary mistake. In fact, the U.S. Supreme Court has
    recently held that failure to conduct staff training on
    harassment and discrimination may expose the employer
    to punitive damages in addition to compensatory
    damages. Because training is so important, it is also
    important to be able to produce evidence that your
    training programs are adequate and that your staff
    members have actually attended the training sessions
    Source: Judith Holmes
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217
Q

2134…

A

.

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218
Q

2135…

A

.

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219
Q

2136…

A

.

220
Q
  1. As a physician operating an offi ce practice, you should
    avoid basing decisions on personal romantic relationships
    outside the offi ce setting, as such allegation would give
    rise to a claim of invasion of policy. However, you have an
    obligation to assure that the offi ce is free from harassment
    by co-workers, including your new physician. If you
    believe the physician may be responsible for creating
    an adverse effect on the offi ce atmosphere, you should
    investigate, and, as with every thing related to medicine,
    document, document, document, you investigation.
    A. Immediately reporting violations to the Department of
    Health and Human Services
    B. Training employees regarding the rules and the practices’
    policies and procedures, and documenting training and
    attendance
    C. Responding to patient complaints of violations of the
    rules within ninety days from the receipt of the complaint
    D. Amending the patient record upon the patient’s request
    E. Maintaining maintenance records for the practice’s
    physical facility
A
  1. Answer: B
    Explanation:
    a)Reporting violations to the Department of Health and
    Human Services is not required.
    b)Proof of proper training of employees regarding the
    HIPAA Administrative Simplifi cation Rules will
    minimize the risk of liability for a physician practice if it
    has not committed a HIPAA violation but an employee of
    the practice has.
    c)There is no time limit on responding to patient
    complaints.
    d)Amending the patient record upon the patient’s request
    is not required.
    e)Maintaining maintenance records for the practice’s
    physical facility is an addressable safeguard under the
    HIPAA Security Rule. Source:45 CFR 164.530(c).
    Source: Erin Brisbay McMahon, JD
221
Q
  1. A 72-year-old female with a long history of anxiety
    treated with diazepam decides to triple her dose because
    of increasing fearfulness about “environmental noises.”
    Several days after her attempt at self-prescribing,
    her neighbor fi nds her to be extremely lethargic and
    nonresponsive. On examination, she is found to be
    stuporous and have diminished reaction to pain and
    decreased refl exes. Her respiratory rate is 8 breaths per
    minute (BPM), and she has shallow respirations. Which
    antidote could be given to reverse these fi ndings?
    A. Naltrexone
    B. Physostigmine
    C. Pralidoxime
    D. Flumazenil
    E. Naloxone
A
  1. Answer: D
    Explanation:
    Reference: Hardman, p 564. Katzung, pp 370, 1013.
    A. Naltrexone is an antagonist therapy for heroin addiction
    B. Physostigmine is used to treat glaucoma
    C. Pralidoxime is used together with another medicine
    called atropine to treat poisoning caused by organic
    phosphorus pesticides
    D. Flumazenil is a competitive antagonist of
    benzodiazepines at the GABA receptor.
    Repeated administration is necessary because of its
    short half-life relative to that of most benzodiazepines.
    E. Naloxone is an opioid antagonist.
    Source: Stern - 2004
222
Q
  1. In a patient with bilateral chest wall pain, a physician
    performed bilateral intercostal nerve blocks at 7th, 8th,
    and 9th intercostal nerves under fl uoroscopy. What is the
    correct coding for these procedures?
    A. CPT 64420 – single intercostal nerve block and CPT
    64421 – multiple intercostal nerve blocks
    B. CPT 64421-50 multiple intercostal nerve blocks and CPT
    76003 – fl uoroscopic visualization
    C. CPT 64420 x 6 – single intercostal nerve blocks and CPT
    76003 x 6- fl uoroscopic visualization
    D. CPT 64421-50 – multiple intercostal nerve blocks, CPT
    76005-50 - fl uoroscopic visualization
    E. CPT 64421 – multiple intercostal nerve blocks, CPT
    76003 fl uoroscopic visualization
A
  1. Answer: E
    Explanation:
    Intercostal nerve blocks are not covered by bilateral
    coding. CPT 64421 describes multiple intercostal nerve
    blocks. Consequently, no modifi ers are required. CPT
    76003 describes the fl uoroscopic visualization of nonspinal
    procedures. CPT 76005 is limited to the spine area.
    Reference: Manchikanti L (ed). Principles of
    Documentation, Billing, Coding & Practice Management
    for the Interventional Pain Professional, ASIPP
    Publishing, Paducah KY 2004.
    Source: Laxmaiah Manchikanti, MD
223
Q
  1. Choose the accurate statements about coding.
    A. Physicians are the best coders as they are trained during
    residency.
    B. Physicians do not need to learn and use CPT language
    C. An informed MD coder is always better than a non-MD
    coder
    D. Physician may not be involved in coding
    E. Coding is black and white without any gray areas
A
2140. Answer: C
Explanation:
Coding
Complex
Requires
Skill and effort
Medical knowledge
“Physician is the best coder”
Physician must be involved in Coding
Physicians are the only one who know what was done
Learn and use CPT language
An informed MD coder is always better than a non-MD
coder
Coding is not black and white
May be several ways to code procedures
Source: Laxmaiah Manchikanti, MD
224
Q

2141.A 65-year old man with cancer and multiple bony
metastasis complains of increasing requirement of
intrathecal morphine. However, he also complains of
increased nausea associated with increased dose. All
the workup with regards to carcinomatous spread failed
to show any progression of the disease. The following
explanation is accurate.
A. The catheter is no longer in the intrathecal space and he
is not receiving appropriate dosages.
B. He is addicted to the drugs and requesting higher doses
C. He is physically dependent on the drug and is nauseated
due to withdrawal symptoms.
D. He developed tolerance to the analgesics effects of intrathecal
morphine.
E. There is significant progression of the disease, which was
unidentified by the evaluation.

A
  1. Answer: D
    Explanation:
    Source: Source: Manchikanti L, Principles of
    Documentation, Billing, Coding & Practice Management
    2004
    The patient is most likely developing tolerance to the
    analgesic effects of the intrathecal morphine while
    continuing to complain of the adverse side effect of nausea
    as the intrathecal dose is increased. The mechanism by
    which tolerance develops is not known. The development
    of tolerance can be minimized by selecting the lowest
    effective narcotic dose; placing the catheter as close as
    possible to the cord level of the painful areas; giving
    multiple, small, divided doses rather than one or two large,
    daily boluses; and using low-dose continuous infusions
    whenever possible.
    Source: Manchikanti L, Board Review 2005
225
Q
  1. The “rules” that, in many cases, defi ne which physician
    referrals are legal and which are not, are found in the
    following regulations:
    A. Stark regulations
    B. Anti-Kickback Statute
    C. Stark regulations and Anti-Kickback Statute
    D. Stark regulations, Anti-Kickback Statute, and Omnibus
    Budget Reconciliation Act of 1993
    E. Stark regulations, HIPAA, and Balanced Budget Act
A
  1. Answer: C
    Explanation:
    A. The “Stark I” regulations were published in the Federal
    Register on August 15, 1995.
    The “Stark II” law that was part of the Omnibus Budget
    Reconciliation Act of 1993, which expanded that
    application of Stark I rules to additional types of health
    care providers and to Medicaid.
    Note that regulations for this law are issued in two
    phases: Phase I, released Jan. 4, 2001, is
    fi nal. Phase II, released March 26, 2004, is effective July
    26, 2004.
    B. The Anti-Kickback Statute also addresses physician
    referrals.
    C. Physician self referrals are governed by Stark
    regulations and Anti-kickback statute.
    D. OBRA of 1993 includes Stark
    E. HIPAA and BBA do not govern physician self referrals
    Source: Manchikanti L, Board Review 2005
226
Q
  1. Each of the following statements about muscle rigidity
    induced by opioids is true EXCEPT:
    A. The degree of rigidity is related to the rate of opioid
    administration
    B. It is more apparent during the administration of nitrous oxide
    C. Muscles of the trunk are affected more than muscles of
    the extremities
    D. It results from a direct effect of the opioid on skeletal
    muscles
    E. It can be produced by large doses of morphine
A
  1. Answer: D
    Source: American Board of Anesthesilogy, In-trainnig
    examination
227
Q

2144.A postoperative patient after total hip replacement
receiving continuous intravenous morphine sulfate
develops confusion four days later. The treatment of
choice for this patient is:
A. Switch patient to patient-controlled analgesia
B. Start him on methylphenidate
C. Stop morphine and start on hydromorphone
D. Reduce the dose of morphine by 80%
E. Start on a fentanyl patch

A
  1. Answer: C
228
Q
  1. An outpatient consultation, new patient requires which
    one of the following:
    A. A self-referral who has seen his primary care physician
    and is consulting you for your opinion.
    B. Service provided by the physician whose opinion or advice
    regarding the evaluation and/or management of a
    problem is requested by another physician.
    C. A patient of the same specialty in the same group
    practice who consults you for your opinion after his
    consultation.
    D. A worker’s comp. case manager, not a physician, requesting
    epidural steroid injection.
    E. A consultation with the patient and generation of carbon
    copy to referring physician.
A
  1. Answer: B
229
Q

2146.Which of the following is not an example of hostile
environment sexual harassment?
A. A physician asks a nurse out on a date and she refuses.
B. A female coworker repeatedly touches a male coworker
on his shoulders, hugs him goodnight, and makes numerous
comments about his “tight little butt.” He tearfully
asks her to stop.
C. The staff posts sexually explicit jokes and cartoons on the
offi ce kitchen bulletin board.
D. A male coworker repeatedly touches another male
coworker on his shoulders, hugs him goodnight, and
makes numerous comments about his “tight little
butt.”
E. All of the above are examples of hostile environment
sexual harassment.

A
  1. Answer: A
    Explanation:
    Explanation: Although it is not advisable, asking an
    employee out for a date and getting turned down ONCE is
    not harassing. The big caveat is that if the physician has
    authority over the employee, and he later takes any adverse
    action against him or her (fi res her, doesn’t promote her,
    switches her to an undesirable work schedule, etc.) there is
    a great danger of the physician being accused of “quid pro quo” or economic harassment. This is very serious
    because it only takes one adverse employment action to
    expose a physician and/or the clinic to liability for sexual
    harassment.
    Source: Judith Homes, Sep 2005
230
Q
  1. What do the physician self-referral Stark rules prohibit?
    A. They prohibit physicians from referring patients to hospitals
    where the physicians work
    B. They prohibit physicians from referring patients for
    designated health services to entities in which the physicians
    have fi nancial relationships, unless an exception
    applies.
    C. They prohibit health care providers from billing for services
    of patients they refer to other providers.
    D. They prohibit health care providers from receiving
    money from their services for any referrals to physical
    therapy.
    E. The prohibit physicians performing cases in ambulatory surgery centers with physician ownership of 50% or
    more.
A
  1. Answer: B
    Explanation:
    Source: Manchikanti L, Principles of Documentation,
    Billing, Coding & Practice Management 2004
    Stark prohibits physicians from referring to an entity with
    which they or their immediate family members have a
    fi nancial relationship for the furnishing of any of 11
    designated Medicare-reimbursable health services if
    claims for those services are submitted to Medicare or
    Medicaid. Also, physicians may not bill Medicare or
    Medicare for such referred services.
    The 11 designated health services are as follows:
    Clinical laboratory services.
    Physical therapy services (including speech-language
    pathology services)
    Occupational therapy.
    Radiology and certain other imaging services
    Radiation therapy services and supplies.
    Durable medical equipment and supplies
    Parenteral and enteral nutrients, equipment and supplies.
    Prosthetics, orthotics, prosthetic devices and supplies.
    Home health services.
    Outpatient prescription drugs
    Inpatient and outpatient hospital services (with
    exceptions).
    A designated health service remains a designated service
    under Stark even when it’s billed as something else or
    bundled with other services.
    CMS has released an
    appendix to the Stark regulations detailing, by CPT and
    HCPCS code, those services that are subject to the
    prohibition.
    Source: Manchikanti L, Board Review 2005
231
Q
  1. Choose the accurate statement with regards to NMDA
    receptors.
    A. Experimental evidence has shown that NMDA can induce
    seizure activity in animals.
    B. NMDA has shown no capability of inducing seizures in
    animals.
    C. Combined with alcohol, NMDA receptors abolish the
    susceptibility to seizures.
    D. NMDA antagonist MK-801 increases the severity of the
    seizures during withdrawal.
    E. Chronic exposure to alcohol reduces the density of MK-
    801 binding sites.
A
  1. Answer: A
    Explanation:
    A. NMDA itself can induce seizure activity in animals.
    B. NMDA itself can induce seizure activity in animals.
    C. In animal experiments, it is suggested that alcohol
    behaves as an NMDA antagonist in the intact animal.
    NMDA receptors are altered during chronic exposure to
    alcohol and appear to be important in mediating some of
    the signs of alcohol withdrawal.
    Increasing numbers of NMDA receptors after chronic
    alcohol exposure may underlie the increase
    susceptibility of animals and humans to seizures during
    abrupt withdrawal from alcohol.
    D. Experiments with mice show that NMDA-induced
    seizure activity was elevated in mice made dependent on
    alcohol and that the NMDA antagonist
    MK-801 could reduce the severity of these seizures.
    E. It has been demonstrated in culture neurons that
    chronic exposure to alcohol increases the densityof
    MK-801 binding sites, suggesting that neurons may
    compensate for the acute inhibitory actions of alcohol
    on NMDAreceptor function by increasing the density of
    these receptors.
    This up-regulation of receptor density is a common
    resposne of many cell and tissue types to theprolonged
    presence of receptor antagonists.
232
Q
  1. You interview a fabulous candidate for your part-time
    business manager. After you hire him and before he starts
    work, he submits to your standard drug test and physical
    exam. You fi nd out he is epileptic, that he can’t lift over
    20 pounds because of a genetic condition, and that he has
    ingested cocaine in the past 24 hours. What can you do?
    A. You can fi re him for having epilepsy.
    B. You can fi re him for not being able to lift over 20
    pounds.
    C. You can fi re him for current illegal drug use.
    D. All of the above.
    E. None of the above.
A
  1. Answer: C
    Explanation:
    Explanation : Epilepsy is a condition that is protected by
    the ADA, so you cannot fi re him on that basis alone. You
    may terminate him only if he cannot perform the essential
    functions of the job of being a part-time businessmanager.
    Although you may have a legitimate concern about the
    effect of his condition on your staff and patients, you have
    the duty to make reasonable accommodations to your new
    employee. You probably cannot terminate your new
    employee simply for not being able to lift 20 pounds,
    because it would be diffi cult to demonstrate an “essential
    function of the job” of business manager includes heavy
    lifting. Because current use of illegal drugs is not
    protected by the ADA, he may be terminated on those
    grounds alone.
    Practically speaking, however, even if you fi re him for
    cocaine use, he will claim that is a pretense, and that you
    really fi red him for the impermissible reasons. As with all
    other aspects of running a medical practice, keep good
    documentation and its sometimes your best defense.
    Source: Judith Homes, Sep 2005
233
Q
2150. A characteristic manifestation of hallucinogen use is:
A. Bruxism
B. Agoraphobia
C. Neologisms
D. Synesthesia
E. Anomie
A
  1. Answer: D
    Explanation:
    There are two groups of hallucinogens based on chemical
    structure:
  2. Indolealkylamines (resembles 5HT);
    includes LSD, Democrat (methyltryptamine), psilocin,
    psilocybin.
  3. Phenylethylamines; includes mescaline
    (from peyote cactus), 2,5-dimethoxyamphetamine (DMS),
    3,4-methylenedioxyamphetamine (MDA), and 3,4-
    methylenedioxymethamphetamine
    (MDMA).
    Symptoms of hallucinogenic drugs use
    include dilated pupils, blurring of vision, sweating,
    incoordination, increased blood pressure, tachycardia,
    tremors, hyperrefl exia, and mood changes ranging from
    euphoria to anxious as well as visual illusion an dperceptual changes (i.e., micropsia, synesthesias).
    Tolerance and cross-tolerance can develop. There are no
    withdrawal phenomena, and they are not reinforcers to
    other drugs.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
234
Q
  1. The true statement with regards to disability includes
    the following:
    A. It is a term that can be used interchangeably with the
    term handicap.
    B. It is a condition that relates to the effects of a disease
    process or injury.
    C. It is a condition that requires the use of an assistive device
    to perform activities of daily living.
    D. It is expressed as a percentage of the body as a whole.
    E. It is a condition that relates to function relative to work
    or other obligations.
A
  1. Answer: E
    Explanation:
    Source: AMA Guides to the Evaluation of Permanent
    Impairment, 2001.
    Disability is the limiting, loss, or absence of the capacity of
    a person to meet personal, social, oroccupational demands,
    or to meet statutory or regulatory requirements.
    Disability relates to function relative to work or other
    obligations and activities of daily living. It may be
    characterized as temporary, permanent partial, or total.
    Methods of assessing functional performance include
    measurement of range of motion, strength, endurance,and
    work simulation. Disability is not synonymous with
    handicap. When an impairment is associated with an
    obstacle to useful activity, a handicap may exist; assistive
    devices or modifi cations of the environment are often
    required to accomplish life’s basic activities.
    Source: Manchikanti L, Board Review 2005
235
Q
  1. True statements in granting a patient’s request for a
    confi dential communication:
    A. A physician may may require a patient to give an explanation
    for making the request.
    B. A physician may require patient to request confi dential
    communication in writing.
    C. A health plan may not require a patietn to give an explanation
    for making the request.
    D. None of the above.
    E. All of the above.
A
  1. Answer: B
236
Q
  1. What is the true statement about global fee policy?
    A. Global fee policy describes packaging or inclusion of certain
    services in allowance for a surgical procedure
    B. Global fee policy describes unbundling or combining
    multiple services into a single charge
    C. Global package includes preoperative and postoperative
    services for 120 days
    D. Global package includes initial evaluation if performed
    on the same day
    E. Global package includes all diagnostic tests
A
2153. Answer: A
Explanation:
Global Fee Policy
Packaged or certain services are included in allowance for
a surgical procedure.
Bundling: Combining multiple services into a single
charge.
Global Package
Includes:
Pre-operative
Procedure
Post-operative
Does Not Include:
Initial evaluation
Unrelated visits
Diagnostic test(s)
Return trips to OR
Staged procedures
Global Period
Major day prior, day of, and 90 days after
Minor day of or day of and ten days after
Source: Laxmaiah Manchikanti, MD
237
Q
  1. Employers are required to provide training to all
    employees with occupational exposure that . . . Which
    one of the following DOES NOT accurately complete this
    sentence?
    A. Is provided at no cost to the employees.
    B. Is provided at the time of initial employment and as
    requested by the employee thereafter.
    C. Is appropriate in terms of content and vocabulary
    given the employees education level, vocabulary and
    language.
    D. Is provided during working hours.
    E. Discusses the employer’s Exposure Control Plan, bloodborne
    diseases and modes of transmission and the use
    of personal protective equipment.
A
  1. Answer: B
    Explanation:
    Training is to be provided at the time of initial assignment
    to tasks where occupational exposure may take place, at
    least annually thereafter, and additional training when changes such as modifi cation of tasks or procedures or
    institution of new tasks or procedures affect the
    employee’s occupational exposure.
    Source: 29 CFR 1910.1030(g)(2).
    Source: Erin Brisbay McMahon, JD, Sep 2005
238
Q
  1. Which of the following is NOT required as part of a postexposure
    evaluation and follow-up?
    A. A confi dential medical evaluation
    B. Documentation of the route of exposure and circumstances
    under which exposure occurred
    C. Identifying and testing source individual’s blood regardless
    of consent
    D. Providing the employee post-exposure protective treatment
    E. Providing the employee counseling
A
  1. Answer: C
    Explanation:
    Answer (c) is not correct. The regulations provide that the
    source individual’s blood shall be tested as soon as
    feasible and after consent is obtained in order to determine
    HBV and HIV infectivity. If consent is not obtained, the
    employer shall establish that legally required consent
    cannot be obtained. However, when the source
    individual’s consent is not required by law, the source
    individual’s blood, if available, shall be tested and the
    results documented.
    Source: 29 CFR 1910.1030 (f)(3).
    Source: Erin Brisbay McMahon, JD, Sep 2005
239
Q
  1. A physician performed interlaminar cervical epidural
    under fl uoroscopy with documentation of nerve
    root fi lling at 4 levels. Identify proper coding for the
    procedure.
    A. 64479-59, 64480 - C/T transforaminal and C/T transforaminal
    additional units
    B. 62310, 76005-26 - C/T epidural and fl uoroscopy
    C. 62310 x 1, 64479 x 1, 64480 x 3 -C/T epidural, C/T transforaminal
    and C/T transforaminal additional units
    D. 62310, 72275-59 and 76005-26 -C/T epidural, epidurography,
    and fl uoroscopy
    E. 64479 x 1, 64480 x 3, 76005-26 x 3 -C/T transforaminal,
    C/T transforaminal additional units and fl uoroscopy
A
  1. Answer: B

Source: Laxmaiah Manchikanti, MD

240
Q
  1. Your physician partner tells your nurse practitioner that
    he will take her to your next medical meeting in Tahiti if
    “she makes it worth his while.” She refuses and fi nds
    herself being transferred to the night shift in your clinic
    located in Omaha. Your nurse practitioner is not happy.
    Do you have reason to worry?
    A. It was just one incident and just one request for a date so
    it isn’t suffi cient to be considered “harassment.”
    B. She turned him down and there is no evidence her
    employment change had anything to do with his hurt
    feelings
    C. The actions involve a supervisor taking adverse action
    against a subordinate – it only takes one incident to
    create liability.
    D. Since you, as managing physician of the clinic, did not
    know about the situation, the clinic has no responsibility
    to prohibit the conduct and therefore has no liability
    for the conduct.
    E. There is no evidence that the physician acted improperly
    by fondling her, making sexually explicit comments, or
    otherwise conducting himself in an inappropriate way.
A
  1. Answer: C
    Explanation:
    Explanation: With “economic harassment,” it only takes
    one incident to fi nd an employer liable. The key points are
    that the head of the medical group or clinic does not even
    need to know the improper conduct took place – it is
    enough that the employee received an adverse employment
    action after refusing a supervisors sexually-oriented
    request.
    Environmental harassment has four elements: 1) The
    conduct is unwelcome; 2) The conduct is directed at a
    protected category; 3) the conduct is offensive to the
    recipient and to a “reasonable person;” and 4) the conduct
    is severe OR pervasive.
    Source: Judith Homes, Sep 2005
241
Q
  1. Which of the following is a physician/employer’s best
    defense to a sexual harassment claim?
    A. The conduct did not cause emotional or psychological
    injury to the complaining employee.
    B. The conduct did not occur very often and wasn’t very
    offensive
    C. The conduct between co employees did not occur during
    business hours
    D. The conduct did not occur at the clinic or in the medical
    offi ces.
    E. Adoption of comprehensive written policies prohibiting
    harassment, conduct of periodic training sessions, well
    publicized procedure and prompt thorough investigations
    .
A
  1. Answer: E
    Explanation:
    Explanation:This is a no brainer but important to teach
    the policies that must be implemented by all employers.
    The U.S. Supreme Court decisions of Faragher and Ellerth
    must be discussed and understood.
    Source: Judith Homes, Sep 2005
242
Q
  1. As described by Beauchamp and Childress, the principles
    that are focal to medical practice are:
    A. casuistry, communitarianism, benevolence and virtue
    B. intellectual, moral, intentional and consequential
    C. benefi cence, non-malefi cence, autonomy and justice
    D. normative, applied, descriptive and meta-ethical
A
  1. Answer: C
    Explanation:
    In their much cited work The Principles of Biomedical
    Ethics [Oxford, NY, 2001], Tom Beauchamp and James
    Childress defi ne the basic, prima facie principles that are
    applicable in medicine as benefi cence, non-malefi cence,
    autonomy and justice, and explicate why and how these
    principles may be employed in the address and resolution
    of ethical issues and problems in the healthcare setting(s).
    Casuistry, and communitarianism are ethical approaches. Normative, applied, descriptive and meta-ethical are types
    of ethics
    Source: Giordano J, Board Review 2006
243
Q
  1. A physician in your group has just converted to
    Scientology. It’s all he can talk about. He hand out fl iers,
    talks about Scientology at lunch, and has put up a poster
    of Tom Cruise and Katie Holmes on the clinic refrigerator.
    As the managing physician, what should you do?
    A. Do nothing. His religion is his business, and you could
    subject yourself and your clinic to claims of religious
    discrimination if you attempt to infl uence what he talks
    about in the offi ce.
    B. Terminate the offending physician immediately.
    C. Make sure you put additional information about several
    other mainstream religions in the offi ce to counterbalance
    the Scientology infl uence.
    D. Encourage other employees to discuss their religions and
    provide a forum for discussions.
    E. None of the above.
A
  1. Answer: E
    Explanation:
    Explanation:Terminating the physician will no doubt
    result in claims of religious discrimination. However, the
    other three approaches will no doubt result in claims of
    religious harassment by other members of your staff who
    do not want to be pressured about religion. You should
    have a policy prohibiting religious solicitation of
    employees or physicians. Make sure the workplace
    atmosphere is free from religious infl uences that may
    make some employees uncomfortable. (and Tom Cruise
    should stick to acting)
    Source: Judith Homes, Sep 2005
244
Q

2161.Which of the following behavior is not considered
unlawful harassment?
A. Constantly yelling at your staff over small, inconsequential
mistakes.
B. Use of epithets, slurs, and insults directed at an individual
because of his national origin.
C. Putting up a screen saver on your office computer that
has a sexually explicit picture of two nurses. (It’s in your office and no one has the authority to use it but
you.)
D. Repeatedly calling yourself and others names such as
“old geezer” and “senile” in meetings and during an
informal discussion with your staff.
E. All of the above are examples of unlawful discrimination.

A
  1. Answer: A
    Explanation:
    Explanation: Harassment is only unlawful if it is directed
    at a protected category. Although yelling at your staff is
    obnoxious and unprofessional, it is not unlawful if you yell
    at everyone- that is, if you are an “equal opportunity
    yeller.” If you treat everyone the same way and do not
    discriminate by yelling more often at women or Hispanics
    or older workers, etc. then you simply need a lesson in
    deportment. With respect to “old geezer” and other ageist
    comments, even if you direct the comments toward
    yourself, other older workers may use that as evidence of
    age discrimination and harassment. With respect to C, if
    the computer screen may be viewed by nurses who need to
    put fi les on your desk, or if you computer may be seen as
    people who walk into or past your offi ce, that may be used
    as evidence of the existence of a hostile work environment
    Source: Judith Homes, Sep 2005
245
Q
  1. Select true statements about upcoding:
    A. It is the largest risk area outside of unbundling
    B. Compliance with documentation guidelines may not be
    the most important aspect
    C. It is not necessary to meet level of care if computerized
    records are used.
    D. Medicare will investigate only down coding.
    E. Medicare will reward you for upcoding
A
  1. Answer: A
    Explanation:
    * Upcoding:
    - Largest risk area outside of unbundling.
    - Compliance with documentation guidelines is
    important.
    - Must assure that level of care meets presenting
    problem(s) of patient.
    * Medicare will investigate up-coding & down-coding.
    Source: Laxmaiah Manchikanti, MD
246
Q
  1. What are the consequences of down coding?
    A. Compliance with guidelines may not the most important
    aspect.
    B. It is not necessary to assure proper coding of the level of
    service during downcoding
    C. Medicare will eventually reimburse all your down coding
    after 5 years.
    D. Down coding is largest area of loss of revenue for the
    practice
    E. Medicare may not investigate down coding.
A
  1. Answer: D
    Explanation:
    * Down Coding
    - Largest area of loss of revenue outside disbundling.
    - Compliance with guidelines is important.
    - Must assure proper coding of the level of service.
    Source: Laxmaiah Manchikanti, MD
247
Q
  1. Which of these statements is true”
    A. A person accused of harassment must have intended to
    harass the coworker. If he or she was merely joking, or
    was just being friendly, his or her actions will not be
    considered “harassment.”
    B. A person is not a victim of harassment if he or she merely
    overhears remarks or “off color” jokes that he or she was
    not intended to hear.
    C. A person claiming to have been harassed must complain
    about the harassment in order to bring a claim against
    his or her employer.
    D. Harassment is not a problem in my offi ce.
    E. None of the above.
A
  1. Answer: E
    Explanation:
    Explanation: If you think you and your offi ce are “bullet
    proof,” think again. You as an employer cannot simply
    assume that because you have a “family atmosphere,” no
    one on your staff will fi le a claim against you. Have you
    ever said “nobody minds the jokes- in fact, they all
    participate,” or “I was just joking!” or “she laughed, too”
    or “she’s just way too sensitive” or “he was evesdropping!”
    or “I didn’t mean to hurt his feelings”? If you have ever
    rationalized your behavior by saying any of the above, it’s
    only a matter of time before the EEOC comes knocking on
    your door.
    Source: Judith Homes, Sep 2005
248
Q
  1. Select true statements about Add-On Codes:
    A. They are never used by themselves and the modifi er 51
    (additional procedure) is not used.
    B. Payment and adjustments are always made with modifi
    ed -51
    C. Examples include epidurography, fl uoroscopy and discography-
    interpretation
    D. Facet joint injections and facet neurolysis do not have
    add-on codes
    E. 64421 - multiple intercostal nerve blocks is an add-on
    code to CPT 64420 – single intercostal nerve block
A
2165. Answer: A
Explanation:
Add-On Codes
* Never used by themselves
* The modifi er 51 (additional procedure) is not used
* No payment adjustments
Examples:
Facet joint injections
Facet neurolysis
Transforaminal epidurals
Not Add-On Codes:
Epidurography
Fluoroscopy
Discography-interpretation
Source: Laxmaiah Manchikanti, MD
249
Q
  1. Identify true statements about Current Procedural
    Technology (CPT) and International Classifi cation of
    Diseases (ICD-9) codes?
    A. ICD-9 is a systematic listing of procedure or service accurately
    defi ning and assisting with simplifi ed reporting
    B. CPT is a systematic listing and coding of procedures and
    services performed by physicians
    C. ICD-9 identifi es each procedure or service with a fi vedigit
    code
    D. CPT provides systematic listing of disease classifi cation
    and provides alphabetic index to diseases
    E. CPT and ICD-9 both provide a tabular list of diseases
A
  1. Answer: B
    Explanation:
    CPT
  2. Systematic listing and coding of procedures and
    services performed by physicians
  3. Procedure or service is accurately defi ned with
    simplifi ed reporting
  4. Each procedure or service is identifi ed with a fi ve-digit
    code
    ICD-9
    International Classifi cation of Diseases
    Organization
    Disease classifi cation: Alphabetic index to diseases
    Tabular list of diseases
    Source: Laxmaiah Manchikanti, MD
250
Q
  1. Your nurse practitioner has complained to you on several
    occasions that the drug rep that comes every Friday has
    repeatedly asked her out, often attempted to kiss her, has
    groped her and has made suggestive remarks to her. She
    has told the drug rep to leave her alone, but the conduct
    continues. What is the appropriate response?
    A. Explain to your nurse that you have no right to control
    an individual who is not your employee.
    B. Suggest to her that she simply make light of the situation
    and not be overly sensitive.
    C. Talk to the drug rep and insist he immediately cease the
    unwanted behavior.
    D. Immediately call the drug company, tell the rep’s boss
    the drug rep is a “sex maniac”, and demand they send
    another rep from now on.
    E. The next time the drug rep comes to your offi ce, you deck
    him.
A
  1. Answer: C
    Explanation:
    Explanation:Most employers believe they can’t control an independent visitor’s conduct while they are at the
    workplace. That is not true. In fact, an employer has a duty
    to protect employees from unwanted sexual conduct,
    including the conduct of third parties. Answer D is not
    correct because, unless the employer actually witnesses the
    conduct,making accusations and possibly causing the drug
    rep to lose his job will subject the employer to
    unnecessary liability. Use that approach only as a last ditch
    effort. Obviously Answer E is an overreaction, and
    Answers A & B are not appropriate reactions, since
    ignoring the problem can subject the employer to a claim
    that the employer tolerated a hostile work environment.
    Source: Judith Homes, Sep 2005
251
Q

2168.True statements regarding causation, apportionment,
and worker’s compensation are:
A. Determining medical causation requires detective work
and witness of the accident.
B. For purposes of the AMA Guides, causation means an
identifiable factor, such as an accident, that results in a
medically identifiable condition.
C. The legal standard for causation in civil litigation and
in worker’s compensation is uniform across the United
States.
D. Apportionment analysis in worker’s compensation represents
assignment of all factors.
E. The role of a physician in worker’s compensation system
is only to provide effective medical care but not be involved
in other aspects of the care.

A
2168. Answer: B
Explanation:
AMA Guides to the Evaluation of Permanent Impairment,
2001.
Source: Manchikanti L, Board Review 2005
252
Q
  1. You are interviewing an applicant for a receptionist
    position in your offi ce. One of the applicants is in a
    wheelchair. What should you do?
    A. As diplomatically as possible, explain that her appearance
    at the front desk may be upsetting to patients and
    may make your staff uncomfortable. Try to refer her to
    job openings at other facilities.
    B. Thank her for applying, but explain to her that she is not
    qualifi ed for the job.
    C. Don’t shy away from discussing her disability – ask her
    about how she became disabled, and how she feels
    about being in a wheelchair.
    D. Tell her about the job requirements and ask her to show
    you how she would perform those duties.
    E. None of the above.
A
  1. Answer: D
    Explanation:
    Explanation: When interviewing an applicant who is
    obviously disabled, the physician/employer should have a
    clear understanding of the “essential functions” of the job
    (preferably in writing). The employer should explain
    those job duties to the applicant and ask: “Can you
    perform those duties,with or without an accommodation?”
    You may ask her to demonstrate, for example, how she
    would operate the equipment, handle the phones, etc. The
    ADA prohibits an employer from asking unnecessary
    details about the disability, such as the origin of the
    disability. An employer may not reject an applicant simply
    because of the anticipated reaction of other employees or
    patients.
    Source: Judith Homes, Sep 2005
253
Q
  1. Quality Assurance
    A. Indicates ongoing vigilance to patient satisfaction indices.
    B. Is only necessary during injection techniques to assure medical necessity
    C. Is regulated by governmental and civil agencies.
    D. Is dependent on physician input, and eliminates the need
    for staff input.
    E. Is to prevent malpractice cases
A
  1. Answer: A

Source: Manchikanti L, Board Review 2005

254
Q
  1. Which of the following is a disability protected by the
    ADA?
    A. A broken leg requiring a cast and crutches and that
    causes signifi cant limitations in mobility.
    B. A physical or mental impairment that makes it diffi cult
    for the person to obtain employment.
    C. Signifi cant scarring from burns that causing facial disfi
    gurement.
    D. An extreme phobia involving any type of spider, insect,
    or snake.
    E. None of the above.
A
  1. Answer: E
    Explanation:
    Explanation: In order for a mental or physical condition to
    be covered by the ADA, the impairment must substantially
    limit one or more major life activities on a continuing
    basis. Major life activities include hearing, seeing,
    breathing, walking, working learning, caring for oneself
    on a daily basis, speaking, and performing manual tasks.
    Injuries such as a broken leg are temporary and nonchronic
    impairments and are not covered. A disfi gurement
    is not covered unless it affects a major life activity.
    Source: Judith Homes, Sep 2005
255
Q
  1. Identify the true statement with regards to a physician’s
    role in impairment and disability evaluation.
    A. Determine impairment, provide medical information to
    assist in disability determination.
    B. Provide a disability rating which is binding on the
    administrative law judge for Social Security and Disability.
    C. In state worker’s compensation law, a physician role is
    limited to determining disability only, but not impairment.
    D. The World Health Organization has specifi cally defi ned
    a role of the physician in impairment and disability.
    E. Physician role in impairment and disability determination
    is independently without input from employer and
    without consideration to job duties.
A
  1. Answer: A
    Explanation:
    Source: AMA Guides to the evaluation of Permanent
    Impairment, 2001.
    Physicians’ Role
    A. A physician role as per the Guides to the Evaluation of
    Permanent Impairment:
    Determine impairment, provide medical information to
    assist in disability determination.
    B. Social Security Administration (SSA):
    Determine impairment; may assist with the disability
    determination as a consultative examiner.
    State Workers’ Compensation Law:
    C. Evaluation (rating) of permanent impairment is a
    medical appraisal of the nature and extent of the injury or
    disease as it affects an injured employee’s personal
    effi ciency in the activities of daily living, such as self-care,
    communication, normal living postures, ambulation,
    elevation, traveling, and nonspecialized activities of bodily
    members.
    D. World Health Organization (WHO):
    Not specifi cally defi ned; assumed to be one of the
    decision-makers in determining disability through
    impairment assessment.
    E. Disability is determined based on job requirements and
    needs
    Source: Manchikanti L, Board Review 2005
256
Q
  1. A 38-year old white male with history of low back pain
    with radiation into lower extremity with disc herniation
    demonstrated at L4/5 with nerve root compression,
    and electromyographic evidence of L5 radiculopathy
    was referred for consultation. You have examined the
    patient and decided to perform transforaminal epidural
    steroid injection at L5 nerve root. This encounter is
    appropriately considered as follows:
    A. It is a consultation as the patient was referred by another
    physician for management.
    B. It is a consultation as the patient was referred and your
    opinion was requested.
    C. It is a new offi ce visit since it is a known problem and the
    patient was referred to you for the treatment.
    D. It is a consultation as you told the patient to return to
    the referring physician after completion of course of
    epidurals.
    E. It is a consultation, as you do not plan on billing for another
    consultation within the next 3 years
A
2174. Answer: C
Explanation:
Source: Manchikanti L, Principles of Documentation,
Billing, Coding & Practice Management 2004
Explanation: Consultation
An opinion is requested
Patient is not referred
3 R’s
Request for opinion is received
Render the service/Opinion
Report back to physician requesting your opinion
Source: Manchikanti L, Board Review 2005
257
Q
  1. True statements regarding quality assurance include the
    following:
    A. Quality assurance, quality improvement, and quality
    management are interchangeable words.
    B. Quality assurance is internally driven, follows patient
    care, and has no endpoints.
    C. Quality improvement is externally driven, focused on
    individuals, and works toward endpoints.
    D. Total quality of management, quality management and
    improvement, and continuous quality improvement
    are synonymous with quality assurance.
    E. Quality improvement program is different from quality
    assurance and it focuses on patient care, process, integrated
    analysis
A
  1. Answer: E
258
Q

2177.True statements with reference to Americans with
Disability Act.
A. The physician’s input is not essential for determining any
of the criteria under Americans with Disabilities Act.
B. Conditions that are temporary and are not considered to
be impairment under the ADA include pregnancy, old
age, sexual orientation, sexual addiction, smoking, or
current illegal drug use
C. To be deemed disabled for purposes of ADA protection,
an individual needs to have only mild physical or mental
impairment that does not limit major life activities.
D. The person may be hypothetically or perceived to be
disabled to be qualifi ed under ADA.
E. It is the physician’s responsibility to identify and determine
if reasonable accommodations are possible to
enable the individual’s performance of essential job
activities in his or her employment.

A
  1. Answer: B
259
Q
  1. You are conducting interviews for the position of nurse
    practitioner. You need a reliable, stable, hardworking
    person in the job. During the job interview, what
    questions topics should you cover?
    A. A complete history of job injuries, including details of
    all past worker’s comp claims she has made. Get a list
    of all drugs she is currently taking, and the reasons for
    taking the drugs
    B. A description of all chronic health care problems of her
    husband and children. Include issues such as diabetes,
    epilepsy, and other diseases that may require her to be
    absent from work to care for her family.
    C. Make sure you know if she has ever been treated for
    drug addition or alcoholism, and be sure not to ask
    only about current problems get a history of past abuse,
    including approximate dates she claims she overcame
    the addictions.
    D. All of the above.
    E. None of the above.
A
  1. Answer: E
    Explanation:
    Explanation: Stay away from all of those issues!! Under the
    ADA, it is unlawful to discriminate against someone
    because of alcoholism or past drug use. You may only ask
    about current use of illegal drugs – that is not protected.
    You may not ask about family medical issues or current
    legal drug use because the ADA protects not only disabled
    individuals, but those who are perceived as having a
    disability and those who are associated with individuals
    who have a disability. You also may not refuse to hire
    someone who has fi led worker’s comp. claims in the past.
    Even if it does not directly violate the ADA, the employer
    may be subject to claims of unlawful discrimination for
    fi ling a lawful claim.
    Source: Judith Homes, Sep 2005
260
Q
  1. Your receptionist has just received an e-mail from a
    coworker. It is the fi fth time the coworker has asked
    your receptionist out on a date. Is his conduct sexually
    harassing?
    A. No. And it’s none of your business. Stop reading your
    employees’ e-mails.
    B. Yes. You may become liable to the receptionist for the
    harassment because you knew about it and did nothing
    to stop it.
    C. It depends.
    D. It is sexually harassing behavior, but because it is a private
    e-mail, you may do nothing unless and until she
    complains to you. You should act only after she makes a specific complaint to you.
    E. You may act only if you have a written policy against dating
    coworkers.
A
  1. Answer: C
    Explanation:
    Explanation: Whether or not the conduct is sexually
    harassing depends on whether the invitations for dates are
    unwelcome. We don’t have enough information to
    determine that critical element. For example, is the
    receptionist married to someone else and has she
    repeatedly told him to stop emailing her? Or do they have
    an ongoing romantic relationship and she looks forwardto
    receiving the invitations? A and D are not correct – an
    employer has a right to know what his employees aredoing
    during work hours using the employer’s offi ce equipment.
    Source: Judith Homes, Sep 2005
261
Q
  1. An interventional pain program predominantly
    managing cancer patients may be accredited by all of the
    following EXCEPT:
    A. American Cancer Society (ACS)
    B. Joint Commission on Accreditation of Healthcare Organizations
    (JCAHO)
    C. Accreditation Association for Ambulatory Health Care
    (AAAHC)
    D. Commission on Accreditation of Rehabilitation Facilities
    (CARF)
    E. State Department of Health for Physical, Occupational,
    and Behavioral Components
A
  1. Answer: A

Source: Laxmaiah Manchikanti, MD

262
Q

2181.Identify accurate statements describing federal
regulations?
A. The fi nal Stark regulations expressly prohibit an organization
from offering free compliance training.
B. To qualify for the in-offi ce ancillary Exception under
Stark, the services must be furnished in only the same
building.
C. A provider may never charge Medicare patients additional
fees for services covered by Medicare.
D. The HHS Offi ce of Inspector General (OIG) may seek
criminal penalties as well as administrative sanctions
and civil penalties against violators of the anti-kickback
statutes.
E. A provider may never charge Medicare patients additional
fees for Medicare’s non-covered services.

A
  1. Answer: D
    Explanation:
    A. The Stark rules permit organizations to give physicians,
    the physician’s family members or offi ce staff compliance
    training – without the training being counted as an illegal
    fringe benefi t or perk if:
    * The training takes place in the provider’s services area;
    * The training is not for continuing medical education.
    B. To qualify for the in-offi ce ancillary service Exception,
    services must be furnished in one of the following three
    locations:
  2. The same building if one of the following conditions
    apply:
    * The physician or practice has an offi ce that is
    normally open at least 35 hours a week and offers services,
    including at least some non-DHS, at least 30 hours per
    week; or;
    * The patient usually receives services from the
    referring physician or group at that offi ce. The physician
    or group’s offi ce must normally be open at least eight
    hours a week and the referring physician must personally
    offer service, including some non-DHS, at least six hours a
    week; or;
    * The referring physician or practice member is
    present and orders or provides DHS at that site during a
    patient visit. In addition, the physician or group must own
    or rent an offi ce in the building that is open at lest eight
    hours a week and offer services at least six hours a week.
  3. One or more centralized buildings used by the group
    practice to deliver at least some of its clinical lab services.
    A centralized building may include a mobile vehicle if it’s
    used exclusively by the practice and leased for at least six
    months, 24 hours/day, 7 days/week
  4. One or more centralized buildings used by the group
    practice to deliver at least some of its designated health services other than clinical lab services.
    C & E. Providers may charge Medicare patients extra for
    items and services that are not covered by Medicare, but
    the providers should think carefully when they offer a
    contract for boutique or concierge care to their Medicare
    benefi ciaries.
    D. Health care providers that violate fraud and abuse laws
    risk more than administrative sanctions and civil
    penalties. OIG, working alone or with other law
    enforcement agencies and state Medicaid Fraud Control
    Units, may fi le criminal cases against individuals who
    initiate or participate in illegal activities.
    Source: Laxmaiah Manchikanti, MD
263
Q
  1. How should an employer determine if the employer’s
    employees have occupational exposures to blood or other
    potentially infectious materials?
    A. Consult the list common job classifi cations experiencing
    occupational exposures maintained by OSHA on
    its website.
    B. Rely on responses from employees responsible for direct
    patient care as to their exposure to blood or other potentially
    infectious diseases.
    C. Review job classifi cations within the work environment
    to determine which job classifi cations have occupational
    exposure to blood or other potentially infectious
    materials.
    D. Schedule for an OSHA representative to visit the work
    site and identify individual employees who have occupational
    exposures.
    E. None of the above
A
  1. Answer: C
    Explanation:
    As part of the Exposure Control Plan, an employer is
    required to prepare an exposure determination that
    contains (1) a list of all job classifi cations in which all
    employees in those classifi cations have exposure, (2) a list
    of job classifi cations in which some employees have
    exposure, and (3) a list of tasks/procedures in which
    occupational exposure occurs and that are performed by
    the employees in (2) above. The exposure determination
    must be made without regard to the use of personal
    protective equipment.
    Source:29 CFR 1910.1030(c)(2).
    Source: Erin Brisbay McMahon, JD, Sep 2005
264
Q
  1. You are asked to perform diagnostic facet joint nerve
    blocks to block L3/4 and L4/5 facet joints on the right
    side. What are the correct medial branches needed to
    block these two joints?
    A. Right L2, L3, and L4 medial branches
    B. Right L3 and L4 medial branches and L5 dorsal ramus
    C. Right L1, L2 and L3 medial branches
    D. Right L3 and L4 medial branches
    E. Right L1, L2, and L4 medial branches and L5 dorsal ramus
A
  1. Answer: A
    Reference: Manchikanti L (ed). Principles of
    Documentation, Billing, Coding & Practice Management
    for the Interventional Pain Professional, ASIPP
    Publishing, Paducah KY 2004.
    Source: Laxmaiah Manchikanti, MD
265
Q
  1. The agency of the pain physician should be focal and
    adherent to the defi nable “ends” or distinct ultimate
    goal(s) of pain medicine as a practice. These ends may be
    defi ned as:
    A. Critical decision making so as to recognize when to practice
    acquiescent or defensive medicine
    B. rendering care that is competent, technically advanced
    and consistent with the knowledge relevant to the practice
    and circumstance(s)
    C. establishing equivalent autonomy of the physician to
    exercise the distinct ‘rights’ of medicine as a practice
    D. all of the above
A
  1. Answer: B
    Explanation:
    Medicine, and pain medicine by extension, may be
    philosophically defi ned as the care and treatment of those
    made vulnerable by the effects of disease, illness or injury.
    This premise establishes the primacy of the good of the
    patient,and the ends of medicine to be the rendering of
    care that is both technically competent and right, as well as
    morally and ethically sound as relevant to the patient as a
    person.The physician is an agent of this practice, and must
    be consistent and adherent to these ends. For the pain
    physician, this means not practicing acquiescent or
    defensive medicine, and recognizing the non-trumping,
    reciprocal autonomy of patient and physician in theclinical
    relationship (Giordano J. Moral agency in pain medicine:
    Philosophy, practice and virtue. Pain Physician 2006; 9:
    41-46; Giordano J. Moral virtue and the pain physician:
    Agency, intentions and actions. Practical PainManagement
    2006; 6(4): 76-80. See also: Pellegrino ED.
    Professionalism, profession and the virtues of the good
    physician. Mt Sinai J. Med. 2002; 69: 378-384)

Source: Giordano J, Board Review 2006

266
Q
  1. As a public and/or social good, the practice of medicine
    should seek to:
    A. be effective and effi cient as moral obligations against
    wastefulness
    B. be instrumental to the context of societies and governmental
    agendas
    C. be stipulated by explicit contractual affi rmations
    D. ascribe to a business ethos of effi ciency as a means toward
    maximizing profi table ends
A
  1. Answer: A
    Explanation:
    Medicine is a practice, defi ned as an exchange of good as
    relevant to the relationship of participant agents. These
    agents are part of a public or social structure,and therefore
    medicine seeks to maintain and restore health as a
    fundamental human good. As such, there is the moral
    obligation to provide this good in a way that maximizes its
    benefi t, is not wasteful and achieves what it claims to
    provide. It is not instrumental and cannot and should not
    be commodifi ed and/or subsumed by an ethic and ethos
    of the solely contractual market model or be focally
    subject to social construction.
    (Giordano J. Cassandra’s curse: Interventional pain
    management, policy and preserving meaning against a
    market mentality. Pain Physician 2006; 9: 167-170)
    Source: Giordano J, Board Review 2006
267
Q
  1. The moral obligation to treat pain is:
    A. stipulated in the legal statutes on fair medical
    practice(s)
    B. inherent to the declarative act of profession of the pain
    physician
    C. explicit to a maxim of non-harm
    D. a sole function of NIH and AMA policy on ethical medical
    practice
A
  1. Answer: B
    Explanation:
    The moral affi rmation and obligation to treat pain is
    explicit to the statement that one is a ‘pain physician’ and
    invites patient trust that the physician will act prudently in
    the best interest of the patient to cure, heal and/or care for
    pain. (Giordano J. Moral agency in pain medicine:
    Philosophy, practice and virtue. Pain Physician 2006; 9:
    41-46)
    Legal statutes do not prescribe moral affi rmations.
    The maxim of non-harm exists as constituent to a larger
    foundation of moral affi rmations and obligations.
    Moral values refl ect community interest; these create
    purpose that can be supported and advanced through the
    development and implementation of public healthcare
    policies
    Source: Giordano J, Board Review 2006
268
Q
  1. Which of the following statements is correct?
    A. A patient may request that a provider amend a diagnosis
    that was submitted on a billing claim form.
    B. A provider must act on a patient’s request for amendment
    within 30 days, either deny or amend.
    C. A provider does not agree with a patient’s request for
    an amendment. However, the provider must make the
    amendment but can note disagreement in the amendment
    and inform insurer.
    D. Provider has to amend diagnosis in 30 days as provider
    may not deny the patient request.
    E. Provider has no obligation even if the information on the
    claim was inaccurate.
A
  1. Answer: A
    Explanation:
    The privacy rule allows patients to request amendments of
    their records including amendments to billing records.
    The provider is not obligated to make the amendment if
    the provider believes that the original information (the
    diagnosis in this scenario) was accurate as submitted. In
    fact, from a billing compliance standpoint, the provider
    should not make the amendment if the original
    information was accurate and complete.
    A provider is given 60 days to act on amendment requests
    and providers are always permitted to deny amendment
    request when the information is accurate and complete
    when originally recorded.
    Source:Manchikanti L Principles and Practice of
    Documentation, Billing, Coding, and Practice
    Management 2005.
    Source: Erin Brisbay McMahon, JD, Sep 2005
269
Q
  1. Which of the following statements is correct?
    A. The HIPAA security rule requires that a criminal background
    check be conducted on everyone.
    B. Physician practices with less than ten full-time employees
    are not subject to HIPAA.
    C. A HIPAA-covered physician practice do not need to apply
    security rule standards to laptop computers owned
    by the practice.
    D. If an employee of a HIPAA-covered physician practice
    works from home and accesses electronic protected
    health information via a remote connection, the practice
    has no duty to make sure that its HIPAA security
    standards are followed at the employee’s home.
    E. If an employee of a HIPAA-covered physician practice
    works from home and accesses electronic protected
    health information via a remote connection, the practice
    has a duty to make sure that its HIPAA security
    standards are followed at the employee’s home.
A
  1. Answer: E
    Explanation:
    A covered entity’s responsibility to implement security
    standards extends to the members of its workforce,
    whether they work at home or on-site. Because a covered
    entity is responsible for ensuring the security of the
    information in its care, the covered entity must include ‘‘at
    home’’ functions in its security process.
    Source: 68 Fed. Reg. 8339
    Source: Erin Brisbay McMahon, JD, Sep 2005
270
Q
  1. A patient hand delivers a written request for a copy of
    his medical record to Smith and Jones, PSC, a physician
    practice that is a covered entity under HIPAA. The
    record contains information faxed to the PSC from other
    physicians and from the local hospital. The PSC should . .
    .?Choose the answer that best completes the sentence.
    A. Produce only those records the PSC has created and
    withhold the records received from other physicians
    and from the local hospital.
    B. Refuse the request if it is not notarized.
    C. Refuse the request if it is not signed by a witness.
    D. Produce all the records it has on the patient.
    E. Only release the portions of the record that the patient
    needs for treatment due to the minimum necessary
    rule.
A
  1. Answer: D
    Explanation:
    The Privacy Rule permits a provider who is a covered
    entity to disclose a complete medical record including
    portions that were created by another provider. No
    justifi cation for releasing the entire record is needed in
    those instances where the minimum necessary standard
    does not apply, such as disclosures to or requests by a
    health care provider for treatment purposes or disclosures
    to the individual who is the subject of the protected health
    information.
    Source:
    http://healthprivacy.answers.hhs.gov/
    Source: Erin Brisbay McMahon, JD, Sep 2005
271
Q
2190. Which of the following is NOT an element necessary to
prove a Stark law violation?
A. A referral by a physician
B. For a designated health service;
C. Entity has fi nancial relationship with physician or family
member
D. Billed to Medicare or Medicaid
E. Physician has intent to defraud.
A
  1. Answer: E
    Explanation:
    Stark is a strict liability statute. No intent to defraud is
    required to violate it.
    Source: Furrow B et al. Health Law: Cases, Materials, and
    Problems 2004 at 1034.
    Source: Erin Brisbay McMahon, JD, Sep 2005
272
Q
  1. Which of the following is not true with respect to an
    employer’s duty to communicate hazards to employees?
    A. Labels must include the Biohazard legend found in the
    regulation.
    B. Red bags or containers may be substituted for labels.
    C. The labels shall be fl uorescent yellow, orange, or orangered.
    D. All regulated waste, containers, refrigerators and freezers
    containing blood or other potentially infectious materials
    are required to be specifi cally identifi ed.
    E. All of the above.
A
  1. Answer: C
    Explanation:
    Labels shall be fl uorescent orange or orange-red or
    predominately so, with lettering and symbols in
    contrasting color.
    Source: 29 CFR 1910.1030(g).
    Source: Erin Brisbay McMahon, JD, Sep 2005
273
Q

2192.The patient asks for a prescription with the explicit
intent to end their life. This activity is considered as:
A. Voluntary Active Euthanasia
B. Voluntary Passive Euthanasia
C. Involuntary Passive Euthanasia
D. Involuntary Active Euthanasia
E. Physician Assisted Suicide

A
  1. Answer: E

Source: Weinberg M, Board Review 2005

274
Q
  1. CMS guidelines in a documentation of evaluation and
    management services recommend to use the following:
    A. SOAP- subjective, objective, assessment, and plan
    B. SOAPER - subjective, objective, assessment, plan, education
    and return instructions
    C. SOAPIE - subjective, objective, assessment, plan, implementation,
    and evaluation
    D. SNOCAMP - subjective, nature of presenting problem,
    counseling, assessment, medical decision making, and plan
    E. Documentation involving elements, bullets, and level of care.
A
  1. Answer: E
    Explanation:
    Source: Manchikanti L, Recent developments in evaluation
    and management services. Pain Physician 2000; 3:403-421.
    Source: Manchikanti L, Board Review 2005
275
Q
  1. What are the correct statements about standards and
    guidelines?
    A. Standard is a degree of quality, level of achievement, etc.,
    regarded as desirable and necessary for some purpose.
    B. Standards are systematically developed statements to
    help practitioners and patients make decisions about
    appropriate health care for specifi c clinical circumstances.
    C. Guidelines are documents demonstrating a degree of
    quality, level of achievement, etc., regarded as desirable
    and necessary for some purpose.
    D. Guidelines are superior to standards
    E. Guidelines are the same as standards
A
  1. Answer: A
    Explanation:
    Standard
    A degree of quality, level of achievement, regarded as
    desirable and necessary for some
    purpose.
    Guidelines
    Systematically developed statements to help practitioners
    and patients make decisions about
    appropriate health care for specifi c clinical circumstances.
    Source: Laxmaiah Manchikanti, MD
276
Q
2195. Which of the following is NOT considered an immediate
family member for purposes of Stark?
A. Stepbrother
B. Grandparent
C. Stepparent
D. Nephew
E. Spouse of grandchild
A
  1. Answer: D
    Explanation:
    A physician’s “immediate family member” means the
    physician’s husband or wife, birth or adoptive parent,
    child, or sibling; stepparent, stepchild, stepbrother, or
    stepsister; father-in-law, mother-in-law, son-in-law,
    daughter-in-law, grandparent or grandchild; and spouse of
    a grandparent or grandchild.
    Source: Erin Brisbay McMahon, JD, Sep 2005
277
Q

2196.The OIG does not have the discretion to exclude
individuals and entities from participation in federal
healthcare programs in cases where:
A. The individual or entity submitted a claim substantially
in excess of usual charges.
B. The individual or entity provided unnecessary or substandard
services.
C. An individual defaulted on an education loan in connection
with medical school loans made or secured by
HHS.
D. An individual was convicted of driving under the infl uence
of alcohol or substances.
E. An individual was convicted of a criminal misdemeanor
for fi nancial misconduct with respect to a healthcare
program

A
  1. Answer: D
    Explanation:
    The OIG has discretionary or permissive authority to
    exclude individuals and entities on the basis of all of the
    answers above, except for (d).
    Source: 42 U.S.C. § 1320a-7(b).
    Source: Erin Brisbay McMahon, JD
278
Q
  1. Morality, ethics and legal parameters are interactive in
    many ways. Which statement best describes the ethically
    maximized, legally appropriate practice of medicine?
    A. good laws are those that are morally sound
    B. aws establish limits; ethics establish exceptions
    C. moral affi rmations and obligations allow good use of
    ethics within the law
    D. know thyself and persist beyond mere limits
A
  1. Answer: C
    Explanation:
    What is morally ‘good’ or right is not always legal, and vice
    versa. Moral affi rmations and obligations guide the sound
    practice of medicine. Legal parameters defi ne the scope of
    that practice within a society.Thus, moral affi rmations and
    obligations guide ethical practice within the scope
    afforded by societal law(s) (Giordano J. Moral agency in
    pain medicine: Philosophy, practice and virtue. Pain
    Physician 2006; 9: 41-46).
    Source: Giordano J, Board Review 2006
279
Q
  1. Choose the answer that includes all the categories of
    exceptions under Stark:
    A. Ownership and compensation exceptions
    B. Compensation exceptions
    C. Ownership exceptions
    D. Financial exceptions, ownership exceptions, and compensation
    exceptions
    E. Ownership and compensation exceptions, ownership
    exceptions, and compensation exceptions
A
  1. Answer: E
    Explanation:
    If a fi nancial relationship exists between the DHS entity
    and the referring physician, it must fi t within an exception.
    Exceptions are broken down into three broad categories:
    ownership and compensation exceptions, ownership
    exceptions, and compensation exceptions. An ownership
    or investment interest requires an ownership exception. A
    compensation arrangement requires a compensation
    exception.
    Source: 42 CFR 411.354.
    Source: Erin Brisbay McMahon, JD, Sep 2005
280
Q
  1. Which of the following must appear in an accounting of
    disclosures to the patient?
    A. All disclosures for treatment purposes.
    B. All inadvertent disclosures that have been made to a person
    who is not the patient.
    C. All disclosures made pursuant to an authorization signed
    by the patient.
    D. All incidental disclosures.
    E. All disclosures made for purposes of claims processing
A
  1. Answer: B
    Explanation:
    Inadvertent disclosures of protected health information
    are required to be included in an accounting of disclosures.
    Source: 45 CFR 164.528.
    Source: Erin Brisbay McMahon, JD, Sep 2005
281
Q

2201.In pain medicine, the ‘mantle of responsibility’ ultimately
rests upon:
A. the administration of any medical facility as a community
to guide and shape the scope of practice
B. governmental policy that informs and directs medical
practice
C. the patient as an autonomous person to make and dictate
decisions
D. the physician as both a therapeutic and moral agent

A
  1. Answer: D
282
Q
  1. Although widely used, and indeed useful, one of the
    diffi culties with the sole use of prima facie principles to
    ethically guide medical practice is:
    A. that they are too restrictive and not ‘applied’ in nature
    B. potential collision and/or confl ict between principles
    C. problems in deciding which cases and what factors to
    focus upon
    D. all of the above
A
  1. Answer: B
    Explanation:
    Although principles are regarded as a very valuable system
    of applied ethics, one of the potential problems with using
    principles alone, is that without a grounding base, it may
    be diffi cult to ordinally ‘rank’ which principle should be
    applied in a given situation (ie.- when using the casuistic
    approach), particularly when more than one principle is
    viable. Such collisions or confl ict require some intuition
    on the part of the involved decision maker as ethical agent,
    and require some level of moral affi rmation and/or moral
    obligations to uphold the decision. (Giordano J. Moral
    agency in pain medicine: Philosophy, practice and virtue.
    Pain Physician 2006; 9: 41-46; Giordano J. Moral virtue
    and the pain physician: Agency, intentions and actions.
    Practical Pain Management 2006; 6(4): 76-80)
    Source: Giordano J, Board Review 2006
283
Q

2203.HIPAA mandates that physicians do which of the
following?
A. Obtain written patient consent to obtain a consultation
for services from another physician.
B. De-identify personal health information whenever possible.
C. Secure all medical records and lock the cabinets between
patient visits.
D. Never discuss clinical information with the family of the
patient.
E. Do not provide medical records to the patient when requested

A
  1. Answer: B

Source: Manchikanti L, Board Review 2005

284
Q
  1. You are providing multidisciplinary services. You also
    have ownership in a physical therapy located outside your
    clinic. The patient requires epidural steroid injection,
    along with physical therapy. Your obligation in this
    situation is as follows:
    A. Disclose to the patient at the time of referral
    B. Disclose to insurer upon request
    C. It is okay not to disclose if income from facility is based
    on percent of investment, not based on volume of referrals
    D. It is okay if your income from the facility is based on
    volume of referrals rather than based on percent of
    investment.
    E. Do not refer the patient to your facility and refer to another
    facility
A
  1. Answer: E

Source: Manchikanti L, Board Review 2005

285
Q
  1. Your transcriptionist has been making a signifi cant
    number of mistakes, her behavior has been erratic, and
    her attendance has been unacceptable. You suspect drug
    use. You decide to investigate by searching her desk and
    looking in her locker. When should you conduct the
    search?
    A. Randomly, without warning
    B. If you have a have a well-written policy advising your
    employees that you maintain the right to search the
    lockers and desks at any time, the employees will not
    have an expectation of privacy. Otherwise you will run
    the risk of claims of invasion of privacy
    C. Only after notifying her in advance that the search will
    take place.
    D. You may search her desk on a daily basis if you want to.
    E. You may search only if you suspect a weapon.
A
  1. Answer: B

Source: Judith Homes, Sep 2005

286
Q
  1. A 38-year old white female who underwent multiple
    lumbar surgeries with low back and lower extremity
    pain underwent one-day adhesiolysis with CPT 62264.
    She underwent adhesiolysis in the past with average
    relief of 3 months on 3 occasions in the past. This has
    improved her physical and functional status. Following
    the last adhesiolysis, which was performed bilaterally,
    however, the catheter was positioned at the end of the
    procedure on the left side laterally and ventrally. The
    medications included 5 mL of Xylocaine 2% preservative
    free, 6 mL of 10% sodium chloride solution, and 6 mg of
    non-particulate Celestone. She complained of signifi cant
    pain with the last dose of hypertonic sodium chloride
    injection in the recovery room on the right side. This
    was managed by giving her 1 mL of Fentanyl and 30 mg
    of Toradol. She presented 3 days after the injection with
    severe intractable pain on the right side of the lower
    extremity and low back with inability to move, however,
    the examination showed only mild subject weakness
    with no neurological defi cit. She was unable to tolerate
    Neurontin. She received only 20% to 30% relief with
    hydrocodone 4 times a day. A week after the procedure,
    MRI showed no evidence of abscess, discitis, etc. since she
    continued to be in pain, the physician performed a caudal
    epidural steroid injection under fl uoroscopy in an ASC.
    Choose the correct statement for coding this visit:
    A. Code 62311 – epidural steroid injection and caudal or
    lumbar epidural steroid injection and 99214 – established
    outpatient visit due to a detailed history, detailed
    examination and medical decision making of moderate
    complexity
    B. Code 62311 – caudal epidural steroid injection only
    C. Code 99214-25 – offi ce visit only without a procedure
    D. Neither Code 62311 nor an evaluation code 99214 or any
    other code may be charged as the patient is in the 10-
    day global period for the procedure
    E. Code 62311-78 return to the operating room for a related
    procedure in post-operative period and 99214-25
    – may be charged
A
  1. Answer: D
    Explanation:
    CPT 62264 has a 10-day global period. Since the
    procedure was performed within 10 days, basically the
    statement in D is accurate. However, the procedure may be
    charged with an attached note with modifi er -78 return to
    the operating room for a related procedure during the
    postoperative period. The visit may not be charged alone,
    since this is in the 10-day global period.
    Reference: Manchikanti L (ed). Principles of
    Documentation, Billing, Coding & Practice Management
    for the Interventional Pain Professional, ASIPP
    Publishing, Paducah KY 2004.
    Source: Laxmaiah Manchikanti, MD
287
Q
  1. A 58-year old white male underwent a trial subarachnoid infusion with morphine for neuropathic pain of lower
    extremity. A day after the catheter was removed, the
    patient complained of postural headache and was
    diagnosed with postlumbar puncture headache. The
    patient failed to respond to caffeine and bedrest , hence,
    it was decided to proceed with an epidural blood patch.
    Choose the correct statement with regards to coding of
    this procedure.
    A. CPT 62310 – caudal or lumbar epidural injection and
    CPT 99213-25 – offi ce or other outpatient visit of low
    complexity
    B. CPT 62273- epidural blood patch
    C. CPT 62273 – lumbar epidural blood patch, CPT 99213-
    25 - offi ce or other outpatient visit with medical decision
    making of low complexity
    D. CPT 62311-78 – lumbar epidural injection, return to
    the operating room for a related procedure during the
    postoperative period
    E. CPT 62311-79 – lumbar epidural, unrelated procedure
    or service by the same physician during the postoperative
    period
A
  1. Answer: B
    Explanation:
    The correct answer is 62273 – epidural blood patch. For
    continuos intrathecal catheterization, the global period is
    one day. Consequently, the global period rules do not
    apply. Since the procedure is performed for the same
    purpose as the patient complaints are, no evaluation
    coding may be done in this scenario.
    Reference: Manchikanti L (ed). Principles of
    Documentation, Billing, Coding & Practice Management
    for the Interventional Pain Professional, ASIPP
    Publishing, Paducah KY 2004.
    Source: Laxmaiah Manchikanti, MD
288
Q
  1. Which one of the following gifts is inappropriate?
    A. A $5 gift certifi cate for lunch
    B. $100 stethoscope
    C. $200 pain management book
    D. Information on continuing medical education
    E. One month supply of cholesterol drug for personal use
A
  1. Answer: C

Source: Manchikanti L, Board Review 2005

289
Q

2209.If an implementation specifi cation in the HIPAA
security rule is labeled “addressable,” that means that
the specifi cation . . . ?Choose the word or phrase that best
completes the sentence.
A. Is required.
B. Is optional.
C. Does not need to be implemented now, but will need to
be implemented by April 20, 2010.
D. Is one whose appropriateness and reasonableness must
be assessed.
E. Does not need to be implemented now, but will need to
be implemented by April 20, 2006.

A
  1. Answer: D
    Explanation:
    A covered entity must assess whether an addressable
    implementation specifi cation is appropriate and
    reasonable for it in light of its security risks.
    Source: 45 CFR 164.306.
    Source: Erin Brisbay McMahon, JD, Sep 2005
290
Q
  1. Which one of the following procedures is the most
    correct statement of the requirements of the HIPAA
    privacy rule, assuming that the physician is a covered
    entity under HIPAA?
    A. The HIPAA privacy notice must be posted in a physician’s
    offi ce and a copy need only be given to a patient
    when s/he requests it.
    B. A HIPAA privacy notice must be posted in a physician’s
    offi ce and must be given to every patient on the date
    s/he is fi rst rendered services.
    C. A HIPAA privacy notice need not be posted in a physician’s
    offi ce and a copy need only be given to a patient
    when s/he requests it.
    D. A HIPAA privacy notice need not be posted in a physician’s
    offi ce, but must be given to every patient on the
    date s/he is fi rst rendered services.
    E. If the physician maintains a website, the patients may be
    told to go to the website to obtain a copy of the privacy notce
A
  1. Answer: B
    Explanation:
    The HIPAA Privacy Rule requires a covered health care
    provider with direct treatment relationships with
    individuals to give the notice to every individual no later
    than the date of fi rst service delivery to the individual and
    to make a good faith effort to obtain the individual’s
    written acknowledgment of receipt of the notice. If the
    provider maintains an offi ce or other physical site where
    she provides health care directly to individuals, the
    provider must also post the notice in the facility in a clear
    and prominent location where individuals are likely to see
    it, as well as make the notice available to those who ask for
    a copy.
    Source: 45 CFR 164.520(c).
    Source: Erin Brisbay McMahon, JD, Sep 2005
291
Q
  1. A new patient presenting to your clinic says he is
    OxyContin 100 mg tid with Oxycodone 10 mg qid for
    breakthrough pain. Records from old physician indicate
    that he is worried about addiction. You also realize that
    the physician has started reducing his dosage to 80 mg tid,
    but the patient says he is running out of prescriptions.
    Your diagnosis and options are as follows:
    A. Diagnosis is drug abuse, refer to an addictionologist
    B. Diagnosis is drug addiction, start rapid detoxifi cation
    C. Diagnosis is pseudoaddiction, increase OxyContin and
    oxycodone until he is pain free
    D. Treatment is to change to methadone maintenance for
    addiction
    E. Diagnosis is typical pain behavior, continue narcotic
    therapy
A
  1. Answer: A

Source: Manchikanti L, Board Review 2005

292
Q
  1. Your receptionist has fi led an EEOC Charge against
    you and the clinic, claiming she has been the victim of
    race discrimination and harassment in your offi ce. She
    continues to work for you while this Charge is pending.
    What should you do?
    A. Immediately call a meeting with the rest of your staff,
    tell them about the pending action and warn them not
    to have any unnecessary conversations with the receptionist.
    B. Transfer the receptionist to the fi le room and have her do
    fi ling so that she won’t have contact with anyone she has
    accused of discrimination.
    C. You have the right to terminate her, because the tension
    in the offi ce has cut down on productivity.
    D. Don’t terminate her without fi rst gathering lots of documentation.
    Start monitoring the receptionist’s attendance,
    punctuality, and job performance more closely.
    Document all policy violations, and when you have
    enough ammunition against her, terminate h
    E. Do none of the above as they are all examples of retaliation,
    which is a violation of discrimination laws
A
  1. Answer: E

Source: Judith Homes, Sep 2005

293
Q
  1. A concert pianist and a vice president of a major
    corporation have both suffered the loss of the second
    fi nger of the dominant hand. Which of the following
    statements is true regarding the condition of impairment
    or disability due to the injury?
    A. The concert pianist is more impaired than the vice
    president.
    B. The concert pianist and vice president are equally disabled.
    C. The concert pianist and vice president are both handicapped.
    D. The concert pianist is more disabled than the vice president.
    E. The concert pianist is more handicapped than the vice
    president
A
  1. Answer: D
    Explanation:
    Source: AMA Guides to the Evaluation of Permanent
    Impairment, 2001.
    Both the concert pianist and the company vice president
    have an impairment due to the loss of their digit.
    However, the concert pianist is signifi cantly more disabled
    because the pianist will not be able to perform but the
    vice president will still be able to do the job. They are not
    signifi cantly handicapped because they can still perform
    life’s activities without the use of assistive devices or
    modifi cation of the environment.
    Source: Manchikanti L, Board Review 2005
294
Q
  1. The HIPAA security rule applies to . . .? Choose the
    answer that best completes the sentence.
    A. Electronic protected health information only.
    B. All forms of protected health information.
    C. Protected health information transmitted electronically
    or telephonically.
    D. Oral protected health information.
    E. Protected health information communicated orally or
    telephonically.
A
  1. Answer: A
    Explanation:
    A covered entity must comply with the HIPAA Security
    Rule with respect to electronic health information only.
    Source: 64 CFR 164.302.
    Source: Erin Brisbay McMahon, JD, Sep 2005
295
Q
  1. Which of the following statements is correct?
    A. patient may request that a provider amend a diagnosis
    that was submitted on a billing claim form.
    B. A provider must act on a patient’s request for amendment
    within 30 days, either deny or amend.
    C. A provider does not agree with a patient’s request for an
    amendment. The provider must make the amendment
    but can note disagreement in the amendment and inform
    the insurer.
    D. Provider has to amend diagnosis in 30 days as provider
    may not deny the patient requests.
    E. Provider has no obligation even if the information on the
    claim was inaccurate.
A
  1. Answer: A
    Explanation:
    Source: Manchikanti L, Principles of Documentation,
    Billing, Coding & Practice Management 2004
    The privacy rule allows patients to request amendments of
    their records including amendments to billing records.
    The provider is not obligated to make the amendment if
    the provider believes that the original information (the
    diagnosis in this scenario) was accurate as submitted.
    In fact, from a billing compliance standpoint the
    provider should not make the amendment if the original
    information was accurate and complete.
    A provider is given 60 days to act on amendment
    requests and providers are always permitted to deny
    amendment requests when the information is accurate
    and complete when originally recorded.
    Source: Manchikanti L, Board Review 2005
296
Q
  1. A physician bills bilateral facet joint injections at C4/5,
    C5/6, and C6/7. What are the appropriate nerves to be
    blocked to bill bilaterally C4/5, C5/6, and C6/7 joints?
    A. Bilateral medial branch blocks of C2, C3, C4, and C5
    nerves must be blocked
    B. Bilateral medial branch blocks of C5, C6, and C7 nerves
    must be blocked
    C. Bilateral medial branches of C4, C5, C6, and C7 must
    be blocked
    D. Bilateral C3 through C8 medial branches must be
    blocked
    E. Bilateral 3 nerves (total) only must be blocked
A
  1. Answer: C
297
Q
  1. An interventional pain physician billed for blocking of
    left T5/6 and T9/10 facet joints. What are the nerves to be
    blocked for proper blockage of both joints?
    A. T3 and T4 medial branches on the left side
    B. T4 and T5 medial branches on the right side
    C. T3, T4 and T6, T7 medial branches on the left side
    D. T4, T5 and T7, T8 medial branches on the left side
    E. T5, T6 and T8, T9 medial branches on the left side
A
  1. Answer: D
298
Q
  1. The intentions, motivations and moral affi rmations to
    treat, heal and care as refl ecting the intellectual and moral
    ‘character’ traits of the physician support:
    A. the use of the principlist approach to medical ethics
    B. the benefi t of a casuistic approach to medical ethics
    C. the importance of agent-based system of virtue ethics
    D. a strongly utilitarian (ie.- ends justifying means) approach
    to medical ethics
A
  1. Answer: C
    Explanation:
    Any encounter can be reduced to a circumstance, agents
    involved, actions and consequences; thus the intentional,
    motivational and ultimate acts arise from the agent(s). The
    intentions and motivations, as refl ecting ingrained traits
    of character, refl ect the virtue(s) of the agent involved.
    These intentions, and motivations can empower better
    intuition of the use of principles and the casuistic
    approach in specifi c circumstances, and also ground the
    agents’ actions to the defi ned ends of medicine, keeping
    those acts consistent with the good of the practice.
    (Giordano J. Moral agency in pain medicine:
    Philosophy, practice and
    virtue. Pain Physician 2006; 9: 41-46; Giordano J. Moral
    virtue and the pain physician: Agency, intentions and
    actions. Practical Pain Management 2006; 6(4): 76-80. See
    also: Pellegrino ED. Professionalism, profession and the
    virtues of the good physician. Mt Sinai J. Med. 2002; 69:
    378-384)
    Source: Giordano J, Board Review 2006
299
Q
  1. Which of the following statements about disulfi ram
    treatmetn of chronic alcoholism are correct?
  2. Indicated when the patient will not comply with other
    treatments
  3. Indicated in patients with Korsakoff syndrome
  4. Used when hepatic cirrhosis is present
  5. May be used in patients with antisocial personality
    disorder
A
  1. Answer: D (4 Only)
    Explanation:
    Disulfi ram treatment is an important adjunct to the
    rehabilitation program with the alcoholic. The patient
    only has to make the decision about not drinking, and it
    gives the individual time to think about the impulse to
    drink. Therefore, the patient must be health (due to the
    side effects with alcohol), highly motivated, and
    cooperative.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
300
Q
  1. Select the statements that are true.
  2. A Pain Management Specialist, Specialty 72, may report
    any code in the Osteopathic Manipulation Section of
    the CPT Manual
  3. A Pain Specialist, regardless of specialty designation,
    may report any CPT code for which services h/she is
    trained and licensed to perform
  4. When a Pain Specialist reports a CPT code to a third
    party payer, h/she represents that h/she is trained and
    licensed to perform the service.The provider is legally
    responsible from a patient care perspective and for
    truthful billing of his/her services.
  5. An Interventional Pain Specialist, Specialty 9 may not
    report any of the CPT codes listed in the Chiropractic
    Section of the CPT Manual
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Page xiii of the CPT Manual affi rms that, “It is important
    to recognize that the listing of a service or procedure and
    its code number in a specifi c section of this book does not
    restrict its use to a specifi c specialty group. Any procedure
    or service in any section of this book may be used to
    designate the services rendered by any qualifi ed physician
    or other qualifi ed health care professional”.
    Providers of medical service should consider the risk of
    reporting services for which they are not fully trained and
    licensed to perform. For example, when a Pain Specialist
    advises a patient that a hip arthrogram is being performed
    and charges the insurance carrier for a hip arthrogram, the
    expectation is that a diagnostic radiological study has been
    performed. The doctor would be expected to identify
    whether or not there is any bone disease or arthritic
    condition of the hip. If the doctor fails to identify a
    condition that causes the patient future disability which
    early treatment could have prevented, a malpractice suit
    could result.
    The “take home message” on Page xiii of the CPT Manual
    is “…by any qualifi ed physician or other qualifi ed health
    care professional.”
    Source: CPT Coding Manual, Professional Version 2005
    Source: Joanne Mehmert, CPC
301
Q

2221.Which of the following best describe approaches for
generating employee improvement that can be used as
part of the evaluation process?
1. Develop goals and objectives for employees whose performance
is satisfactory, and those whose performance
is inconsistent or marginal.
2. Develop a bar graph comparing productivity of all
employees in the department/division, and attach it to
each employee’s performance evaluation.
3. Develop performance requirements for employees
whose performance is unsatisfactory
4. Develop photos from the offi ce holiday party and
promise not to post at the front desk if performance
improves

A
  1. Answer: B (1 & 3)
    Explanation:
    Goals and objectives encourage improvement, while
    performance requirements mandate that an unsatisfactory
    employee improve or face the consequences. Both goals
    and requirements are elements of an effective employee
    evaluation
    Source: Judith Holmes
302
Q
  1. Which of the following statements about Alcoholics
    Anonymous are correct?
  2. Closely integrated with mental health services in most
    areas
  3. Control is primarily through group support
  4. Goal is a socially acceptable level of alcohol intake
  5. Typical attendance is several times per week
A
  1. Answer: C (2 & 4)
    Explanation:
    Alcoholics Anonymous (AA) is a voluntary, supportive
    fellowship, self-help group, and is worldwide. It was
    founded in 1936 by Bill Wilson. Meetings provide
    acceptance, understanding, forgiveness, confrontation, and
    a means of positive identifi cation. Programs consist of 12
    steps and the use of sponsors. AA is not tied to any
    religion, but does allow for spiritual reevaluation.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
303
Q
  1. Abrupt drug withdrawal is likely to be life threatening in a patient addicted to:
  2. Cocaine
  3. Heroin
  4. Diazepam
  5. Meprobamate
A
  1. Answer: D (4 Only)
    Explanation:
    A physical withdrawal syndrome occurs when a drug has
    become necessary to maintain homeostasis, usually after
    months of use and doses above therapeutic level. Abrupt
    stoppage of commonly used drugs such as narcotics,
    benzodiazepines, barbiturates, and alcohol can result in
    seizures, delirium, and cardiovascular collapse.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
304
Q
  1. Which of the following statements are correct in the
    treatment of pregnant opioid addicts?
  2. High-dose methadone maintenance leads to low-risk
    neonatal withdrawal
  3. Opioid withdrawal may lead to miscarriage or fetal
    death
  4. Women using opioids tend to have easy, uncomplicated
    deliveries
  5. Many opioid dependence women seek treatment when
    they become pregnant
A
  1. Answer: C (2 & 4)
    Explanation:
    Opioid addicts who are pregnant present special risks as
    high doses of narcotics (especially methadone) can lead to
    fetal problems on withdrawal or during delivery.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
305
Q
  1. Which of the following statements about the treatment
    of chronic alcoholism with disulfi ram are correct?
  2. Alcohol dehydrogenase is inhibited
  3. Aldehyde accumulation causes vasodilation and hypotension
  4. Indicated in alcohol-induced dementia
  5. Treatment benefi t is not dose-related
A
  1. Answer: C (2 & 4)
    Explanation:
    Disulfi ram is taking in a 250-500 mg dose per day.
    Higher doses can be toxic, resulting in psychosis, memory
    impairment, and confusion without offering any better
    control.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
306
Q
2226. Medical complications of chronic alcoholism include all
of the following except:
1. Cardiomyopathy
2. Chronic pancreatitis
3. Fetal growth retardation
4. Hepatolenticular degeneration
A
  1. Answer: D (4 Only)
    Explanation:
    Medical complications of chronic alcoholism are gastric
    bleeding, gastritis, achlorhydria, gastric ulcers, chronic
    pancreatitis, fatty liver, hepatitis, cirrhosis,
    cardiomyopathy, lowered immune response, hypoglycemia
    (may result in sudden death), an inhibited vitamins and
    amino acids absorption. In males, testicular atrophy,
    feminine pubic hair pattern, breast enlargement, and
    impotency may occur; female alcoholics may show
    decreased menstruation and infertility. Fetal alcohol
    syndrome (growth retardation before or after birth, small
    head circumference, fl attening of facial features, CNS
    problems) is likely to be present in infants of female
    alcoholics.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
307
Q
2227. Which of the following statements about alcoholinduced
blackouts are correct?
1. Remote memory defi cit
2. Immediate memory defi cit
3. Does not occur in non-alcoholics
4. Short-term memory defi cit
A
  1. Answer: D (4 Only)
    Explanation:
    During alcohol induced blackouts, an “amnestic disorder,”
    there are periods of retrograde amnesia (short-term
    memory defi cits), even though state of consciousness may
    not appear to be abnormal.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
308
Q
  1. Which of the following statements are true?
  2. An employee must complain to the appropriate supervisor
    in order to have claim of harassment
  3. If most people laugh at your colorful language and jokes,
    it’s not harassment.
  4. Harassment doesn’t cover joking with people who are
    my same sex or race.
  5. Only the person who is targeted with offensive behavior
    can complain.
A
  1. Answer: C (2 & 4)
    Explanation:
    An employee may have a claim of harassment even though
    some people don’t fi nd the conduct or language offensive,
    even if the comments were not directed to that employee,
    and even if the harasser and victim are the same sex or
    race.
    Under certain circumstances, the employer will have a
    defense to a harassment suit if the victim did notcomplain,
    but the victim’s failure to complain will not insulate an
    employer from an EEOC claim and subsequent costly
    lawsuit
    Source: Judith Holmes
309
Q
  1. True statements defi ning disability include the
    following:
  2. An alteration of an individual’s capacity to meet personal,
    social, or occupational demands because of an
    impairment.
  3. Activity limitation or a diffi culty in the performance, accomplishment,
    or completion of an activity at the level
    of the person.
  4. The inability to engage in any substantial, gainful activity
    by reason of any medically determinable, physical, or
    mental impairment(s).
  5. Disability is a barrier to full functional activity that may be overcome by compensating in some way for the
    causative impairment.
A
  1. Answer: A (1, 2, & 3)
    Explanation:
  2. An alteration of an individual’s capacity to meet
    personal, social, or occupational demands because of an
    impairment (AMA Guides to the Evaluation of Permanent
    Impairment).
  3. Activity limitation (formerly disability) is a diffi culty in
    the performance, accomplishment, or completion of an
    activity at the level of the person. Diffi culty encompasses
    all of the ways in which the doing of the activity may be
    affected (WHO).
  4. The inability to engage in any substantial, gainful
    activity by reason of any medically determinable physical
    or mental impairment(s), which can be expected to last for
    a continuous period of not less than 12 months (SSA).
  5. “Temporary disability” means a decrease in wageearning
    capacity due to injury or occupational disease
    during a period of recovery. “Permanent disability”
    results when the actual or presumed ability to engage in
    gainful activity is reduced or absent because of permanent
    impairment and no fundamental or marked change in the
    future can be reasonably expected (Work Comp Law).
    Source: AMA Guides to the evaluation of Permanent
    Impairment, 2001.
310
Q
  1. Which of the following medications can be used
    therapeutically in the rehabilitation of opioid dependent
    patients?
  2. Methadone
  3. Naltrexone
  4. Clonidine
  5. Levo-alpha-acetylmethadol
A
  1. Answer: E (All)
    Explanation:
    Medications used in the rehabilitation (maintenance) of
    opioid-dependent patients are methadone (as a substitute
    for opiates), a combination of naltraxone and clonidine
    (long-acting antagonists) and L-alpha-acetylmethadol
    (LAAM, an agonist similar to methadone but longer halflife).
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
311
Q
  1. The true statements with regards to Americans with
    Disabilities Act include the following:
  2. The Americans with Disabilities Act is a civil rights law
    that was signed by President Bush in 1990.
  3. ADA was intended to provide a clear and comprehensive
    national mandate to end discrimination against
    individuals with disabilities and bring those individuals
    into economic and social mainstream of American life.
  4. The ADA defi nes disability as a physical or mental impairment
    that substantially limits one or more of the
    major life activities of an individual.
  5. A person needs to meet all the 3 criteria in the defi nition
    to gain the ADA’s protection against discrimination.
A
  1. Answer: A (1, 2, & 3)
    Explanation:
    The ADA defi nes disability as a physical or mental
    impairment that substantially limits one or more of the
    major life activities of an individual; a record of
    impairment, or being regarded as having an impairment.
    A person needs to meet only 1 of the 3 criteria in the
    defi nition to gain the ADA’s protection against
    discrimination.
    The physician’s input often is essential for determining the
    fi rst 2 criteria and valuable for determining the third.
    To be deemed disabled for purposes of ADA protection, an
    individual generally must have a physical or mental
    impairment that substantially limits one or more major
    life activities. A physical or mental impairment could be
    any mental, psychological, or physiological disorder or
    condition, cosmetic disfi gurement, or anatomical laws that
    affects one or more of the following body systems:
    neurological, special sense organs, musculoskeletal,
    respiratory, speech organs, reproductive, cardiovascular,
    hematologic, lymphatic, digestive, genitourinary, skin, and
    endocrine.
    Conditions that are temporary are not considered to be
    severe, such as normal pregnancy, are not considered
    impairments under the ADA. Other non-impairments
    include features and conditions such as hair or eye color,
    left-handedness, old age, sexual orientation, exhibitionism,
    pedophilia, voyeurism, sexual addiction, cleptomania,
    pyromania, compulsive gambling, gender identity
    disorders not resulting from physical impairment,
    smoking, and current illegal drug use or resulting
    psychoactive disorders.
312
Q
  1. Reduced effectiveness of cancer pain control with
    intraspinal morphine infusions may be due to which of
    the following:
  2. Fibrosis
  3. Tolerance
  4. Disease progression
  5. Morphine metabolites
A
  1. Answer: A (1, 2, & 3)
    Explanation:
    Long-term loss of effi cacy is associated with technical
    problems, disease progression and drug tolerance.
313
Q
  1. True statements about NMDA receptors are as follows:
  2. A number of heterogenous chemicals are antagonists of
    the N-methyl-D-aspartate (NMDA) receptor subtype
    of the major excitatory neurotransmitter, glutamic
    acid, in the brain.
  3. NMDA antagonists include phencyclidine, dizocilpine,
    and nitrous oxide.
  4. Most of the known NMDA antagonists are drugs of
    abuse.
  5. NMDA antagonists in low doses induce a psychotomimetic
    state, which resembles schizophrenia.
A
  1. Answer: E (All)
    Explanation:
  2. A number of heterogenous chemicals are antagonists of
    the N-methyl-D-aspartate (NMDA) receptor subtype of
    the major excitatory neurotransmitter, glutamic acid, in
    the brain.
  3. NMDA antagonists include arylcyclohexylamines (of
    which phencyclidine and ketamine are best known),
    dizocilpine (MK-801), and nitrous oxide.
  4. Most of the known NMDA antagonists are drugs of
    abuse when used in sub-anesthetic doses/concentrations.
  5. Sub-anesthetic doses of phencyclidine and ketamine
    induces psychotomimetic state, which resembles many of
    the signs and symptoms of schizophrenia.
    Nitrous oxide or laughing gas has not yet been classifi ed
    as psychotomimetic. However, its euphoric and dysphoric
    properties have been known for more than 200 years but
    have not been well studied by psychiatrists
314
Q
  1. In a malpractice action, the fi nal determination of
    culpability and liability are determined by:
  2. Deviation of the standards of practice
  3. Causation of incident
  4. Damage and suffering due to the incident
  5. History of previous lawsuits
A
  1. Answer: A (1, 2, & 3)
    Explanation:
    The fi nal determination of culpability or lack thereof is
    contingent on determining whether the physician followed
    standards of practice for his or her specialty.
    Source: Hall and Chantigan.
315
Q
  1. Which of the following is a true statement with respect
    to HIPAA Privacy Compliance?
  2. Only practices with 10 or more employees need to comply
    with the HIPAA Privacy Rule.
  3. Disclosures for treatment, payment, and health care operations
    must be tracked for accounting of disclosures
    purposes
  4. Even if it is discovered that an employee of the practice
    violated the HIPAA Privacy Rule, no sanction need be imposed for a minor violation
  5. The three major issues with respect to HIPAA privacy
    compliance are (a) how to use and disclose protected
    health information; (b) the patient’s rights under the
    Privacy Rule; and (c) the provider’s legal obligations
    under the Privacy Rule
A
  1. Answer: D (4 Only)
    Explanation:
    If a provider has less than ten full time employees, it can
    continue submitting claims on paper. However, all
    physician practices that conduct any of the electronic
    transactions covered by HIPAA (including fi ling claims
    electronically with a third-party payor) must comply with
    HIPAA Privacy Rule.
    2)Disclosures for treatment, payment, and health care
    operations are not required to be tracked for accounting of
    disclosures purposes. 45 CFR 164.528.
    3)Sanctions have to be imposed under both the Privacy
    and the Security Rules if an employee is found to have
    violated either rule, no matter how small the violation
    Source: Erin Brisbay McMahon, JD
316
Q
  1. Choose the answers that apply? Do non-Medicare payers
    allow separate payment for supplies such as needles,
    syringes and/or surgical trays used for nerve blocks and
    injections when they are performed in the offi ce, POS 11?
  2. No, private payers do not allow additional payment for
    supplies
  3. Payment for supplies used for nerve blocks and injections
    is payer specifi c. There is no “every carrier”
    policy. Payers that have a fee differential modeled after
    Medicare’s higher “offi ce” rate are less likely to pay for
    supplies
  4. Yes, private payers will pay an additional fee for all supplies
    used in the offi ce
  5. Payment for supplies is an issue that should be addressed
    in the fee schedule section of the contractual
    agreement, especially when the carrier doesn’t have a
    higher payment for services performed in an offi ce
A
  1. Answer: C (2 & 4)
    Explanation:
    Payer fee schedules seldom address the payment of
    supplies nor are there any codes listed for surgical trays
    and/or supplies. Unless the contractual agreement
    specifi cally prohibits the physician from reporting
    supplies, it is appropriate to bill separately for the
    supplies. More expensive equipment and supplies should
    be carved out to ensure adequate reimbursement.
    Source: Manchikanti L, Principles and Practice of
    Documentation, Billing, Coding, and Practice
    Management 2005
    Source: Joanne Mehmert, CPC
317
Q
2237. In adults with no prior history of seizure disorder,
seizures may be caused by:
1. Phencyclidine intoxication
2. Cocaine intoxication
3. Amphetamine intoxication
4. Meperidine intoxication
A
  1. Answer: E (All)
    Explanation:
    Drugs that can cause seizures are phencyclidine, cocaine,
    alcohol, lithium, amphetamine, meperidine, and
    benzodiazepines.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
318
Q
  1. Which of the following statements about psychedelic
    drug use are corrects?
  2. Tolerance quickly develops if used frequently
  3. Tolerance persists for extended period after drug use
    stopped
  4. No withdrawal phenomena when stopped after chronic
    use
  5. Cross-tolerance between LSD and amphetamines
A
  1. Answer: B (1 & 3)
    Explanation:
    Repeated psychedelic drug use over an extended period of
    time can quickly result in tolerance. There is a crosstolerance
    with LSD, mescaline, and psilocybin, but not
    between LSD and emphetamines or delta9-THC. There is
    no known withdrawal pattern.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
319
Q
  1. Level IA evidence for interventions to reduce blood
    borne infections from central venous catheters include:
  2. Maximal sterile barrier precautions
  3. Povidone-iodine ointment at exit site
  4. Chlorhexidine-based antiseptic is preferred
  5. Complete infusion of crystalloid fl uids within 4 hours
A
  1. Answer: A (1, 2, & 3)
    Explanation:
    No recommendations can be made regarding fl uid hang
    time other than for lipids and blood. Povidone-iodine
    ointment is Level II.
320
Q
  1. Payment for clinical services based on the Medicare
    RBRVS includes all of the following components:
  2. Physician work
  3. Malpractice
  4. Clinically-related practice expenses
  5. Physician availability for emergency care
A
  1. Answer: A (1,2, & 3)

Source: Manchikanti L, Board Review 2005

321
Q
  1. The term handicap
  2. Applies to a person who has impairment that substantially
    limits life’s activities.
  3. Is related to but different from the term impairment.
  4. Can be applied to an impaired person who requires the use of an assistive device to perform activities of daily
    living.
  5. Can be applied to a disabled person who requires
    modifi cation of the environment to perform activities
    of daily living.
A
  1. Answer: E (All)
    Explanation:
    All the statements listed apply to the term handicap as
    defi ned in the AMA guidelines. It is the physician’s
    responsibility to evaluate a patient’s health status and
    determine the degree of impairment. If the physician also
    has the ability to assess the patient’s activities and need for
    assistive devices to perform those activities, an opinion
    regarding the degree of disability or handicap may be
    given as well.
    Source: AMA Guides to the evaluation of Permanent
    Impairment, 2001.
322
Q
  1. History of present illness includes multiple descriptors
    showing the chronological description of development of
    patient’s symptom(s). These include:
  2. Location and quality
  3. Severity and duration
  4. Modifying factors
  5. Review of pertinent systems involved in the complaint
A
2242. Answer: A (1, 2, & 3 )
Explanation:
Four components of history include:
chief complaint
(CC)
history of present illness (HPI)
past, family,
social history (PFSH)
review of systems (ROS)
History of present illness includes:
location
quality
severity
duration
timing
context
modifying factors
associated signs and symptoms but not review of systems
323
Q
  1. The medical record includes each of the following:
  2. To be secure and uniquely identify the patient
  3. To be immediately available for patient and physicians
    to review
  4. Contain completed operative note within 24 hours of
    the procedure
  5. To explain rationale of procedure for CPT assessment
A
  1. Answer: B ( 1 & 3)
    Explanation:
    To comply with the recommended mandates in the
    medical record, the record should be timely and legible,
    secure, anduniquely identify the patient, confi dential,
    contain a recent history and physical to be completed
    within 24 hours of procedure, and contain preoperative,
    intraoperative and postoperative nursing notes. At the
    time the ASC experiences patient contact, medical decision
    making is already completed for the procedure. The
    ASC’s position is to assist in best documentation of the
    procedure, and to assist the physician in supportive
    documentation.
    Source: Hans C. Hansen, MD
324
Q
2244. The following statements are true regarding Fentanyl as
a good agent for transdermal use,
1. Low molecular weight
2. Adequate lipid solubility
3. High analgesic potency
4. Low abuse potential
A
  1. Answer: A (1, 2, & 3)
    Explanation:
    Fentanyl has a low molecular weight and high lipid
    solubility; this allows it to be administered by the
    transdermal route. It is interacts primarily with the ?-
    receptors. It is about 80 times more potent than morphine.
    The low abuse potential for fentanyl is a property of the
    transdermal delivery system and not of the opioid itself.
    Source: Chopra P, 2004
325
Q
  1. Which of the following statements about diazepamdependent
    patients are correct?
  2. Withdrawal symptoms become disabling within 24
    hours of stopping
  3. Low alcohol intake may precipitate overdose
  4. Most likely to be black male
  5. May show no disability until stopping diazepam use
A
  1. Answer: C (2 & 4)
    Explanation:
    Diazepam has a high potential for abuse and dependence,
    which may develop over months (high doses) to years
    (low doses). Alcohol, opiates, or cocaine intake may
    precipitate overdose. The patient, if tolerant or dependent,
    may show no disability until several days later after
    stopping the use of diazepam when withdrawal symptoms
    develop.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
326
Q
2246. The following are components of the RBRVS payment
system:
1. Physician work component
2. Practice expense component
3. Professional liability component
4. Business risk component
A
  1. Answer: A (1, 2 & 3 )

Source: Marsha Thiel, RN, MA

327
Q
2247. In amphetamine delusional disorder, the patient is likely
to show:
1. Paranoid delusions
2. Craving for food
3. Tactile hallucinations
4. Excessive REM sleep
A
  1. Answer: B (1 & 3)
    Explanation:
    Amphetamine and cocaine delusion disorders are very
    similar and can resemble paranoid schizophrenia.
    Common symptoms are paranoid delusions with
    distortions of body image and misperception of face, a
    predominance of visual and tactile hallucinations,
    confusion, incoherence, hyperactivity and hypersexuality.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
328
Q

2248.The following components of physical therapy visit or
treatment cannot be carried out by a physical therapist
assistant:
1. Ultrasound and electrical stimulation treatment
2. Initial evaluation, examination, diagnosis
3. Daily assessment of patient’s progression toward goals
4. Discharge summary documentation

A
  1. Answer: C (2 & 4)
    Explanation:
    1)Modalities such as ultrasound and electrical stimulation
    can be performed by a PTA when they are part of the
    designated plan of treatment.
    2)Initial evaluation, examination, and diagnosis require
    the clinical decision making skills of a physical therapist
    and therefore cannot be carried out by a PTA.
    3)PTA’s are able to and should document a patient’s
    progression at each visit.
    4)Discharge documentation requires clinical decision
    making and again, must be done by PT
    Source: Guide to Physical Therapist Practice
    Source: Marsha Thiel, RN, MA
329
Q
  1. Which of the following statements about L-alpha-acetyl methadol are correct?
  2. Similar in action to methadone
  3. Dispensed only three times a week
  4. May cause nervousness and stimulation
  5. Withdrawal syndrome much shorter than methadone
A
  1. Answer: A (1, 2, & 3)
    Explanation:
    Levo-alpha-acetylmethadol (LAAM) is an opioid agonist
    similar to methadone in action but with a longer half-life.
    Since it provides a longer time of suppression of
    withdrawal for 72-96 hours, it can be dispensed (30-80
    mg) only three times per week and has less abuse potential
    due to its slow induction. LAAM may cause nervousness,
    overstimulation, and mood side effects.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
330
Q
2250. Compared with fentanyl, characteristics of alfentanil
include
1. Greater protein binding
2. More rapid clearance
3. Shorter elimination half-life
4. Greater volume of distribution
A
  1. Answer: A (1, 2, & 3)
331
Q
  1. Which of the following statements about LSD fl ashbacks
    are correct?
  2. Often triggered by marijuana use
  3. Usually cease within a few months of stopping hallucinogen
  4. Often pleasant to the hallucinogen user
  5. Subject may intentionally induce
A
  1. Answer: E (All)
    Explanation:
    LSD fl ashbacks are common, with 25% of users
    experiencing an episode and with 5% there will be a severe reaction. Flashbacks usually cease in a few months after
    stopping the drug use. The most common type of
    fl ashbacks are hallucinations of formed objects (face,
    geometric), sounds, voices, fl ashes of color, false
    perceptions of movement, positive afterimages, and trails
    of images from moving objects. Most of the fl ashback
    symptoms are enjoyable. It is rare for the drug to produce
    any lethal effects. Chromosomal damage from the use of
    hallucinogens or from marijuana use is still questionable.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
332
Q
  1. Alcoholics using disulfi ram should avoid using?
  2. Aftershave
  3. Tricyclic antidepressants
  4. Cough syrup
  5. Pickled herring
A
  1. Answer: B (1 & 3)
    Explanation:
    Disulfi ram (Antabuse) results in a severe reaction if
    alcohol is ingested; therefore, one must avoid using any
    products containing alcohol such as aftershave lotions,
    cough syrups, sauces, and vinegar. Disulfi ram completely
    inhibits the enzyme aldehdye dehydrogenase, causing a
    toxic reaction due to acetaldehyde accumulation in the
    blood.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
333
Q
2253. Agents that produce an acute withdrawal response in
patients addicted to heroine include
1. Pentazocine
2. Nalbuphine
3. Buprenorphine
4. Naloxone
A
  1. Answer: E (All)
334
Q

2254.The duration of severity of withdrawal symptoms in
sedative-anxiolytic abusers depend on:
1. Duration of drug use
2. Amount of drug used
3. Rate of elimination of drug and metabolites
4. Method of drug administration

A
  1. Answer: A (1, 2, & 3)
    Explanation:
    Sedative,hypnotic, or anxiolytic drugs have a high index or
    therapeutic safety but can be abused, especially in
    combination with other substances such as alcohol.
    Duration of drug use (use is usually for short-term
    adjustments), the amount of drug use, and the role of
    elimination of drug and metabolites, all are factors in
    producing tolerance of dependency.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
335
Q

2255.Clinically signifi cant Cytochrome P450 related
interactions include which of the following?
1. Tricyclics and tetracyclic agents, dopamine receptor antagonists
and type 1C antiarrhythmic drugs are safe to
use with concomitant use of SSRIs
2. Fluvoxamine and fl uoxetine should be used in combination
with alprazolam, or carbamazepine to negate their
activating side effects
3. Induction of CYP enzymes is of no clinical importance
relative to the problems caused by inhibition of these
enzymes
4. Codeine and hydrocodone may not be effective when
given in combination with fl uoxetine and paroxetine

A
  1. Answer: D (4 Only)

Source: Cole EB, Board Review 2003

336
Q
  1. When children of alcoholics are compared with controls
    in adopt-out studies, which of the following statements
    are correct?
  2. Six times higher incidence of psychopathology in children
    of alcoholics
  3. Three times risk of psychopathology in daughters of
    alcoholics
  4. Ten times higher risk of alcoholism in sons of alcoholics
  5. Four times rate of alcoholism in sons of alcoholics
A
  1. Answer: D (4 Only)
    Explanation:
    There is a strong genetic factor seen in alcoholics and their
    families. Sons of male alcoholics are more vulnerable than
    daughters and become alcoholic four times more often
    than children of nonalcoholics, even when they are not
    raised by their biological parents. Monozygotic twins have
    twice the concordance rate for alcoholism as compared
    with dizygotic twins of the same sex. Further, family
    alcoholism results in earlier onset, mor antisocial features,
    worse medical problems, and a poorer prognosis.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
337
Q

2257.CPT provides Level I modifi ers to explain all of the
following situations:
1. When face-to-face services provided by a provider are
greater than usually required for the highest level of
E&M service for a given category
2. When one surgeon provides only postoperative services
3. When the same laboratory test is repeated multiple
times on the same day
4. When a patient sees a surgeon for follow-up care after
surgery

A
  1. Answer: A (1,2, & 3)
338
Q
2258. True statements regarding drug therapy in terminal pain
syndromes include:
1. Anxiolytics are useful
2. Anti-infl ammatory agents are useful
3. Narcotics are useful
4. Neural blockade is useful
A
  1. Answer: E (All)
    Explanation:
    Useful therapeutic modalities in the treatment of pain fromterminal disease include anti-infl ammatory agents,
    narcotics, anxiolytics, antidepressants, and neural
    blockade. Also essential to treating terminal pain are
    psychological support, family support, and a
    multidisciplinary approach to managing this complex
    problem.
339
Q

2259.The true statements describing tolerance include the
following:
1. Tolerance is defi ned as requiring more drug to produce
the same effect.
2. Tolerance can occur with or without physical dependence.
3. Tolerance is generally a characteristic feature of opioids.
4. Tolerance is synonymous with abuse and addiction

A
  1. Answer: A (1, 2, & 3)
340
Q
  1. Which of the following are likely to be shown by patients
    with alcoholic hallucinosis?
  2. Hallucinatory voices commenting unfavorably
  3. Underlying schizophrenic illness
  4. Consciousness not impaired
  5. No evidence of delusional thinking
A
  1. Answer: B (1 & 3)
    Explanation:
    Alcohol hallucinosis is a rare withdrawal symptom in
    which the patient experiences vivid visual or auditory
    voices commenting unfavorably. It usually last 48 hours,
    but may go on for one week or more. The symptoms occur
    shortly after cessation (within a day or two) or after the
    reduction of heavy ingestion of alcohol. Patients are likely
    to show fear, anxiety, and agitation. The hallucinations are
    not part of the alcohol withdrawal delirium, and the
    sensorium is clear.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
341
Q
2261. Requirements for informed consent include statements
of:
1. Material risks
2. Expected outcome
3. Alternative treatments
4. Effects of no treatment
A
  1. Answer: E (All)
    Explanation:
    Fifth not included in the question is
  2. Statement of the material risks.
    2.Statement of the expected outcome and the likelihood of
    success.
  3. Statement of alternative procedures or
    treatments and supporting information regarding those
    alternatives.
  4. Statement of the effect of no treatment, the effect on
    the prognosis, and material risks associated with no
    treatment.
    Other: Statement of the nature and purpose of
    the proposed treatment.
342
Q
  1. Choose the accurate statement(s) below:
  2. To provide equal access to all patients, a hospital with
    high occupancy rate offers a small bonus to doctors for
    each patient they discharge in less than 10 days.
  3. Hospitals may bill Medicare or Medicaid for experimental
    drugs used in clinical trials.
  4. Hospitals may recruit physicians by offering them productivity
    bonuses if it requires them not to apply for
    privileges at any other hospital.
  5. Falsifying trial results is considered fraud, while paying
    for doctors enrolling patients in bona fi de clinical trials,
    if properly disclosed, is not fraud.
A
  1. Answer: D (4 Only)
    Explanation:
  2. It is illegal for a hospital to knowingly make payments
    directly or indirectly to a physician as an inducement to
    reduce or limit services provided to Medicare or Medicaid
    benefi ciaries who are under the physician’s direct care.
    Hospitals that make (and physicians who receive) such
    payments are liable for CMPs of up to $2,000 per patient
    covered by the payments.
  3. Some clinical-trial risk areas to avoid are as follows:
    Institutions billing Medicare for services that are already
    paid by the sponsor of a clinical trial are committing fraud
    by double billing.
    Trial patients should be separated from the regular patient
    mix.
    Medicare does not pay for most procedures using
    experimental drugs or devices.
    The physicians who run these studies or principal
    investigator must supervise the work being done.
    Falsifying results has clear quality-of-care implications for
    patients.
    Prosecutors also might argue that providers
    must return payments for procedures performed using
    devices that were approved due to falsifi ed trial results.
  4. Both the Stark and anti-kickback laws sometimes allow
    hospitals in health care professional shortage areas to,
    under certain circumstances, persuade doctors to their
    service areas by offering inducements that might normally
    be viewed as illegal.
    Under Stark, hospitals may persuade a physician to move
    to the hospital’s area if certain specifi c conditions are met.
    The Anti-Kickback Statute also has a corresponding
    physician recruitment exception with many detailed
    requirements that must be satisfi ed.
  5. Patient enrollment fees: These might be paid to doctors
    for enrolling patients in bona fi de clinical trials. If such
    fees are not fully disclosed, they could be prosecuted as
    fraud.
343
Q
  1. Multiple types of documentation are as follows:
  2. Procedural documentation
  3. Discharge
  4. Billing and coding
  5. Patient payment sources
A
  1. Answer: A (1,2, & 3)

Source: Manchikanti L, Board Review 2005

344
Q
2264. Which of the following symptoms are characteristic of
phencyclidine intoxication?
1. Elevated blood pressure
2. Pinpoint pupils
3. Vertical nystagmus
4. Hematuria
A
  1. Answer: B (1 & 3)
    Explanation:
    Phencyclidine (PCP, “angel dust,” developed in the 1950s
    for veterinary use) and related arycyclohexylamines have
    CNS stimulation, CNS depressnat, hallucinogenic and
    analgesic actions. Structurally related compounds are
    dexoxadrol, ketamine (Ketalar), and N-(1-[z-thienyl]
    cyclohexyl)-piperidine (TCP). PCP can be detected in the
    urine for several days after use. Prominent features of
    PCP use are increased blood pressure, heart rate, and
    vertical or horizontal nystagmus. There is decreased
    response to pain, ataxia, dysarthria, muscle rigidity,
    seizures, and hyperacusis. Individual can have a serious
    catatonic syndrome, toxic psychosis, acute mental
    syndrome, or come. Suicide is a risk.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
345
Q
  1. The physician may however refuse to see a patient who
    is:
  2. Non-compliant
  3. A non-payer of services
  4. Potential threat to the offi ce personnel
  5. Diffi cult to accommodate due to specifi c disease type
    such as HIV
A
  1. Answer: A (1, 2 & 3)

Source: Hans C. Hansen, MD

346
Q
  1. The function of vocational rehabilitation
  2. Use physical therapy and occupational therapy to improve
    work skills.
  3. Vocational rehabilitation includes an interdisciplinary
    approach.
  4. Vocational counselor works as a case coordinator and
    mediator between employer and patient.
  5. Vocational specialist identifi es patient’s vocational interest,
    transferrable skills,and identifi es the job market
    availability for positions within patient’s transferrable
    skills.
A
  1. Answer: E (All)
347
Q
  1. True statements regarding suicide are:
  2. Less than 10% of patients who commit suicide have seen
    their physicians in the last 3 months.
  3. Women between the ages of 40 and 50 have the highest
    suicide rate.
  4. Five percent of suicide victims use medications prescribed
    by their physicians to commit suicide.
  5. Depressed chronic pain patients should routinely be
    asked about suicidal ideation.
A
  1. Answer: D (4 Only)
    Explanation:
  2. Eighty percent of patients who commit suicide have
    seen their physician in the last 3
    months
  3. Elderly males with a chronic illness have the highest
    risk of suicide.
  4. 50% of the patients commit suicide with medications
    prescribed by a physician.
  5. All depressed patients should be routinely asked about
    suicidal thoughts.
348
Q
  1. A 27-year-old nurse who works for you has come in
    contact with blood from a spill. The patient is unknown,
    as is the HIV and HBV status. The owner/physician
    should perform the following:
  2. Document routes of exposure
  3. Identify if a vector source is known, and identify.
  4. Provide the employee the opportunity for serological
    testing
  5. Avoid repeat exposure by allowing the employee to convalesce
    for one month.
A
  1. Answer: A (1, 2 & 3)
    Explanation:
    If an exposure incident occurs, the employer’s
    responsibility is to document the routes of exposure and
    how the exposure occurred, placed in an appropriate
    documentation manual. If an injury occurs, an OSHA 300
    form must also be displayed, prominently in a place of
    commonality, such as a lunchroom. Furthermore, the
    employer must attempt to identify the vector source,obtain
    consent and test the individual serology, and provide the
    employee needed information about test results. If the
    employee does not want testing, 90 days may be offered for
    retesting
    Source: Hans C. Hansen, MD
349
Q
2269. Which of the following agents is associated with
withdrawal anxiety
1. Opioids
2. Lorazepam
3. Dexamethasone
4. Haloperidol
A
  1. Answer: A (1, 2, & 3)

Source: Jackson KC. Board Review 2003

350
Q
  1. An upset patient presenting with depression, anxiety, and
    possible substance abuse has been labeled by Workman’s
    Comp as a “malinger”. The differential diagnosis should
    include:
  2. Somatoform disorder
  3. Undiagnosed or untreated psychopathology such as
    bi-polar disease.
  4. Untreated depression
  5. Early signs of suicidal ideation
A
  1. Answer: A (1, 2 & 3)
    Explanation:
    Undiagnosed psychopathology in the pain management
    population is a signifi cant concern. A patient health
    questionnaire is sometimes useful, including simple
    questions as to lifestyle, interactions with individuals, and
    directed questions to diagnose depression and anxiety.
    Questions should determine complaints of altered sleep,
    which shouldn’t be confused with depression and mood
    alterations such as dysphoria, anxiety, and potential for
    substance abuse. Patients with undiagnosed psychiatric
    illnesses have increased incidences of drug abuse,
    diversion and misuse, as well an increased risk
    management concern for the pain management physician
    Source: Hans C. Hansen, MD
351
Q
  1. The following may be considered reasons for alterations
    and stress in the patient-physician relationship:
  2. Managed care constraints.
  3. Physician time of encounter less than 5 minutes.
  4. Poor response to patient concerns and follow-up.
  5. Magnifi cation of the disease.
A
  1. Answer: A (1, 2 & 3)
    Explanation:
    In our healthcare system, “the patient-physician
    relationship has resulted in many stressors over the past
    number of years, particularly the managed care system has
    increased patient mistrust” Theodosakis, J. et al. Don’t Let
    Your HMO Kill You: How to Wake Up Your Doctor, Take
    Control of Your Health, and Make Managed Care Work
    for You. New York: Routledge 2000. Patients are
    dissatisfi ed with their visits when they don’t feel nursing
    staff has time, physician has time, and that they are not
    being heard. A correlation to mistrust, and lack of patient satisfaction is related to time of encounter, and ability of
    the patient to contact the staff either during business
    hours or on-call, after hours.Patients have high levels of
    expectations, and when these expectations are unmet,
    patients become more demanding and they feel the
    physician is less responsive their needs. This may result in
    alteration of patient-physician relationship, at the least, or
    increased malpractice risk and unnecessary accusations of
    poor care.
    Source: Hans C. Hansen, MD
352
Q
  1. Patients who are non-compliant, may be manifesting:
  2. Unrecognized psychiatric disease
  3. Malingering, or factitious disease
  4. Secondary gain
  5. Operant conditioning
A
  1. Answer: A (1, 2 & 3)
    Explanation:
    A considerable number of patients fall into the category, of
    a variant of personality disorder. According to the Journal
    American Family Physician, Leonard J. Haas, PhD et al.
    volume 72 number 10, sub-clinical personality disorders
    interfere with the patient-physician relationship. These
    patients may become dependant, demanding and selfdestructive.
    This is a common patient we see in the Pain
    Management setting. Operant conditioning is irrelevant.
    Source: Hans C. Hansen, MD
353
Q
  1. The Balance Sheet is a fi nancial statement that includes:
  2. Assets
  3. Liabilities
  4. Owners Equity
  5. Expenses
A
  1. Answer: A (1,2, & 3)
    Explanation:
    The Balance Sheet is a fi nancial picture of all the assets
    owned, the money owed and the owners value in the
    company. This statement is updated monthly, but refl ects
    the ongoing fi nancial position of the company since it
    started.
    Source: Trent Roark,MBA
354
Q

2274.A physician may choose to exclude a patient from the
practice, but must be very careful when a protected status
of patient may emerge. In the case of HIV, discrimination
may be alleged unless the physician has made it clear
that there is no discrimination of care, particularly to
a protected status, where the practice chooses not to
treat the individual based solely on preference and not
by discrimination. This may be diffi cult to prove, and
the costly legal pathways to defense are borne on the
physician should even an allegation be made. It may be
seen that the patient is actually represented at no cost, on
the basis of discrimination. The physician pays his/her
own defense. Discrimination laws tend to vary state to
state. The Americans Disability Act (ADA) is broad in its
scope and favors the patient.When confronting a patient
for non-payment of bill, you may consider discharging
the patient if:
1. A formal process in writing warns the patient of discharge
2. The patient has not made an effort to pay
3. The patient is not protected from fi nancial crisis such
as bankruptcy
4. The patient has refused all attempts to pay

A
  1. Answer: A (1, 2 & 3)
    Explanation:
    To avoid allegations of abandonment the patient, the
    practice must have no barriers to communication with the
    physician, understanding that the offi ce will accommodate,
    and be responsive to a patient’s fi nancial distress, but open
    communication is necessary. If a patient is unable to pay,
    and the process was formally, in writing, elaborated with
    the patient, it is felt that the patient has received suffi cient
    notice to withdraw care. 30-days notice usually applies,
    but for risk management purposes, particularly as
    individual states vary, a policy should be developed with
    practice council to discharge patients for non-payment to
    avoid allegations on discrimination or abandonment.
    Source: Hans C. Hansen, MD
355
Q
2275.Types of methods to measure patient satisfaction
include:
1. Mystery Shopper
2. Survey
3. Testimonials
4. Physician’s”feeling”
A
  1. Answer: A (1, 2 & 3 )
    Explanation:
    Mystery Shopper will evaluate the practice from the
    patient’s point of view. Surveys can be useful if designed
    correctly, but can’t be overused. It is important with
    surveys that you get a large return of surveys on your
    sample size. Testimonials are important because a patient
    willing to speak on behalf of their experience is the
    strongest source of referral.
    Source: Trent Roark,MBA
356
Q
2276.Physicians may be accused of the following when
improperly discharging a patient:
1. Abandonment
2. Discrimination
3. Wrongful Termination
4. Unethical accommodation
A
2276. Answer: A (1, 2 & 3)
Explanation:
If a physician chooses not to treat a patient, he/she may do
so by statutes of involuntary servitude.
Source: Hans C. Hansen, MD
357
Q

2277.Choose the accurate statement(s) about physical
examination of a patient with low back and lower
extremity pain of 6 months duration.
1. Physical examination may be conducted either by
choosing general multi-system examination or a single
system examination.
2. A single system examination utilizing psychiatric, respiratory,
or skin is suffi cient.
3. To cover appropriate physical examination in the above
patient, the examination should consist of a general
multi-system examination or a single system examination
encompassing musculoskeletal or neurological
systems.
4. Single system examination of musculoskeletal system
involves examination of all components in musculoskeletal
system and no other examination is required.

A
  1. Answer: B (1 & 3)
358
Q

2278.True statements associated with abuse of opioid
analegesics are:
1. No cross-tolerance develops among opiod analgesics
2. Tolerance develops equally to all effects of opioids
3. Opioids reduce pain, aggression, and sexual drives
4. The symptoms of acute methadone withdrawal are
qualitatively different from those of acute heroin withdrawal

A
  1. Answer: D (4 Only)
    Explanation:
    Reference: Hardman, pp 556-559.
    1.In opioid abuse, there is always a high degree of crosstolerance
    to other drugs with a similar pharmacologic
    action even if the chemical composition of the opioids is
    totally different.
    2.Tolerance develops at different rates to different effects
    of opioids. Signifi cant tolerance develops to most of the
    effects of narcotics, except for constipation and pinpoint
    pupils, to which there is minimal tolerance.
    3.Opioids reduce pain, aggression, and sexual drive.
    4.With methadone, abrupt withdrawal causes a syndrome
    that is qualitatively similar to that of morphine but is
    longer and less intense, thus following the general rule that
    a drug with a shorter duration of action produces a
    shorter, more intense withdrawal syndrome.
    5.The crimes associated with narcotic abuse are considered
    to be motivated by the need to acquire the drug and not
    from the effects of the drug per se.
    Source: Stern - 2004
359
Q
  1. In evaluation of a work injury patient, the following
    statements are accurate:
  2. Maximum medical improvement is defi ned as a state
    when the patient has been optimally treated, medically
    and surgically, so that no further improvement is expected
    in the condition or the patient’s function.
  3. Permanent impairment is provided within 1 year after
    the injury with or without maximum medical improvement.
  4. Temporary impairment is not expected to last indefi -
    nitely and there is no assignment of the rating for temporary
    impairment.
  5. Partial impairment implies that the entire body is impaired,
    but rating is provided to only a portion of the
    body.
A
  1. Answer: B (1 & 3)
    Source: AMA Guides to the evaluation of Permanent
    Impairment, 2001.
360
Q
  1. Engineering controls in Universal/Standard Precautions
    in exposure prevention requires that:
  2. Staff consultants engineer recommended protocols for
    waste disposal
  3. Develop mechanical biosafety protocols
  4. Develop and build a waste station
  5. Assist in device management such as disposable needle
    precaution systems, and waste containment devices
A
  1. Answer: C (2 & 4)

Source: Hans C. Hansen, MD

361
Q

2281.True statements concerning carbon monoxide (CO)
poisoning include
1. blood gases show normal PaCO2 and PaO2 , metabolic
acidosis, and low oxygen saturations of hemoglobin
2. hypoxia is caused by the strong affi nity of CO for hemoglobin
3. tissue hypoxia is caused by a shift to the left of the oxygen
dissociation curve by carboxyhemoglobin
4. there is a direct toxic effect on aerobic metabolic pathways

A
  1. Answer: E (All)
    Explanation:
    (Miller, 4/e, pp 2431-2432.)
    Carbon monoxide poisoning is the most common cause
    death in people involved in fi res. One must have a high
    index of suspicion for CO poisoning. Treatment is with
    100% oxygen or hyperbaric oxygen if available. An arterial
    blood gas will also give a carboxyhemoglobin level that
    will be helpful with the diagnosis. Patients with severe CO
    poisoning do not hypervnetilate in response to metabolic
    acidosis. CO diffuses into cells, binding to myoglobin and
    cytochromes. This may be why measured levels of COHb
    do not always correlate with the severity of the clinical
    presentation.
    Source: Curry S
362
Q

2282.True statements with regards to perioperative pain
management in opioid-tolerant patients including the
following:
1. During the intraoperative phase, maintain baseline
opioids
2. Increase intraoperative and postoperative opioid dose to
compensate for tolerance
3. In the postoperative period, use patient-controlled
analgesia
4. In the postoperative period, you should not provide any
opioids other than baseline opioids

A
  1. Answer: A (1, 2, & 3)
363
Q
  1. When terminating a patient it is suggested that:
  2. The physician confronts the patient regarding non-compliance,
    and document in the chart.
  3. In cases of non-payment, it should be elaborated to the
    patient that services rendered require service payment.
  4. Recommended that the patient not be provoked, withholding
    specifi cs, that might lead to misunderstanding,
    and discharge from the practice.
  5. Defi ne in patient friendly terminology of policies and
    procedures to avoid patient confusion when confronted.
A
  1. Answer: C (2 & 4)
    Explanation:
    Experts and risk managers have some disagreement about
    this point, but agree that non-compliance should be
    documented in the chart. Putting too many specifi cs into
    the discharge letter might allow for a patient to formulate
    a
    debate, or allege inappropriate discharge. Better put, “the
    patient-physician relationship based on trust and
    compliance has eroded, and therefore I must withdraw as
    your physician”. The exact reason for discharge may
    ultimately avoid confusion, but the termination letter
    should not be written to evoke anger.
    Source: Hans C. Hansen, MD
364
Q

2284.Identify the true statements in reference to work
hardening programs.
1. Work hardening is a highly structured, goal oriented, individualized
treatment program designed to maximize
ability to return to work.
2. Work hardening provides a transition between acute
care and return to work and addresses the issues of
productivity, physical tolerance, etc.
3. Indications for work hardening program include signifi -
cant impairment that prohibits a safe return to work.
4. Major psychological or behavioral dysfunction is an
indication for work hardening.

A
  1. Answer: A (1, 2, & 3)
    Explanation:
    Explanation:
  2. Work hardening is a highly structured, goal oriented,
    individualized treatment program designed to maximize
    ability to return to work.
    Work hardening programs are interdisciplinary and use
    conditioning tasks that are graded for progressive
    improvement of the injured worker’s biomechanical,
    neuromuscular, cardiovascular, metabolic, and
    psychological function by using a series of real or
    simulated work activities.
  3. Work hardening provides a transition between acute
    care and return-to-work and addresses the issues of
    productivity, safety, physical tolerance, and behavior.
    ·Emphasis is placed is placed on job-specifi c simulation
    activities with the goal of returning an injured worker to
    the workplace.
  4. Indications include:
    Signifi cant impairment that prohibits a safe return to
    work
    To return safely to regular or modifi ed duty
    Contraindications include:
    Major psychological or behavior dysfunction
    Incomplete medical work up or treatment
    Serious health risks that may outweigh benefi t of the
    program
365
Q
  1. Identify accurate statements describing the difference
    between fraud and abuse?
  2. Fraud involves deliberate deception used to get money
    from Medicare that a provider is not owed.
  3. There is no difference between fraud and abuse.
  4. Abuse involves errors caused by mistakes or aggressive
    billing or coding inconsistent with accepted practices
    that result in a loss of Medicare funds.
  5. Fraud results in overpayments to a provider $100,000
    or more, in contrast to abuse which results in overpayments of $10 to $99,999.
A
  1. Answer: B (1 & 3)

Source: Laxmaiah Manchikanti, MD

366
Q
  1. Which of the following can result in the imposition of
    civil money penalties?
  2. Upcoding.
  3. Billing a service as “incident to” a physician’s service if
    the physician falsely represented to the patient that he/
    she was certifi ed by a medical specialty board.
  4. Routinely waiving co-payments for Medicare recipients.
  5. Being convicted of a misdemeanor relating to the prescription
    of controlled substances.
A
  1. Answer: A (1, 2 & 3 )
    Explanation:
    1)Civil money penalties may be imposed for knowingly
    fi ling claims for services that were not provided as
    claimed. See 42 U.S.C. § 1328a-7a(a)(1).
    2) Billing a service as “incident to”a physician’s service if
    the physician falsely represented to the patient that he/she
    was certifi ed by a medical specialty board may result in the
    imposition of civil money penalties. See 42 U.S.C. §
    1328a-7a(a)(1).
    3)Routinely waiving co-payments for Medicare recipients
    may result in a civil money penalty under 42 U.S.C. §
    1320a-7a(i)(6)(A).
    4)Being convicted of a misdemeanor relating to the
    prescription of controlled substances can lead to exclusion
    from federal health care programs, but is not a basis for
    imposing a civil money penalty.
    Source: Health Care Fraud and Abuse: Practical
    Perspectives, Linda A. Baumann ed. (American Bar
    Association 2002).
    Source: Erin Brisbay McMahon, JD
367
Q
  1. Why does the Federal Anti-Kickback Law prohibit
    referrals for remuneration?
  2. It can distort medical decision making.
  3. It can cause a reutilization of services or supplies.
  4. It can increase costs to federal healthcare programs.
  5. It can result in unfair competition by shutting out competitors
    who are unwilling to pay for referrals.
A
  1. Answer: E (All)
    Explanation:
    The federal government lists all of the above as problems
    that can result from referrals for remuneration.
    Source:65 Fed. Reg. at 59940.
    Source: Erin Brisbay McMahon, JD
368
Q

2288.This question contains four suggested responses of
which one or more is correct.
1. If a group practice recruits a physician with an income
guarantee from a hospital, a written agreement signed
by the hospital, the group practice, and the physician is
required to meet a Stark law exception
2. If a group practice recruits a physician with an income
guarantee from a hospital, the income guarantee cannot
be conditioned on the recruit making referrals to
the hospital
3. If a group practice recruits a physician with an income
guarantee from a hospital, the income guarantee must
be for the purpose of inducing the physician to relocate.
4. A group practice that recruits a physician with an income
guarantee from a hospital can require the physician
to sign a covenant not to compete.

A
  1. Answer: A (1, 2 & 3)
    Explanation:
    A group practice that recruits a physician with an income
    guarantee from a hospital cannot require the physician to
    sign a covenant not to compete.
    Source: 42 USC §1395nn(e)
    Source: Erin Brisbay McMahon, JD
369
Q
  1. Choose correct statements in reference to exclusion:
  2. A health care provider may knowingly employ an excluded
    person when the excluded person’s job does not
    involve providing or billing for services reimbursed by a
    federal health care program
  3. A provider with a felony conviction relating to a controlled
    substance is subject to mandatory exclusion
  4. The minimum length of time for mandatory exclusion
    is 10-15 years
  5. The Balance Budget Act enacted a three strikes – you are
    out provision
A
  1. Answer: C (2 & 4)
    Explanation:
  2. If a provider employs, contracts or enters into an
    arrangement with an individual or company that the
    provider “knows or should know” is excluded from
    Medicare or Medicaid, the provider is liable for a civil
    money penalty of up to $10,000.
  3. Individual or companies must be excluded under the
    following circumstances.
    ¨A criminal offense conviction related to items or services
    covered by Medicare or Medicaid.
    ¨A criminal offense conviction relating to patient abuse or
    neglect (the patient doesn’t have to be a Medicare or
    Medicaid benefi ciary).
    ¨A felony conviction related to health care fraud or “anyact
    of omission” under Medicare, Medicaid, or other health
    care program fi nanced in whole or in part by federal, state
    or local governments. The felonies include fraud, theft,
    embezzlement and breach of fi duciary responsibility.
    ¨A felony conviction relating to controlled substances,
    including unlawful manufacture, distribution, prescription
    or dispensing of a controlled substance.
    A person or company is considered to be convicted when
    any of the following has happened.
    ¨A conviction has been entered against an individual or
    company by a federal, state or local court, regardless of
    whether there’s a post-trial motion or appeal pending, or
    whether conviction or other record of the criminal
    conduct has been expunged or removed.
    ¨A federal, state or local court has made a fi nding of guilt
    against an individual or company.
    ¨A federal, state or local court has accepted a guilty please
    or a plea of nolo contendere by an individual or company.
    ¨An individual or company has entered into participation
    in a fi rst offender, deferred adjudication or other program
    or arrangement where the conviction has been withheld.
  4. For offenses requiring mandatory exclusion, the
    minimum period is fi ve years, with one exception: In the
    case of providers convicted of program-related crimes,
    HHS can waive the exclusion of a company or individual
    that is either a sole community physician or the sole source
    of essential specialized services in a community.
  5. The Balanced Budget Act of 1997 included a threestrikes-
    and-you’re-out provision, under which an
    individual convicted on one previous occasion of one or
    more exclusion offenses will be excluded from Medicare
    or Medicaid for at least 10 years, and a person convicted
    ontwo or more previous occasions of one or more
    exclusion offenses will be permanently excluded.
370
Q
  1. Which of the following is a requirement for the rental of
    space or equipment exception under the Stark law?
  2. The rental must be documented by a signed written
    agreement
  3. The rental must have a term of at least one year
  4. The rent is for fair market value.
  5. The rent does not vary with the volume or value of
    referrals
A
  1. Answer: E (All)
    Explanation:
    All four of the above are requirements for the rental of
    space or equipment exception under the Stark law.
    Source: 42 USC §1395nn(e)
    Source: Erin Brisbay McMahon, JD
371
Q
  1. The following statement or statements accurately refl ect
    duties and actions of carriers and fi scal intermediaries.
  2. When they suspect fraud that involves sensitive issues or
    that may get widespread publicity they alert the Department
    of Justice
  3. A carrier or fi scal intermediary have to notify a provider
    if it’s going to suspend payments to the provider; except
    when they fi nd reliable evidence of fraud or willful misrepresentation
  4. A carrier or fi scal intermediary may exclude a provider
    from participation in Medicare, Medicare, or other federally
    funded health care program
  5. When the HHS Offi ce of Inspector General (OIG) receives
    a recommendation for a sanction from a carrier
    or fi scal intermediary; OIG develops a proposal and
    sends it to the affected provider(s)
A
  1. Answer: C (2 & 4)
372
Q
  1. The income statement is done monthly and captures:
  2. Revenue
  3. Expenses
  4. Net Income
  5. Assets
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Income Statement includes the Revenue less the Expenses
    which leaves the Net Income. The income statement is a
    snap shot taken at a moment in time – usually monthly.
    Source: Trent Roark,MBA
373
Q
2293. True statements regarding employee indemnity benefi ts
in compensation system include:
1. Wage continuance benefi ts
2. Termination of temporary benefi ts
3. Permanency awards
4. Death benefi ts
A
  1. Answer: E (All)
374
Q
  1. True statements based on the Controlled Substances Act
    and State Board of Medical Licensure:
  2. A physician may prescribe all scheduled drugs to family
    members.
  3. A physician cannot prescribe Schedule II or III for family
    members.
  4. A physician may provide samples and prescriptions of
    any drugs to a person in a sexual relationship.
  5. A physician cannot provide controlled substances to
    anyone, including friends, if documentation of H & P
    and current medical condition is not available.
A
  1. Answer: C (2 & 4)
    Explanation:
    The following rules must be followed in prescribing
    controlled substances based on State Board of Licensure
    Rules and Regulations.
    (1)A physician may not prescribe any scheduled drugs to
    family members.
    (2)A physician cannot prescribe Schedule II or III for
    family members.
    (3)A physician may not provide samples and prescriptions
    of any drugs to a person in a sexual relationship.
    (4)A physician cannot provide controlled substances to
    anyone, including friends, if documentation of H & P and
    current medical condition is not available.
    State Board Rules:Cannot Rx Schedule II or III for family
    members
    Can provide samples of unscheduled drugs for family,
    but MUST document in a medical record
    Cannot Rx for anyone in sexual relationship, EVER.
    Cannot Rx for yourself, EVER.
    Cannot Rx to anyone (including friends) if you have not
    documented their H&P and have a current chart on fi le.
375
Q
  1. When considering an electronic medical record in an
    Ambulatory Surgery Center, the risk-reward benefi t
    favors an electronic environment. An electronic medical
    record would be expected to:
  2. Increase quality and productivity
  3. Enhance compliance
  4. Improve physician compliance and decrease variability
    in documentation
  5. Improve reimbursement
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Reimbursement at the ASC is set by CPT guidelines, and
    should not necessarily be affected by the EMR. EMR in the
    offi ce setting improves documentation for specifi c
    evaluation and management codes, and improves
    diagnostic considerations. The Ambulatory Surgery
    Center will best utilize an EMR to improve
    communication, and to enhance inter-physician
    communication. The EMR should also help the
    Ambulatory Surgery Center document procedures, and
    improve the medico-legal risk of documentation deletions
    or errors.
    Source: Hans C. Hansen, MD
376
Q
  1. Accurate statements describing interventional procedure
    documentation are:
  2. Procedural documentation in an offi ce includes only the
    procedure and discharge
  3. Procedural documentation in an offi ce includes medical
    necessity and procedure.
  4. Documentation for an offi ce procedure requires H & P,
    medical necessity and procedure.
  5. Documentation of a procedure in a facility requires H &
    P, medical necessity and procedure.
A
2296. Answer: C (2 & 4)
Explanation:
INTERVENTIONAL PROCEDURE DOCUMENTATION
1. History & Physical
2. Medical necessity
3. Procedure
FACILITY Requires 3 of 3
OFFICE Requires 2 of 3
377
Q
  1. Components of documentation of a procedure include:
  2. Preoperative: informed consent, discussion and plan,
    preparation
  3. Intraoperative: monitoring, preparation, description
  4. Postoperative: monitoring, complications
  5. Discharge/Disposition: Status, instructions, return appointment
A
  1. Answer: E (All)
    Explanation:
    DOCUMENTATION OF PROCEDURE
    PREOPERATIVE: Informed consent, discussion and plan,
    preparation
    INTRAOPERATIVE: Monitoring, preparation, sedation,
    position, description
    POSTOPERATIVE: Monitoring, complications
    DISCHARGE/DISPOSITION: Status, instructions, return
    appointment
378
Q
  1. Principles of development quality clinical policies
    include the following:
  2. Evidence-based approach
  3. Standardized criteria for assessing literature
  4. Defi ned process for development
  5. Levels of strength of recommendations
A
  1. Answer: E (All)
    Explanation:
    Principles of Quality Clinical Policies include the
    following:
    Evidence-based approach
    Consensus with disclosure
    Defi ned process for development
    Standardized criteria for assessing literature
    Levels of strength of recommendations
    Identify participants
    Incorporation societal/ethcial/cost issues
379
Q
  1. What are the documentation guidelines for physical
    examination?
  2. Level 1 - Problem Focused visit requires a limited exam
    of affected body area with documentation of 1-5 elements
    in one or more area(s)/systems(s)
  3. Level 2 - Expanded Problem Focused - Limited visit
    requirements include exam of affected body area and
    other symptomatic or related organ systems with
    documentation of 6 elements in one or more area(s)/
    systems.
  4. Level 3 - Detailed Extended - Detailed visit requirements
    include exam of affected body area and other symptomatic
    or related organ systems with documentation
    of at least 2 elements from each of 6 area(s)/system(s)
    or at least 12 elements in 2 or more are
  5. Level 4 & 5 - Comprehensive visit requirements encompass
    documentation of at least 18 elements from at least
    9 area(s)/system(s).
A
  1. Answer: E (All)
    Explanation:
    LEVEL 1 - PROBLEM FOCUSED
    Limited Exam of Affected Body Area.
    1-5 Elements in one or more area(s)/systems(s)
    LEVEL 2 -EXPANDED PROBLEM FOCUSED -LIMITED
    Exam of affected body area and other symptomatic or
    related organ systems.
    6 Elements in one or more area(s)/systems.
    LEVEL 3- DETAILED EXTENDED - DETAILED
    Exam of Affected Body Area and other symptomatic or
    related organ systems.
    At least 2 elements from each of 6 area(s)/system(s)
    OR
    At least 12 elements in 2 or more area(s)/system(s)
    LEVEL 4 & 5 - COMPREHENSIVE
    At least 18 Elements from at least 9 area(s)/system(s).
380
Q
  1. Which of the following statements about alcohol
    metabolism are correct?
  2. In the liver, alcohol is metabolized to acetic acid
  3. When exposed to air, alcohol is broken down to acetic
    acid
  4. Disulfi ram blocks the enzymatic breakdown to acetic
    acid
  5. A large proportion of alcohol ingested is expered in the
    breath
A
  1. Answer: A (1, 2, & 3)
    Explanation:
    Alchol metabolism and excretion begin immediately after
    absorption. Kidneys and lungs excrete about one-tenth of
    the alcohol ingested unchanged, whereas the rest
    undergoes a fairly constant rate of oxidation. The liver is
    the main site for alcohol catabolism. Disulfi ram inhibits
    the enzyme aldehyde dehydrogenase and alcohol ingestion
    causes a toxic reaction due to the acetaldehyde
    accumulation in the blood. Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
381
Q
  1. True statements about fraud and abuse include the
    following:
  2. Fraud is an intentional deception or misrepresentation
    that the individual knows to be false.
  3. Abuse is when physician does not believe to be true,
    and physician makes knowing that the deception could
    result in some unauthorized benefi t to himself/herself
    or some other person.
  4. Abuse is billing Medicare for services that are not covered.
  5. Fraud is coding incorrectly.
A
  1. Answer: B (1 & 3)
    Explanation:
    Fraud
    - Intentional deception or misrepresentation that the
    individual knows to be false or
    - Does not believe to be true, and the individual makes
    knowing that the deception
    could result in some unauthorized benefi t to
    himself/herself or some other person.
    Abuse
    - Billing Medicare for services that are not covered or
    - Coding incorrectly.
    Fraud = Felony
    - Knowingly, willfully, and intentionally
    - Deliberate miscoding
    - False documentation
    - Billing for services
    - not provided
    Abuse
    - Unknowing and unintentional
    Fraud as per HIPAA
    . . . the term should know means that a person . .
    (A)acts in deliberate ignorance of the truth or falsity of the
    information;
    or
    (B) acts in reckless disregard of the truth or falsity of the
    information, and no proof of specifi c intent to defraud is
    required.
    Abuse
    - Most errors do not represent fraud
    - Most errors are not knowing, willful, and intentional.
    Fraud
    - High error rate
    - Repeated submission of claims with errors
    - Failure to follow plan of correction
382
Q
  1. This question contains four suggested responses of
    which one or more is correct. Select:
  2. Developing a mechanism for responding to and correcting
    identifi ed problems is important in developing
    a corrective action plan
  3. Developing warning indicators is important in developing
    a corrective action plan
  4. Open door policies are important in implementing a
    compliance plan
  5. Sanction policies are not required for an effective compliance
    plan
A
2302. Answer: A (1, 2 & 3)
Explanation:
A sanction policy is necessary in order for employees to
take the compliance plan seriously.
Source: 65 Fed. Reg. at 59,444
Source: Erin Brisbay McMahon, JD
383
Q
  1. Medical decision making involves multiple components.
    The following are involved in medical decision making.
  2. Risk of signifi cant complications, morbidity, mortality
  3. Risks associated with presenting problems, diagnostic
    procedures, management options
  4. Review of records and investigations
  5. Comprehensive physical examination
A
  1. Answer: A (1, 2, & 3)
384
Q
  1. A 26-year old male hurt his back while lifting a large,
    heavy box. He described the pain as being in the
    lumbosacral region. Examination shortly after the injury
    was normal, except for a slight decrease in lumbar motion
    due to pain, and mild paravertebral tenderness. He was
    off work for 3 days and then returned and continued to
    work. However, he continued to have occasional soreness
    in the low back with heavy lifting. He denied any leg
    pain or numbness. Physical examination continued to
    be normal. Identify the accurate statements with his
    impairment rating.
  2. The diagnosis is lumbar strain
  3. The diagnosis is lumbar disc herniation
  4. Impairment rating is 0% impairment of the whole
    person
  5. 10% impairment of the whole person
A
  1. Answer: B (1 & 3)
385
Q
  1. The following statements regarding partial agonists are
    true
  2. the slope of the dose-response curve is less steep than
    that of a full agonist
  3. the dose-response curve has no limit
  4. concomitant administration of a partial and a full agonist
    can antagonize the effect of the full agonist
  5. the agent can act as an agonist at one receptor and an
    antagonist at another simultaneously
A
  1. Answer: D (4 Only)
    Explanation:
    Partial agonists exhibit certain characteristic
    pharmacologic properties:
    (1) the slope of the dose-response curve is less steep than
    that of a full agonist;
    (2) the dose response curve exhibits a ceiling effect (i.e., a
    submaximal response as compared with that of a full
    agonist); and
    (3) concomitant administration of a partial and a full
    agonist can reduce (antagonize) the effect of the full
    agonist.
    (4) Mixed agonist-antagonists act simultaneously as an
    agonist at one receptor and an antagonist at another.
386
Q
  1. Which of the following statements about daily, heavy
    marijuana users are correct?
  2. Decrease in tachycardia caused by marijuana
  3. Detectable in urine 2-3 weeks after stopping
  4. Reduced mood elevation effect
  5. Reduced need to continue marijuana use
A
  1. Answer: A (1, 2, & 3)
    Explanation:
    Heavy marijuana users have an “amotivational syndrome,”
    characterized by passivity, decreased drive, diminished
    goal-directed activity, decreased memory, fatigue, apathy,
    and poor problem solving. Physiological changes consist
    of an increased heart rate, blood pressure (therefore
    problems with those who have cardiovascular diseases),
    and chronic obstructive lung disorders. Cannabinoids can
    be detected in urine up to 21 days after stopping in chronic
    users, due to redistribution in fat, but are usually detected
    from one to fi ve days in occasional users.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
387
Q
  1. The Sharps Injury Log is established to record
    subcutaneous injuries from contaminated objects or
    from contaminated items. The log will contain:
  2. Type and brand of inflicting item
  3. A complete explanation of incident
  4. The exposure incident location
  5. Then length and gauge
A
  1. Answer: A (1, 2 & 3 )

Source: Hans C. Hansen, MD

388
Q
  1. When an employee is involved in a minor contact with
    blood or body fl uids the employee may:
  2. Administer their own fi rst aid
  3. Dispose of the material in a plastic lined container or
    toilet
  4. Allowed cleansing and covering of the injury
  5. Required to seek immediate medical care.
A
  1. Answer: A (1, 2 & 3 )

Source: Hans C. Hansen, MD

389
Q
  1. The Hepatitis B vaccination (HBV) is:
  2. Offered to all employees
  3. Non required for employees with no positive serology
  4. Refused by an employee, if the employee desire.
  5. Required only in employees that are in immediate contact
    with patients
A
  1. Answer: A (1, 2 & 3 )

Source: Hans C. Hansen, MD

390
Q

2310.Which of the following statements are applicable to
alcohol idiosyncratic intoxication?
1. Amnesia for time of intoxication
2. Behavioral changes usually last several days
3. Occurs within minutes of drinking
4. Hallucatinations occur in stat of clear consciousness

A
  1. Answer: B (1 & 3)
    Explanation:
    Alcohol idiosyncratic intoxication, also known as
    “pathological intoxication,” is manifested by the sudden
    onset of marked behavior changes after consumption of a
    small amount of alcohol: these symptoms usually last for
    a few hours, terminate in prolonged sleep, and the
    individual is able to recall the episode. There can be blind,
    unfocused, assaultive behavior, as well as suicidal ideation
    and attempts.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
391
Q
  1. OSHA training is considered:
  2. Voluntary
  3. Mandatory for full-time employees only
  4. Congruent to the individual practice
  5. Necessary employment requirement for full time and
    part time employees
A
  1. Answer: D (4 only)
    Explanation:
    OSHA training is considered mandatory and the employer
    can be fi ned if adherence is not followed. Refresher
    courses are suggested annually, or when a serious violation
    occurs, or when a major change in OSHA statutes is
    placed.
    OSHA training, and familiarity with Blood Borne
    pathogens in particular, is important to the pain management practitioner. Failure to follow this directive
    may lead to expensive and cumbersome fi nes and
    sanctions. OSHA training is included for all members of
    the practice, or those that might be in contact with a risk
    environment. This includes independent contractors, and
    full-time, part-time or leased employees.
    Source: Hans C. Hansen, MD
392
Q
  1. The following statements are true with relation to routine
    drug screens and their detectability. The following drugs
    may not be detected in routine urine drug screens:
  2. Methadone
  3. Fentanyl
  4. Oxycodone
  5. Morphine
A
  1. Answer: A (1, 2, & 3)
393
Q
  1. Intervals for OSHA training are required at:
  2. Hiring
  3. With changes in regulatory statutes
  4. Annual thereafter
  5. When a violation occurs
A
  1. Answer: A (1, 2 & 3 )
    Explanation:
    OSHA training is required at hiring, and suggested
    annually thereafter, and is a part of an active compliance
    environment. A major event does not necessarily refl ect
    poor training,but should reveal an appropriate response in
    policies and procedures within the practice. Incidents will
    occur, and the employee/owner is ready.
    Source: Hans C. Hansen, MD
394
Q
  1. Appropriate therapy for alcohol withdrawal includes the
    administration of the following medications:
  2. Diazepam
  3. Clonidine
  4. Lorazepam
  5. Buprenorphine
A
  1. Answer: B (1 & 3)
    Explanation:
    1 & 3. Diazepam and Lorazepam are long-acting
    benzodiazepines are the most commonly administered
    medications to prevent the onset of potentially lethal
    delirium tremens during abstinence from alcohol.
    Dosages should be high enough to prevent symptoms of
    delirium tremens and should be tapered slowly as the
    patient undergoes detoxifi cation in a setting that provides
    psychological and social support to the recovering
    alcoholic. Lorazepam and diazepam are long-acting
    benzodiazepines.
    2 & 4. Clonidine and buprenorphine have been used in
    opioid detoxifi cation programs.
    (Savage, J Pain Symptom Management 1993; 8:265-278)
    Source: Kahn CH, DeSio JM. PreTest Self Assessment and
    Review. Pain Management. New York, McGraw-Hill, Inc.,
    1996.
395
Q
  1. HHS Offi ce of Inspector General (OIG) may exclude
    individuals or companies from participation in federal
    health care program:
  2. If convicted of certain misdemeanors
  3. Convicted of any misdemeanor offense related to controlled
    substances
  4. If they refuse to permit examination or duplication of records that OIG states are needed to determine if reimbursement
    was due
  5. If whistleblower suits are brought by employees, former
    employees, or anyone
A
  1. Answer: A (1, 2, & 3)
    Explanation:
  2. OIG can exclude individuals or companies if they have
    been convicted of the following violations:
    A misdemeanor for fraud, theft embezzlement, breach of
    fi duciary responsibility or other fi nancial misconduct
    related to either:
    Health care items or services
    Act or omissions under any health care program fi nanced
    by federal, state or local governments other than Medicare
    or Medicaid (which are covered under mandatory
    exclusions).
    A criminal offense for fraud, theft,embezzlement,breach of
    fi duciary responsibility or other fi nancial misconduct
    related to an act or omission in any non-health care
    program fi nanced by federal, state or local governments.
    Length of exclusion: Three years, unless there are
    aggravating or mitigating factors, in which case the
    exclusion period may be increased or decreased.
    Aggravating Factors:
    The acts caused a loss of $1,500 or more to thegovernment
    or other entities, or had a “signifi cant fi nancial impact” to
    patients or others.
    The acts were committed over a period of one year or
    more.
    The acts had a signifi cant adverse physical or mental
    impact on patients or others.
    The court sentence included prison time.
    The convicted individual had a prior record of criminal,
    civil or administrative actions.
    Mitigating Factors:
    The individual or company was convicted of three or fewer
    misdemeanors, and the loss to Medicare or Medicaid was
    less than $1,500.
    The court found that the individual had a mental, physical
    or emotional condition that reduced his or her culpability.
    Cooperation by the individual or company with federal or
    state offi cials resulted in others being convicted or
    excluded from Medicare, Medicaid or any other federal
    health care program or the imposition of a civil money
    penalty or assessment against anyone.
    Alternative sources of the type of health care items or
    services provided by the individual or company aren’t
    available.
  3. OIG can exclude individuals or companies if they are
    convicted of a criminal offense related to the unlawful
    manufacture, distribution, prescription or dispensing of a
    controlled substance.
    Length of exclusion: Three years, unless there are
    aggravating or mitigating factors, in which case the
    exclusion period may be increased or decreased.
    Aggravating factors:
    The acts were committed over a period of one year or
    more.
    The acts had a signifi cant adverse physical or mental
    impact on patients or others.
    The court sentence included prison time.
    The convicted individual had a prior record of criminal,
    civil or administrative actions.
    Mitigating factors:
    Cooperation by the individual or company with federal or
    state offi cials resulted in others being convicted or excluded from Medicare, Medicaid or any other federal
    health care program or the imposition of a civil money
    penalty or assessment against anyone.
    Alternative sources of the type of health care items or
    services provided by the individual or company aren’t
    available.
  4. OIG can exclude any individual or company that fails to
    supply Medicare or Medicaid with payment information
    necessary to determine whether the payments were due, or
    that refuses to permit examination or duplication or
    records needed to verify payments.
    Length of exclusion: OIG must consider the following
    factors in determining the exclusion period:
    Number of times information was provided
    Circumstances under which the information was provided
    Amount of payment at issue
    Individual or company’s prior record of criminal, civil or
    administrative sanction (the lack of a record is considered
    neutral).
    Availability of alternative sources of the type of health care
    items or services provided by the individual or company.
  5. Civil actions for false claims or whistleblower lawsuits
    – private citizens fi ling lawsuits on behalf of the
    government and receiving a portion of any money
    collected are authorized by the False Claims Act.
    Whistleblower lawsuits are more formally known as qui
    tam suits, the Latin name derived from an expression
    meaning “who as well for the king as for himself sues in
    this matters.
    Whistleblower suits can be fi led by virtually anyone. The
    whistleblower doesn’t even have to be an employee, but
    could literally be “the guy on the street. While
    whistleblowers can fi le suits by themselves, most go
    through attorneys, given the various forms and procedures
    that must be followed. The suits are fi led with the U.S.
    District Court in whatever region they are located.
    Whistleblower suits in themselves are not a cause for
    exclusion.
396
Q
  1. Which of the following statements regarding Hepatitis
    B vaccinations is true?
  2. All employees with occupational exposure must receive
    the hepatitis B vaccine and vaccination series.
  3. The hepatitis B vaccine and vaccination series should be
    provided at no cost to employees.
  4. The hepatitis B vaccine must be provided within 10
    calendar days of an employee’s initial assignment to a
    position with occupational exposure.
  5. The hepatitis B vaccine must be provided within 10
    working days of an employee’s initial assignment to a
    position with occupational exposure.
A
  1. Answer: C (2 & 4)
    Explanation:
    1) The regulations specifi cally provide that the hepatitis B
    vaccine must be offered to all employees with occupational
    exposures, but that the employee can decline to receive the
    vaccine. In such an instance, the employee must sign a
    Vaccine Declination form.
    2) The vaccine, vaccine series and post-exposure followup
    are to be made available to the employee at no cost.
    3) The vaccine must be made available within 10 working
    days of initial assignment to all employees who have
    occupational exposure unless the employee has previously
    received the complete hepatitis B vaccination series,
    antibody testing has revealed that the employee is
    immune, or the vaccine is contraindicated for medical
    reasons.
    4) See number 3) above.
    Source: 29 CFR 1910.1030(f).
    Source: Erin Brisbay McMahon, JD, Sep 2005
397
Q
  1. Which of the following statements about opioid
    potencies are true?
  2. The potency of hydromorphone to morphine is 5:1.
  3. The potency of morphine to hydrocodone is 10:1.
  4. The potency of levorphanol to morphine is 5:1.
  5. The potency of morphine to codeine is 10:1.
A
  1. Answer: B (1 & 3)

Source: Reddy Etal. Pain Practice: Dec 2001, march 2002

398
Q
  1. Which of the following practices can lead to problems
    for physician groups?
  2. A group practice bills for services performed by Dr.
    Brown, who has not been issued a Medicare provider
    number, using Dr. Adams’ Medicare provider number
  3. Dressings and instruments were included in a fee for
    a minor procedure, but the dressings were also billed
    separately
  4. A group practice has no system in place to screen for
    National Correct Coding Initiative restrictions, coding
    patterns, and groupings
  5. A group practice relies on a bookkeeper with no training
    in coding and billing to submit claims to Medicare.
    They have provided the bookkeeper with a sheet of
    commonly used codes with which to bill
A
  1. Answer: E (All)
    Explanation:
    All four of these practices can lead to false claims act
    liability.
    Source: 65 Fed. Reg. at 59439; CMS Manual System, Pub
    100-04 Medicare Claims, Transmittal 563 at p. 2 (May 20,
    2005).
    Source: Erin Brisbay McMahon, JD
399
Q
  1. Which of these drugs are the most hydrophilic
  2. fentanyl
  3. morphine
  4. hydromorphone
  5. sufentanil
A
  1. Answer: D (4 Only)

Source: Lou Etal. Pain Practice: march 2001

400
Q
  1. This question contains four suggested responses of
    which one or more is correct. Select:
  2. Workstation use is an addressable physical safeguard
    under the HIPAA Security Rule
  3. Contingency operations is an addressable physical safeguard
    under the HIPAA Security Rule
  4. Audit controls are an addressable technical safeguard
    under the HIPAA Security Rule
  5. Automatic logoff is an addressable technical safeguard
    under the HIPAA Security Rule
A
  1. Answer: C (2 & 4)
    Explanation:
    1)Workstation use is a required physical safeguard under
    45 CFR 164.310.
    2)This is a true statement. See 45 CFR 164.310.
    3)Audit controls are required technically safeguard under
    the HIPAA Security Rule. See 45 CFR 164.312.
    4)This is a true statement under 45 CFR 164.312.
    Source: 45 CFR 164.310-.312
    Source: Erin Brisbay McMahon, JD
401
Q
  1. Which of the following statements about the treatment
    of chronic alcoholics are correct?
  2. It is essential to face them with the physical consequences
    of their drinking during the fi rst interview
  3. It is necessary to discuss frankly the patient’s drinking
    patterns when initially interviewed
  4. Family history of alcoholism is irrelevant in the individual
    treatment prognosis
  5. The alcoholic’s denial often makes the patient unavailable
    for treatment
A
  1. Answer: C (2 & 4)
    Explanation:
    Treatment of chronic alcoholics is the treatment of a
    chronic relapsing illness. A nonjudgmental approach
    needs to be used towards slips, drinking patterns, and the
    patient’s denial. Education and treatment of the family are
    essential. Emphasis on support groups, self-help aspects
    of treatment, especially AA’s 12-step program, aids
    resocialization and acceptance of an identity as a
    recovering person.
    Treatment of underlying psychiatric disorders is
    important. About two-thirds of chronic alcoholics have
    additional psychiatric problems such as depression,
    anxiety disorder, and attention defi cit. Those alcoholic
    patients with a primary or secondary psychiatric illness
    have an increased suicide rate compared with those who
    do not hae any additional psychiatric diagnosis.
    Source: Psychiatry specialty Board Review By William M.
    Easson, MD and Nicholas L. Rock, MD
402
Q
  1. Select the accurate statements?
  2. A local nursing home, hires a consulting fi rm to put
    together a defense in an elder abuse case. An attorney
    engaged for this purpose would be considered a business
    associate and an agreement is required.
  3. Ambulatory Surgery Centers, Inc. discloses PHI to a
    health plan for payment purposes. A business associate
    agreement is not required.
  4. A medical malpractice insurer is given PHI by an insured
    to provide a malpractice risk assessment of a case. An
    attorney engaged for this purpose would be considered
    a business associate and an agreement is required.
  5. None of these entities are considered business associates.
A
  1. Answer: A (1,2, & 3)
    Explanation:
  2. A local nursing home, hires a consulting fi rm to put
    together a defense in an elder abuse case. Yes, an attorney
    engaged for this purpose would be considered a business associate and an agreement is required.
  3. Ambulatory Surgery Centers, Inc. discloses PHI to a
    health plan for payment purposes. No, this disclosure is
    for the benefi t of the health plan, not the covered entity,
    and therefore a business associate agreement is not
    required.
  4. A medical malpractice insurer is given PHI by an
    insured to provide a malpractice risk assessment of a case.
    Yes, an attorney engaged for this purpose would be
    considered a business associate and an agreement is
    required.
  5. Entities described in 1 & 3 are considered business
    associates.
    Source: Laxmaiah Manchikanti, MD
403
Q
  1. The following statements are true with regards to
    physical dependence.
  2. It is interchangeable with DSM-IV defi nitions of substance
    abuse and dependence.
  3. The defi nition meets the criteria for addiction defi nition
    by the Controlled Substances Act.
  4. It encompasses loss of control, craving, compulsive use,
    and continued use despite consequences.
  5. It is a state of adaptation manifested by a withdrawal
    syndrome produced by abrupt cessation or rapid dose
    reduction.
A
  1. Answer: D (4 Only)
    Explanation:
    Physical Dependence:A state of adaptation manifested by a
    withdrawal syndrome produced by abrupt cessation, rapid
    dose reduction, decreasing blood levels of a drug or
    administration of an antagonist
    DSM-IV defi nition for substance dependence is as follows:
    ¨Tolerance
    ¨Withdrawal
    ¨Larger Amounts/Longer periods
    ¨Efforts or desire to cut down
    ¨Large Amount of time using/obtaining/recovering
    ¨Activities given up: social/work/recreation
    ¨Continued use despite problems
    ¨Need 3 of above in 12 months
    An alternate defi nition from the American Society of
    Addiction Medicine for addiction is as follows:
    ¨Addiction
    A primary, chronic neurobiologic disease with genetic,
    psychosocial and environmental factors effecting its course
    and presentation
    Characterized by one or more of the following
    ·Impaired control of drug use
    ·Compulsive use
    ·Craving
    ·Continued use despite harm
    The 4 Cs of addiction are as follows:
    ¨Loss of Control
    ¨Craving
    ¨Compulsive Use
    ¨Continued use despite consequences
404
Q

2324.True statements regarding worker’s compensation
include:
1. Medical expenses are paid.
2. There is monetary compensation for pain and suffering.
3. There is compensation for lost wages.
4. Fault or negligence of the employer must be established.

A
  1. Answer: B (1 & 3)
    Explanation:
  2. Worker’s compensation provides injured workers with
    funds to cover medical expenses and lost wages.
    It does not, however, totally replace lost income.
    A totally disabled worker will receive approximately
    two-thirds of his average weekly wage.
  3. There is no compensation for pain and suffering.
  4. There is compensation for lost wages.
  5. There is not any determination of fault or negligence
    on the part of the employer or the worker.
    Source: AMA Guides to the evaluation of Permanent
    Impairment, 2001.
405
Q
  1. A 34-year old male was evaluated for back and lower
    extremity pain which started following a twisting injury
    in a fl exed position during lifting. He had a positive
    straight leg raising test, Achilles tendon refl ex separation,
    and sensory defi cit. Treatment with physical therapy
    and transforaminal epidural steroid injection failed to
    provide any signifi cant improvement. He underwent
    surgical discectomy. He improved and returned to work
    without restrictions after rehabilitation after 6 months of
    injury. He has no pain at rest or numbness in the lower
    extremities. He was able to do almost all activities of daily
    living but complained of back pain with heavy lifting.
    The following are true statements.
  2. His diagnosis is herniated disc with radiculopathy, resolved
    after discectomy.
  3. Due to discectomy, his impairment is greater than without
    discectomy.
  4. He is entitled to 10% impairment of the whole person.
  5. He is entitled to 20% impairment of the whole person.
A
  1. Answer: A (1, 2, & 3)
406
Q
2326. The medications which could be used as treatment for
opioid withdrawal include the following:
1. Clonidine
2. Diphenylhydantoin
3. Buprenorphine
4. Phenobarbital
A
  1. Answer: B (1 & 3)
    Explanation:
  2. Clonidine, an alpha-adrenergic agonist, and
    buprenorphine, a mixed agonist-antagonist opioid, have
    been used to successfully treat the symptoms of opioid
    withdrawal.
    Clonidine should be administered around the clock in a
    tapered protocol over the fi rst 7 days of withdrawal.
    Hydroxyzine, dicyclomine, and triazolam may be helpful
    as well.
  3. Diphenylhydantoin and phenobarbital are not generally
    used in opioid withdrawal.
  4. Buprenorphine is given in a tapered regimen, every 4 h
    over the fi rst 6 days of withdrawal. However, a physician
    will need a separate approval from the DEA to do this.
  5. Diphenylhydantoin and phenobarbital are not generally
    used in opioid withdrawal.
407
Q
  1. Which of the following include the seven common
    elements that the HHS Offi ce of Inspector General (OIG)
    strongly encourages providers to have in a comprehensive
    compliance program?
  2. Written standards of conduct
  3. Hotline for complaints
  4. Disciplinary procedures
  5. Procedures to prevent qui tam law suits
A
  1. Answer: A (1, 2, & 3)
    Explanation:
    At a minimum, comprehensive compliance programs
    should include the following seven elements:
    ¨Written standards of conduct, policies and procedures
    that promote the company’s commitment to compliance
    (for example, by including adherence to the compliance
    program as an element in evaluating managers and
    employees) and that address such specifi c areas ofpotential
    fraud as the claims submission process, code gaming and
    fi nancial relationships with providers.
    ¨Designating a compliance offi cer and other appropriate
    high-level corporate structures (for example, a corporate
    compliance committee that operates and monitors the
    compliance program and reports directly to the CEO and
    the governing body. (Important: Structure the compliance
    program so it accomplishes the key functions of a
    corporate compliance offi cer and a corporate compliance
    committee).
    ¨Compliance training and education program for all
    affected employees. They should be detailed and
    comprehensive, covering specifi c procedures, as well as
    the general areas of compliance.
    ¨Communication. Maintaining a hotline to receive
    complaints and the adoption of procedures to protect the
    anonymity of complainants and protect callers from
    retaliation.
    ¨Auditing and monitoring or other risk-evaluation
    techniques to monitor compliance and assist in the
    reduction of identifi ed problem areas.
    ¨Disciplinary procedures and development of policies
    addressing the non-employment of sanctioned
    individuals.
    ¨Corrective actions to enforce appropriate disciplinary
    action against employees who violate laws, regulations,
    guidelines or company policies.
    The elements are a guide that can be tailored to fi t the
    needs and fi nancial realities of a particular billing
    company, large or small, regardless of the type of services
    offered.
408
Q
2328. What are the consequences of a violation of the
Stark Law?:
1. Civil monetary penalties
2. Repayment of all affected claims
3. Exclusion from Medicare
4. Assessed up to 3 times of the money
A
  1. Answer: E (All)
    Explanation:
  2. Civil monetary, assessed and exclusion.
  3. Refunds. If a provider collects on a bill for a service that
    was in violation of Stark, the provider must refund the
    money within 60 days.
  4. The physician may be excluded from the Medicare and
    Medicaid programs.
  5. Any provider presenting a claim or bill for a service that
    the provider knows or should know is a violation or for
    which a refund has not been made can be hit with a civil
    monetary penalty of up to $15,000 for each service
    claimed.
    In addition, an assessment of up to three times the amount
    of money may be required.
    Other:
    Violators of the Stark Law are subject to one or more of
    the following sanctions:
    Denial of payment. Medicare will deny payment for
    services rendered in violation of Stark.
    Civil monetary penalty and exclusion for circumvention
    schemes.
    This provision is intended to crack down on physicians
    who enter into arrangements or schemes (such as crossreferral
    arrangements) that they know or should know are
    designed to get around the Stark prohibition.
    Civil monetary penalty for failure to report information.
    Any provider who fails to report required information to
    Medicare or Medicaid is liable under the Stark law for
    civil monetary penalty of up to $10,000 for each day the
    information goes unreported.
409
Q

2329.Drs. Abbott and Costello are in a group practice and
they employ a nurse practitioner. Dr. Abbott implanted
a permanent tunneled catheter (90 day global) and a
programmable pump (90 day global) to control the pain
condition of a Medicare benefi ciary on March 17. On
March 30, when the patient returned for a post operative
check up, Dr. Abbott was on vacation and Dr. Costello did
the post operative check up and sent an encounter form
to billing to record the post-op visit. A new person in
the billing department reported Dr. Costello’s visit using
code 99213 and a diagnosis code of 722.83, which was the
condition reported for the March 17, surgery. Medicare
allowed $59.13 for Dr. Costello’s visit. The offi ce manager
should instruct the physicians and billing staff:
1. The group can increase its revenue if a different physician
or the nurse practitioner does the post-operative
follow-up visits within the global period since Medicare
allows payment when a different provider bills the
visit;
2. Instruct the providers that to prevent an overpayment
of this type, the person that sees a patient during a post
operative global period, should indicate on the encounter
form that there is no charge and that the encounter
should be recorded for records
3. The practice can keep the money since Medicare made
a mistake in paying the group for an E&M service for
same condition for which the procedure with a 90-day
global was performed.It isn’t groups fault that Medicare
doesn’t process its claim correctly
4. Provide in-service education to the billing/collection
staff relative to global days and refund Medicare because
the group is not entitled to payment;

A
  1. Answer: C (2 & 4)
    Explanation:
    Medicare’s payment rules relative to payment for group
    practices are available on the CMS web site and providers
    are expected know the payment rules. When in a group
    practice, all physicians, in the same specialty, that reassign
    payment to the group, are paid as a single physician. It
    would be a deliberate intent to be paid for services that the
    group is not entitled to be paid for if a different provider
    performed post op care because the Medicare carrier did
    not have its claim edits in place. When a provider knows
    or should have known that money has been paid in error,
    regardless of payer error, the provider is required to
    return the money.
    Sources: Source: Medicare Claims Processing Manual,
    100-04 Chapter 12 Physicians/Nonphysician Practitioners
    and OIG Compliance Program Guidance for individual
    and Small Group Physician Practices (65 FR59434;
    October 5, 2000)
    Source: Joanne Mehmert, CPC
410
Q
  1. You are asked to consult on a patient who has end-stage
    liver disease. The cirrhotic patient has severe pancreatitis,
    and legitimate need of medication is met. The primary
    care physician asks you to choose a medication for pain
    control that will effectively treat pain, and have minimal
    risk of toxicity to the patient. Furthermore, the patient
    will be in a long-term care facility where the medications
    are controlled by others. Choices for consideration
    include:
  2. Sustained release Morphine Sulfate, with immediate
    release Morphine for breakthrough.
  3. Timed release Oxycodone with immediate release Oxycodone
    for breakthrough.
  4. Hydromorphone prn.
  5. Hydrocodone
A
  1. Answer: A (1, 2 & 3 )
    Explanation:
    Hydrocodone requires liver participation in breakdown, and is believed that some of the bio-activity and pain relief
    characteristics of hydrocodone are derived from
    hydrocodone breakdown components, one being
    hydromorphone. Oxycodone and Morphine have been
    used in end-stage liver disease effectively, with the
    understanding that there is no ideal drug. In Morphine’s
    case, breakdown products, particularly glucuronides, may
    accumulate, particularly if there is renal excretion issues.
    These glucuronides may result in dysphoria. Oxycodone
    has breakdown components as well, but is very well
    tolerated, particularly in the elderly. Hydromorphone
    again, has a long-standing safety profi le, and is tolerated
    well by patients with liver disease, and is excreted
    predictably. Each drug should be scrutinized by the
    concept of elimination. The liver and kidneys are the two
    principal organs of elimination, where the kidney is
    responsible for the excretion of chemically unaltered drug.
    The liver is the primary path of metabolism, but other
    organs may also contribute after metabolism, therefore
    explaining the effective elimination of a number of drugs
    when liver function is poor.
    Source: Hans C. Hansen, MD
  2. Answer: B (1 & 3)
    Explanation:
    Impairment is a medical condition specifi cally related to a
    disease process. It is expressed as a percentage of the body
    as a whole and may be defi ned as the derangement or loss
    of use of any body part, system, or function. Disability
    relates to employment or activities of daily living and is
    characterized as temporary, permanent, partial, or total
411
Q
  1. Impairment may be defi ned as:
  2. Derangement or loss of use of any body part, system,
    or function.
  3. The limiting, loss, or absence of the capacity of a person
    to meet personal, social, or occupational demands.
  4. A condition that relates to a disease process.
  5. A condition that relates to function relative to work or
    other obligations
A
  1. Answer: B (1 & 3)
    Explanation:
    Impairment is a medical condition specifi cally related to a
    disease process. It is expressed as a percentage of the body
    as a whole and may be defi ned as the derangement or loss
    of use of any body part, system, or function. Disability
    relates to employment or activities of daily living and is
    characterized as temporary, permanent, partial, or total
412
Q
  1. True statements regarding tolerance include
  2. it is characteristic of opioids as a class of drugs
  3. it cannot occur without physical dependence
  4. it is defi ned as requiring more drugs to produce the
    same effect
  5. it is synonymous with addiction
A
  1. Answer: B (1 & 3)

Source: Kahn and Desio

413
Q

2333.True statements about suggested guidelines for
administration of methadone are as follows:
1. Recovering opioid dependent patients enrolled in
maintenance programs should receive methadone daily
doses at the same time as usual.
2. The relationship between oral and parenteral methadone
is 2 is to 1.
3. Opioid dependent patients not enrolled in maintenance
programs should receive methadone 20 to 40 mg orally
every 24 hours or 1.25 to 2.5 mg intravenously every 5
to 10 minutes.
4. Recovering opioid dependent patients enrolled in maintenance
programs should receive double the dose of
methadone at the same time as usual.

A
  1. Answer: A (1, 2, & 3)
414
Q
  1. Which of the following statements are accurate?
  2. Voluntary Disclosure Program offers immunity to providers
    who come forward within 30 days of discovering
    an offence.
  3. Providers must always repay all Medicare overpayments
    within 30 days.
  4. Health care providers in Medically Underserved Areas
    (MUAs) may automatically waive coinsurance and deductible
    payments.
  5. Before the HHS Offi ce of Inspector General (OIG) may
    issue a demand letter in a civil money penalty case, the
    government must have legally suffi cient evidence for 8 elements of civil monetary penalties offense.
A
  1. Answer: D (4 only)
    Explanation:
    1.The Voluntary Disclosure Program is designed to allow
    providers and others to come forward and admit health
    care fraud in exchange for the possibility of lenient
    treatment from the federal government. Providers already
    under investigation for fraud can also come forward to
    volunteer information. Making full disclosure to the
    investigative agency at an early stage generally benefi ts the
    individual or company, but there is no limit as to 30 days.
    2.Normally, Medicare expects overpayments to be paid
    back in 30 days after the fi rst demand letter. But if a lump
    sum refund would cause severe fi nancial hardship, a
    provider can apply for an extended repayment plan (either
    through direct payments or deductions from theprovider’s
    future payments). For Part B providers, here are the
    deadlines a provider may face for making payments(MCM
    7160) (MIM 2224):
    $5,000 or less within 2 months
    $5,001-$25,000 within 3 months
    $25,001-$100,000 within 4 months
    $100,001 and above within 6 months
    3.Regardless of their location, doctors, durable medical
    equipment (DME) suppliers and other Part B billers must
    make a good faith effort to collect the deductible and
    coinsurance payments owed by their Medicare patients
    – or face reimbursement cuts from CMS and possible
    Medicare suspension or exclusion. OIG sent out a Fraud
    Alert in 1990 targeting physicians and other suppliers who
    inappropriately waive co-payments or deductibles.
    The government also could hold a provider liable under
    the Anti-Kickback Statute because routinely forgiving copayments
    or deductibles may be considered an improper
    inducement for patients to buy Medicare items or services.
    Government penalties for illegal waivers can include
    imprisonment, criminal fi nes, civil damages and
    forfeitures, fi nes and exclusion from Medicare and
    Medicaid.
    Typically, if providers make a reasonable collection effort
    for coinsurance or deductibles, failure to collect payment
    isn’t considered a reason for the carrier to reduce the
    charge or refer the provider to OIG or the Justice
    Department. A “reasonable collection effort” is one that is
    consistent with the effort a doctor’s offi ce typically makes
    to collect co-payments and deductibles. It must involve
    billing the patient and may include subsequent billings,
    collection letters, telephone calls or personal contacts,
    depending on the provider’s usual practice. These efforts
    must be genuine, not token, collection efforts. A provider
    should check to see whether its local carrier or
    intermediary has defi ned a Fair Effort to Collect, for
    instance, three bills in 120 days.
    4.The HHS Offi ce of Inspector General (OIG) has
    identifi ed eight elements of a civil money penalties offense:
    Any person
    Presents or causes to be presented
    To the United States or an agent of the United States
    A Claim
    For an item or Service
    Not provided as claimed
    Which the person knows or has reason to know was not
    provided as claimed
    Materiality
    Source: Manchikanti L, Board Review 2005
415
Q

2335.The 28-year-old male is sent to your offi ce for
evaluation and management of pain. The MRI reveals
modest facet disease in the cervical spine, and the
exam is unremarkable. His complaints are intractable
paracervical and suprascapular pain interfering with his
ability to work. He requests narcotics, Percocet® by name,
and when this is refused he states that he will report
you to the Medical Board because he will “go through
withdrawal” if not given his medication.Your correct
response is:
1. Discharge the patient and document aggressive behavior.
2. To prescribe Percocet® as legitimate medical need may
be argued
3. Develop a multimodality treatment course emphasizing
function and progressive analgesic, initiating with the
milder schedule for drug, such as CIV Darvocet®.
4. Treat the patient as any other with similar presenting
symptoms emphasizing function,and defi ning clear
legitimate medical need for controlled substances, irrespective
of a patient’s demands.

A
  1. Answer: D (4 Only)
    Explanation:
    It is recommended that patients who are focused on
    controlled substances, particularly those that ask for
    medications by name, be addressed from a risk
    management perspective. Patients do not necessarily need
    a controlled substance simply because the statement of
    “pain” is made. Assessment of function and quality of life
    indices is refl ected in the medical record. If controlled
    substances are recommended, the schedule of the drug does not refl ect potency. The schedule suggests abuse
    potential,and therefore, Darvocet® has the same
    habituation potential as oxycodone, and is not necessarily
    “milder”.
    Source: Hans C. Hansen, MD
416
Q
  1. Hazardous chemicals require:
  2. Container labels
  3. Training as to appropriate response to spill and storage
  4. Material Safety Data Sheets, MSDS, referencing these
    chemicals
  5. Reinforced glass container
A
  1. Answer: A (1, 2 & 3 )
    Explanation:
    Hazardous chemicals require each of the above and an
    antidote if available. These important safety items are
    defi ned by OSHA. MSDS fi les should be kept in view, or
    easily retrieved. Glass is an option for containment, but
    not required.
    Source: Hans C. Hansen, MD
417
Q
  1. You are maintaining a patient with carcinoma on 300
    mg of morphine, by mouth, once daily. In the process of
    a trial for and intrathecal infusion system, she was given
    1 mg of intrathecal morphine and the oral morphine
    was discontinued. Approximately 36 hours later, she
    complains of diaphoresis and tachycardia. The most
    likely diagnosis is:
  2. cocaine use
  3. methamphetamine use
  4. accidental injection of naloxone instead of morphine
  5. morphine withdrawal
A
  1. Answer: D (4 Only)
    Explanation:
    This dose of intrathecal morphine, although appropriate
    for pain control, will not prevent opioid withdrawal.
418
Q
  1. The OSHA hazard violation most commonly cited is:
  2. Blood Borne Pathogen
  3. Chemical
  4. Fire
  5. Communication
A
  1. Answer: D (4 Only)
    Explanation:
    Communication standard. Lack of training and posting.
    Source: Hans C. Hansen, MD
419
Q
  1. OSHA training includes familiarity with procedures
    to handle on Blood Borne pathogens, a citation will be
    issued if:
  2. The employer fails to keep the workplace free of hazard
  3. Hazard was recognized and not responded to in an appropriate
    or timely manner
  4. Hazard, was, or could cause harm, and no corrective
    response was made by the employer
  5. Antiseptics and spill kits weren’t at the site of exposure
A
  1. Answer: A (1, 2 & 3 )
    Explanation:
    Citations and enforcement policy are a necessary part of
    OSHA. Fines can be imposed fi nancially, or far more
    punitive in nature (prison) depending on the infraction.
    Willful risk of an employee from an employer might result
    in civil and criminal prosecution, with generally an
    expensive outcome. Spill kits and personal protective gear
    must be readily available, not necessarily at the site of a
    spill.
    Source: Hans C. Hansen, MD
420
Q
  1. Characteristics that describe methadone for cancer pain include:
  2. High potency
  3. Long half-life
  4. Low cost
  5. Low lipid solubility
A
  1. Answer: A (1, 2, & 3)

Source: Reddy Etal. Pain Practice: Dec 2001, march 2002

421
Q

2341.Identify true statements to assist in your practice
by specialty designation of interventional pain
management:
1. Physician profi ling or comparative utilization assessment
2. 500% increase of practice expense calculation immediately
3. Carrrier Advisory Committee (CAC) membership
4. 100% increase in physician reimbursement

A
2341. Answer: B (1 & 3)
Explanation:
Interventional Pain Management -09 designation
Profi ling
Practice Expense
CAC Membership
Source: Laxmaiah Manchikanti, MD
422
Q
  1. What are some of the true statements describing
    bundling and unbundling?
  2. Bundling is combining multiple codes or charges into
    one comprehensive charge, when separate codes or
    charges are justifi able
  3. Unbundling is charging multiple CPT codes when one
    code generally describes the service
  4. Unbundling is charging multiple procedures with the
    primary service that are generally included in primary
    service
  5. Bundling and unbundling are essential elements of
    proper coding and accurate reimbursement
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Bundling Or Disbundling
    Combining multiple codes or charges into one
    comprehensive charge, when separate codes or charges are
    justifi able.
    Vs
    Unbundling
    Charging multiple CPT codes when one code generally
    describes the service.
    Charging multiple procedures with the primary service
    that are generally included in primary service.
    Source: Laxmaiah Manchikanti, MD
423
Q
  1. Correct coding essentially means:
  2. Unbundling codes to achieve maximum reimbursement.
  3. Using whichever code is most convenient for the physician
    performing a procedure.
  4. Using multiple codes to ensure that at least one code will
    be reimbursed.
  5. Reporting a group of procedures with appropriate comprehensive
    code.
A
  1. Answer: D (4 Only)
    Explanation:
    CMS has developed general policies that defi ne the coding
    principles and edits that apply to procedure and service
    codes. Item #4 best describes the essential idea of these
    policies. The remaining items represent coding practices
    that should be avoided.
    Source: James A. Mirazita, MD, Sep 2005
424
Q
  1. The Health Insurance Portability and Accountability Act
    (HIPAA):
  2. Is also referred to as the Kennedy-Kassebaum Health
    Reform Bill of 1996.
  3. Provides the offi ce of Inspector General and the Federal
    Bureau of Investigations (FBI) with broad powers to
    identify and prosecute health care fraud and abuse.
  4. Makes correct medical coding mandatory.
  5. Includes patient privacy provisions.
A
  1. Answer: E (All)

Source: James A. Mirazita, MD, Sep 2005

425
Q
  1. What are different places of service?
  2. POS 11 = Offi ce
  3. POS 21 = Inpatient hospital
  4. POS 22 = Outpatient hospital
  5. POS 24 = ASC
A
  1. Answer: E (All)
    Explanation:
    Place of Service
    * POS 11 = Offi ce = Higher reimbursement
    “Where you routinely provide health examinations,
    diagnosis, & treatment”
    * POS 21 = Inpatient hospital
    * POS 22 = Outpatient hospital
    * POS 24 = ASC
    Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
    Meeting
426
Q
  1. How do Program Safeguard Contractors work?
  2. They show up unannounced
  3. You have to talk
  4. They generally want to talk to MD
  5. Call attorney only after you talk
A
2346. Answer: B ( 1 & 3)
Explanation:
Program Safeguard Contractors
* Show up unannounced
* Want to talk to MD
* Don’t have to talk
* Call attorney immediately
* Example
Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
Meeting
427
Q

2347.What are components of bullet methodology in
Evaluation and Management(E/M) services?
1. History - 8 possible factors
2. ROS - 14 possible factors
3. Exam includes single organ system or multi-system
4. Medical decision making

A
2347. Answer: E (All)
Explanation:
Bullet Methodology
* History
- History - 8 possible factors
- ROS - 14 possible systems
- PFSH - 3 possible histories
* Exam
- Single organ system
- Multi-system
* Medical Decision Making
Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
Meeting
428
Q
  1. What are Safe Harbor requirements common to all types
    of ASC?
  2. No loans from ASC or other investors
  3. Returns directly proportional to capital invested
  4. Non-discriminatory treatment
  5. “One-third income” test - at least one-third of each
    physician’s practice income from ASC procedures
A
  1. Answer: E (All)
    Explanation:
    Safe Harbor Requirements - Common to all types of ASCs
    Terms not related to previous or expected volume or value
    of referrals
    “One-third income” test
    At least one-third of each physician’s practice income
    from ASC procedures
    No loans from ASC or other investors
    Returns directly proportional to capital invested
    No separately billable ancillaries
    Non-discriminatory treatment
    Disclosure
    Source: Ron Wiser, JD
429
Q
  1. What are the rules of “incident to” services?
  2. For initial visit, the MD must do the entire visit/consult
  3. Incident to in the hospital even if MD has no face to face
    documentation
  4. MD must be in the offi ce
  5. Regulations are applied uniformly across the US
A
2349. Answer: A (1,2, & 3)
Explanation:
Incident to:
* For initial visit, the MD must do the entire visit/consult
* TN/NY Medicare: 2005
- Not just the assessment/plan
- The HPI, exam, and MDM
* MD must be in the offi ce
* No incident to in the hospital
- Unless MD rounds & notes face to face
Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
Meeting
430
Q
  1. Due to the Needlestick Safety and Prevention Act,
    employers of an ASC should understand the following
    items to be true:
  2. The new regulation has language that requires an employer
    to evaluate innovations in technology development
    that reduce sharps exposure.
  3. Employers need to seek input regarding sharps safety
    devices from non managerial employees who are responsible
    for direct patient care and may be exposed to
    injuries themselves.
  4. Requires employers to maintain a “sharps incident”
    tracking log
  5. Requires exposure control plans be reviewed and updated
    at least annually to refl ect changes in sharps safety
    technology.
A
  1. Answer: E (All)
    Explanation:
    The provisions of the Needlestick Safety and Prevention
    Act did not include penalties for increased injuries of
    employers who fail to comply with the provisions of the
    Needlestick Safety and Prevision Act.
    American Society of Interventional Pain Physicians page
    235,236,237
    http://www.osha.gov/SLTC/bloodbornepathogens/index.h
    tml _ for some reason you can not click on this web site
    from here you need to copy this email address then paste it
    to your internet and select go.
    http://www.osha.gov/pls/oshaweb/owadisp.show_docume
    nt?p_table=NEWS_RELEASES&p_id=36
    1910.1030(c)(1)(iv) The Exposure Control Plan shall be
    reviewed and updated at least annually and whenever
    necessary to refl ect new or modifi ed tasks and procedures
    which affect occupational exposure and to refl ect new or
    revised employee positions with occupational exposure.
    The review and update of such plans shall also:
    1910.1030(c)(1)(iv)(A) Refl ect changes in technology that
    eliminate or reduce exposure to bloodborne pathogens;
    and
    1910.1030(c)(1)(iv)(B) Document annually consideration
    and implementation of appropriate commercially
    available and effective safer medical devices designed to
    eliminate or minimize occupational exposure.
    1910.1030(c)(1)(v) An employer, who is required to
    establish an Exposure Control Plan shall solicit input
    from non-managerial employees responsible for direct
    patient care who are potentially exposed to injuries from
    contaminated sharps in the identifi cation, evaluation, and
    selection of effective engineering and work practice
    controls and shall document the solicitation in the
    Exposure Control Plan
    Source: Marsha Thiel, RN, MA, Sep 2005
431
Q

2351.What are the correct statements about lysis of
adhesions?
1. 62264: 1 day
2. 62263: 2 or more days
3. Bundled services include epidural, fl uoro/epidurography,
and transforaminal epidural
4. 62264 must be used to report spinal endoscopy

A
2351. Answer: A (1,2, & 3)
Explanation:
Lysis of Adhesions
* 62263: 2 or more days
* 62264: 1 day
* Services which are bundled:
- Contrast injection (62311/19)
- Fluoro/epidurography (76005/03/72275)
- Transforaminal epidural (64483)
- Peripheral nerve blocks (64450)
Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
432
Q
  1. What are add-on codes?
  2. Primary procedure has a code
  3. Add-on codes are modifi er 51 exempt
  4. Second level has a separate code
  5. Multiple interlaminar epidural codes may be used as
    add-on codes
A
2352. Answer: A (1,2, & 3)
Explanation:
Add-on Codes
* Primary code has a code
* Second level has a separate code
* Examples:
- Facets, therapeutic and RF
- Transforaminal epidurals
- Vertebroplasty
* Do not use a 51 modifi er; pays differently
* Add-on codes are modifi er 51 exempt
Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
Meeting
433
Q
2353.What are the some of coding methodologies for
injections affecting multiple levels?
1. Add-on code methodology
2. 51 Modifi er methodology
3. Mutually exclusive code methodology
4. Single code methodology
A
2353. Answer: E (All)
Explanation:
4 Coding Methodologies for Injections Affecting Multiple
Levels
* Add-on code methodology
* 51 Modifi er methodology
* Mutually exclusive code methodology
* Single code methodology
Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
Meeting
434
Q
  1. Areas of development of the EMR include:
  2. Data input and development of outcome management
  3. Document transfer to federal health programs
  4. Information management of medication interactions,
    dosing areas, and document management
  5. Portable tools to eliminate redundant systems such as:
    pagers, cell phones, and telephone systems
A
  1. Answer: B ( 1 & 3)
    Explanation:
    The role of the EMR is not to eliminate access tools; it is
    for data management, and data assessment. It is also a risk
    reduction tool. The EMR’s role fi rst and foremost is to
    safely retrieve information, in a secure environment.
    There is no one single tool that allows the EMR to
    eliminate pagers, telephones, etc. Expecting an EMR to be
    a multitasking tool diminishes the effectiveness of the
    primary purpose of the EMR; that being electronic
    paperless storage of the medical record and patient data
    management.
    Source: Hans C. Hansen, MD
435
Q
  1. An EMR performs the following roles:
  2. Enhances quality of care
  3. Decreases cost of care
  4. Improves quality of life for providers
  5. Increases potential risk of record breach to the practice
A
  1. Answer: A (1,2, & 3)
    Explanation:
    The electronic medical record performs each of the rolesof
    enhancing quality of care, decreasing cost, and improving
    quality of life of the providers, if implementation of the
    proper tools, hardware, and training is afforded the
    practice. The EMR should be considered a risk reduction
    tool, and not an item where further contamination or loss
    of data could be incurred. The purpose of the EMR is
    convenience, safety, and improved productivity.
    Source: Hans C. Hansen, MD
436
Q
  1. Doctoral level clinical psychologists are licensed to
    practice independently within a scope of practice that
    includes:
  2. The assessment, diagnosis, and treatment of mental
    health disorders
  3. Billing for services when working within the hospital
    setting
  4. Assessment and treatment, but not diagnosis, of physical
    health disorders
  5. Conducting research in the university hospital setting
A
  1. Answer: E (All)
    Explanation:
    Doctoral level clinical psychologists are licensed to
    practice independently within a scope of practice that
    includes the assessment, diagnosis, and treatment of
    mental health disorders; assessment and treatment,but not
    diagnosis, of physical health disorders; hospital
    privileges, in many states; as well as consultation;
    supervision; research; teaching.
    Principles of Documentation, Billing, Coding, and
    Practice Management for the Interventional Pain
    Professional (ed by) Laxmaiah Manchikanti, ASIPP
    Publishing: Paducah, KY.
    Source: Marsha Thiel, RN, MA, Sep 2005
437
Q
2357. What are the components of OIG Work Plan for 2005 for
coding issues?
1. E & M Coding
2. 25 Modifi er
3. 59 Modifi er
4. ASC billing
A
2357. Answer: E (All)
Explanation:
OIG Work Plan for 2005 Coding Issues
* E&M Coding - $29 Billion
- Correct level
* 25 Modifi er - $1.7 Billion
- Procedure and visit on same day
* 59 Modifi er
- Bypass CCI edits
Source: David M. Vaughn, Esq., CPC - ASIPP 7th Annual
Meeting
438
Q
  1. A physical therapy visit is 37 minutes in length. During
    that 37 minutes, ultrasound (CPT code 97035) is
    performed for 4 minutes; exercise instruction (CPT code
    97110) is performed for 25 minutes; and neuromuscular
    re-education (CPT code 97112) is performed for 8
    minutes.This visit would be billed as:
  2. 97035 x 1 unit, 97110 x 2 units, 97112 x 1 unit
  3. 97110 X 1 unit, 97035 X 1 unit
  4. 97035x 1 unit, 97110 x 1 units, 97112 x 1 unit
  5. 97110 x 1 unit, 97112 x 1 unit
A
  1. Answer: D (4 Only)
    Explanation:
    The total treatment time was 37 minutes which supports
    only two units to be billed with the “8 Minute Rule”. The 8
    minute rule applies to all timed PT CPT codes that
    require direct, one to one contact by the PT provider. It
    states that for any single, timed CPT code, providers bill a
    single 15’ unit for treatment greater than or equal to eight
    minutes and less than 23 minutes. Two units would be
    billed for treatment 23 minutes to less than 38 minutes. If
    more than one CPT code is billed during a calendar day,
    then the total number of units that can be billed is
    constrained by the total treatment time. Ultrasound was
    performed for only four (4) minutes and therefore should
    not be billed.
    Source: WPS Comminque May 2005, PHYSMED-009
    Source: Marsha Thiel, RN, MA, Sep 2005
439
Q
  1. In order to properly bill for behavioral health services,
  2. The clinical psychologist should follow all appropriate
    state and federal guidelines.
  3. The clinical psychologist should bill incident to the interventional
    pain physician.
  4. The clinical psychologist should bill under his or her
    own provider number.
  5. The clinical psychologist should bill incident to the certifi
    ed nurse practitioner who did the original medical
    evaluation
A
  1. Answer: B (1 & 3)
    Explanation:
    A Clinical Psychologist should follow all appropriate state
    and federal guidelines). The CP is eligible to obtain a
    Medicare provider number and should bill under this
    number. Clinical Psychologists are licensed to practice
    independently in all 50 states and are generally not billed
    incident to interventional pain physicians because in most
    cases interventional pain physicians would not have the
    requisite training and skill set to appropriately supervise
    the work of a pain psychologist.
    Principles of Documentation, Billing, Coding, and
    Practice Management for the Interventional Pain
    Professional (ed by) Laxmaiah Manchikanti, ASIPP
    Publishing: Paducah, KY.
    Source: Marsha Thiel, RN, MA, Sep 2005
440
Q
  1. A physical therapist is employed by a physician group
    practice. The therapist does not have an individual
    provider number with the designation of physical
    therapist in private practice but instead bills for physical
    therapy services incident to the physician present in the
    offi ce, which is the case today. A Medicare patient arrives
    at the clinic with an order for physical therapy. The order
    was written by a physician who is not a member of the
    group practice that employs the physical therapist. Which
    statements are true about this situation?
  2. The patient cannot be seen by the PT because the service
    cannot be billed incident to a physician who has
    not participated in the patient’s care.
  3. The patient can be seen by the PT but would fi rst need to
    be seen by one of the physician members of the group
    practice that employs the physical therapist, to allow
    billing incident to.
  4. The physical therapist can bill under her own Medicare
    provider number with payment reassigned to the group
    practice, in order to receive referrals for physical therapy
    from physicians outside of the group practice.
  5. The patient can be seen with the visit billed incident to
    the physician because the physician is present in the offi
    ce suite at the time of the visit.
A
  1. Answer: B ( 1 & 3)
    Explanation:
    Physical therapy services cannot be billed incident to a
    physician who is not involved in the patient’s care,
    regardless of whether or not physician supervision of
    ancillary personnel is met. Physical therapists can accept
    referrals for physical therapy from providers outside of a
    group practice they are employees of if they have their
    own
    Medicare provider numbers to bill under Source: WPS- PHYSMED-004, WPS National Coverage
    Provision, Incident To Billing
    Source: Marsha Thiel, RN, MA, Sep 2005
441
Q
  1. A physical therapist assistant(PTA) is working within a
    medical clinic as an employee of the group practice. She
    is approached by the physician who has just evaluated
    a patient and would like the patient to begin physical
    therapy immediately to assist with pain management.
    The PTA points out that she cannot see the patient. What
    is the reason that the patient cannot be seen?
  2. The patient has not exhausted all medical options for
    pain management fi rst
  3. The patient has not been an active patient of the medical
    clinic for at least 30 days
  4. The patient cannot receive physical therapy on the same
    day they see the physician if both are employed by the
    same group practice.
  5. The patient has not been evaluated by a physical therapist
A
  1. Answer: D (4 only)
    Explanation:
    Physical therapy is provided upon evaluation and
    examination of a patient in accordance with the plan of
    care, treatment frequency and duration, and functional
    goals that were established by a physical therapist. Physical
    therapy services cannot be initiated by physical therapist
    assistants.
    Source: Medicare Benefi t Policy Chapter 15, 230.1,
    Practice of Physical Therapist
    Source: Marsha Thiel, RN, MA, Sep 2005
442
Q
  1. A physical therapist assistant performs treatment with a
    Medicare benefi ciary. The physical therapist assistant is
    an employee of the physician group practice which also
    employees a physical therapist. The physical therapist
    has gone home for the day at the time of the Medicare
    benefi ciary’s visit with the PTA. The physician is still
    present in the clinic. How would the PTA bill for physical
    therapy services for this patient?
  2. The charges would be billed incident to the physician.
  3. The charges would be billed under the physical therapists
    Medicare provider number.
  4. The charges would be billed under the physical therapist
    assistant’s Medicare provider number.
  5. The visit would not be billable.
A
  1. Answer: D (4 Only)
    Explanation:
    Physical therapist assistants do not have provider
    numbers. Services provided by a physical therapist
    assistant may be billed by the supervising physical
    therapist if the physical therapist is in the clinic. The visit
    cannot be billed by the supervising PT if the PT is not
    present in the clinic. Medicare does not allow PTA’s to bill
    work that they do incident to a physician who may be
    present. In this case therefore, there are no options for
    billing for the visit and it would be a no charge visit.
    Source: Medlearn Matters #SE0533
    Source: Marsha Thiel, RN, MA, Sep 2005
443
Q
  1. A Medicare benefi ciary is seen by his physician on March
    1 and physical therapy is ordered at that time. The patient
    begins physical therapy on March 3 and on May 2, at the
    patient’s tenth visit, the decision is made by the PT that
    three additional PT visits will be needed. The patient has
    not seen his physician since March 1 however the original
    PT plan of care included a treatment frequency and duration of 1 x per week for 12 weeks and the physician
    has recertifi ed the therapy plan of care twice. What would
    prevent this patient from continuing physical therapy?
  2. He would need a new signed order from his physician
    before returning to PT because the original order was
    more that 60 days old.
  3. Medicare limits the number of physical therapy visits to
    10 per episode of care.
  4. The maximum duration for physical therapy services
    is 60 days.
  5. He has not seen his physician in the last 60 days.
A
  1. Answer: D (4 Only)
    Explanation:
    Medicare requires benefi ciaries receiving physical therapy
    services to see their ordering physician or a member of the
    physician’s group practice within 60 days of starting PT if
    PT care is to continue beyond 60 days. The benefi ciary is
    then required to see the physician every 30 days thereafter
    if therapy is ongoing.
    Source: www.cms.hhs.gov/manuals/pm_trans/R5BP.pdf,
    CMS Manual, Pub 100-02, Medicare Benefi t Policy,
    Transmittal 5, January 9, 2004
    Source: Marsha Thiel, RN, MA, Sep 2005
444
Q
  1. Certifi cation documentation completed by the physical
    therapist for Medicare benefi ciaries receiving Physical
    Therapy services must contain the following elements:
  2. Certifi cation period dates which encompass a thirty
    day period
  3. A treatment duration that does not exceed 30 days
  4. Functional and measurable treatment goals
  5. Records of previous physical therapy episodes of care
A
  1. Answer: B ( 1 & 3)
    Explanation:
    Certifi cation documentation requires a stated treatment
    frequency and duration, an identifi ed certifi cation period
    that is thirty days from the time of the physical therapy
    evaluation, and a treatment plan to address functional and
    measurable goals. Mention of previous PT is not
    necessary but may be helpful in establishing the chronicity
    of a condition. The treatment duration is required to be a
    stated and defi ned period, but does not need to be thirty
    days.
    Source: CMS Manual, Pub 100-02, Medicare Benefi t
    Policy, Transmittal 34, Chapter 15, Sections 220 and 230
    Source: Marsha Thiel, RN, MA, Sep 2005
445
Q
  1. True statements regarding coding in interventional pain
    procedures include:
  2. Coding in 2000, 2001, and 2002 Current Procedural Terminology
    (CPT) procedure manuals is identical.
  3. No understanding of procedure codes is required by the
    physician; rather only billing personnel must understand
    procedure codes.
  4. Current Procedural Terminology (CPT) procedure
    manuals, whether older or newer, are interchangeable.
  5. The interventional pain physician should thoroughly
    understand each procedure code used in describing interventional
    pain procedures to avoid misunderstanding,
    incorrect coding, or unbundling.
A
  1. Answer: D (4 Only)

Source: James A. Mirazita, MD, Sep 2005

446
Q
  1. Four patients are seen for physical therapy for one hour,
    simultaneously, as part of a back stabilization group class.
    The four patients are performing similar exercises, under
    the instruction and direction of one physical therapist.
    How would you most appropriately bill for this?
  2. Each patient would be billed for four units of therapeutic
    exercise, CPT code 97150.
  3. Each patient would be billed for one unit of therapeutic
    exercise, CPT code 97110 and a group therapy code,
    CPT code 97150.
  4. Each patient would be billed for four units of therapeutic
    exercise and one group therapy code.
  5. Each patient would be billed for one group therapy
    code, CPT 97150.
A
  1. Answer: D (4 Only)
    Explanation:
    If a provider is overseeing the therapy of more than one
    patient during a period of time, he or she must bill 97150
    since he or she is not furnishing constant attendance to a
    single patient. The therapist is required to be in constant
    attendance but one on one patient contact is not required
    This is an un-timed code and can only be charged one
    time per patient per visit.The therapeutic exercise code
    identifi es one on one instruction and is a timed code. A
    physical therapist can provide direct one to one patient
    contact with only one patient at a time.
    Source: Federal Register November 22, 1996, page 59542;
    Transmittal #1753, May 17, 2002.
    Source: Marsha Thiel, RN, MA, Sep 2005
447
Q
  1. What are the true statements about federal regulations
    impacting ambulatory surgery centers?
  2. Immunity from anti-kickback prosecution
  3. Ownership of ASCs includes - Physician Ownership,
    Single Specialty, Multi-Specialty and Hospital/
    Physician owned
  4. Protection limited to physician investors who either use
    facility on regular basis, or practice in same specialty
  5. Non-compliance with safe harbors means illegal leading
    to hefty criminal and civil penalties
A
2367. Answer: A (1,2, & 3)
Explanation:
ASC Safe Harbors
Immunity from anti-kickback prosecution
4 Categories: Surgeon-Owned, Single Specialty, Multi-
Specialty and Hospital/Physician
Protection limited to physician investors who either –
Use facility on regular basis, or
Practice in same specialty (so cross referrals less likely)
Must meet all requirements to qualify
Voluntary
Non-compliance does not mean illegal
Source: Ron Wisor, JD
448
Q
  1. A physical therapist is providing physical therapy
    treatment to Patient A in a closed treatment room. A
    physical therapist assistant is providing treatment to
    Patient B in a different room, within the same clinical
    space. There is a physician (who is also the employer
    of the PT and the PTA) is also working on site. The
    physical therapist is employed by the medical clinic but
    has an individual Medicare provider number, making it
    a physical therapy private practice setting. The physical
    therapist assistant services are billed by the supervising
    PT. The level of PTA supervision by the physical therapist
    required for this setting is:
  2. General supervision
  3. Direct supervision by the physician only
  4. Direct personal supervision
  5. Direct supervision
A
  1. Answer: D (4 Only)
    Explanation:
    Direct supervision requires the PT to be present and
    immediately available for direction and supervision; it is
    the supervision level required in a physical therapy private
    practice setting, unless state practice requirements are
    more stringent, in which case those requirements must be
    followed. Although the PT and PTA are working within a
    medical clinic, because PTA services are billed by the
    supervising PT, they are considered to be a part of a
    physical therapy private practice.
    Source: APTA website, H.O.D. 06-00-15-26
    Source: Marsha Thiel, RN, MA, Sep 2005
449
Q
  1. True statements about postoperative pain management
    in patients receiving methadone maintenance treatment
    are as follows:
  2. Continue maintenance treatment without interruption.
  3. Immediately stop maintenance treatment.
  4. Provide adequate individualized doses of opioid agonists,
    which must be titrated to the desired analgesic
    effect.
  5. If opioids are administered in methadone maintenance
    patients, doses should be given less frequently and on
    a prn basis.
A
  1. Answer: B (1 & 3)
    Explanation:
  2. Continue maintenance treatment without
    interruption.
  3. Maintenance treatment must be continued.
  4. Provide adequate individualized doses of opioid
    agonists, which must be titrated to the desired analgesic
    effect.
  5. Doses should be given more frequently and on a fi xed
    schedule rather than prn basis.
450
Q
  1. A patient called to schedule an appointment at
    your clinic. He told you that he has Federal Workers’
    Compensation coverage for his area of pain. As a medical
    provider, you will have to be aware of the following:
  2. You can know what the accepted conditions are for
    a claim by asking the injured worker. If the worker
    does not know, he can contact the Employing Agency
    directly.
  3. With Federal Workers’ Compensation all services need
    to be prior authorized
  4. You need to be enrolled as a provider to treat an injured
    federal employee.
  5. Authorization may be obtained by any one of the following
    means: online, by phone, or by fax.
A
  1. Answer: B ( 1 & 3)
    Explanation:
    Explanations under www.dol.gov/esa—-Information for
    Medical Providers
    “Ask the injured Worker for her/his accepted conditions.
    If s/he doesn’t know these, s/he can contact her Employing
    Agency or OWCP district offi ce for this information, or
    you can contact the Employing Agency directly. The
    Privacy Act prohibits OWCP and ASC from disclosing
    this information to anyone other than the Injured Worker.”
    “To be paid for treating federal employees covered by the
    FECA, you must enroll. As of March 31. 2004, all bills
    submitted by non-enrolled Providers will be returned
    along with instructions on how to enroll. Enrollment is
    free and is simply a registration process to ensure proper
    payments. It is not a PPO enrollment.”
    “Level 1 procedures (for example, Offi ce Visits, MRI’s,
    Routine Diagnostic Tests) do not require authorization.
    Level 2, 3 and 4 procedures require authorization”
    “An authorization is not required when an Injured Worker
    is referred by her/his treating physician to a specialist for a
    consultation. However, you must be enrolled as a
    Provider to be paid for the consultation visit.”
    “You may request authorization online at
    http://owcp.dol.acs-inc.com. Or you may fax the
    appropriate Medical Authorization form and supporting
    documentation to 800-215-4901. The Medical
    Authorization forms are available online at
    http//owcp.dol.acs-inc.com.” You may not call for
    authorization.
    Source: Marsha Thiel, RN, MA, Sep 2005
451
Q
  1. As you are walking by an exam room, you hear your
    nurse practitioners making fun of the new physician (a
    Muslim) you have hired. Although the physician was not
    in the room, you heard the nurses mock his accent and
    call him “towel head.” What should you do?
  2. Deal with the situation immediately. Explain to the
    nurses that they are violating the clinic’s policy against
    harassment, and warn them that any future inappropriate
    conduct will result in discipline, up to and including
    termination. Then note the warning
  3. Ignore it – the physician didn’t hear it and you simply
    overheard the remarks. Injecting yourself into the situation
    will simply cause morale problems.
  4. Run to the personnel manual and make sure you have an
    anti-harassment policy.
  5. Have a private conversation with the new Muslim doctor.
    Explain that his accent and his turban is causing
    distractions to the offi ce staff. Ask him to dress like
    other doctors in the offi ce, and to work on speaking
    without an accent.
A
  1. Answer: B (1 & 3)
    Explanation:
    Explanation:This is not as outlandish as it sounds.
    Harassment and discrimination against employees of
    mideastern origin are on the rise since 9/11. It is critical to
    adopt a zero tolerance policy. Inappropriate racial or
    ethnic jokes and mocking an employee’s accent are not
    acceptable merely because the “target” did not hear the
    remarks or because you only “overheard.” If you know
    about the conduct and do nothing,you and the clinic are at
    risk.
    Source: Judith Homes, Sep 2005
452
Q
  1. What is sequential coding?
  2. Line 1, surgery with greatest relative value – 100%
  3. Line 1, describes the procedure you had complications
    with
  4. Lines 2-5, surgery with 50% reduction
  5. Lines 2-5, describe easiest procedures
A
2372. Answer: B (1 & 3)
Explanation:
Sequential Coding:
* Line 1
Surgery with greatest relative value – 100%
* Lines 2-5 - 50%
Source: Laxmaiah Manchikanti, MD
453
Q
  1. Which of the following is true about the cash accounting
    method?
  2. Must use this method if business carries inventory to
    sell to public
  3. Revenue is recorded when earned
  4. Evens out revenue and expenses over time
  5. Expenses are recorded when a check is written
A
  1. Answer: D (4 Only)
    Explanation:
  2. A business that stocks inventory for sale to the public
    must use the accrual method of accounting
  3. Revenue is recorded when earned under the accrual
    method of accounting
  4. Accrual accounting will even out the revenue and
    expenses over time
  5. Under the cash method of accounting, expenses are
    recorded when cash is paid out
    Source: Marsha Thiel, RN, MA, Sep 2005
454
Q
  1. Your offi ce manager fi led an EEOC charge against your
    clinic, claiming he was terminated because of his age. He
    has evidence that he was called “senile,” an “old fart,” and
    was accused of having “Old-Timer’s Disease.” Which of
    the following are potential defenses to his Charge?
  2. He is under the age of 40
  3. You have several good examples of his poor work product
    and you have documented the warnings he received
    before his termination.
  4. He was hired 6 months ago by the same person that
    terminated him.
  5. He has always been a “whiner” and you can present evidence
    that he complains about everything.
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Explanation: Age discrimination complaint may be made
    by those who are 40 years or older. The issue of age
    discrimination is a growing concern as the “baby
    boomers” continue to age and demand their rights. It is
    important to keep ageist comments out of the workplace
    and to make certain that those individuals responsible for
    employment decisions, such as hiring and fi ring, do not
    engage in discriminatory conduct. You have a better
    chance of prevailing on a discrimination claim if you have
    good documentation to show a legitimate reason for the
    termination, such as poor work quality.
    Source: Judith Homes, Sep 2005
455
Q
  1. The following statements about the eight minute rule
    are true:
  2. The number of units billed cannot exceed the total time
    spent with the patient.
  3. One unit of a timed code refl ects treatment that encompasses
    at least 8 minutes and up to 22 minutes.
  4. Interventions that require less than 8 minutes of work
    should not be billed.
  5. Total treatment time can include the time spent to set up
    equipment for the visit
A
  1. Answer: A (1,2, & 3)
    Explanation:
    The eight minute rule applies to all timed PT CPT codes
    that require direct, one to one contact by the PT provider.
    It states that for any single, timed CPT code, providers bill
    a single 15’unit for treatment greater than or equal to eight
    minutes and less than 23 minutes. Two units would be
    billed for treatment 23 minutes to less than 38 minutes. If
    more than one CPT code is billed during a calendar day,
    then the total number of units that can be billed is
    constrained by the total treatment time. Time is defi ned as
    actual treatment time.
    Source- WPS Communique May 2005, PHYSMED-009
    Source: Marsha Thiel, RN, MA, Sep 2005
456
Q
  1. Which of the following is a true statement with respect
    to an Exposure Control Plan?
  2. An Exposure Control Plan must include an exposure
    determination, procedures for evaluating the circumstances
    surrounding an exposure incident, and a schedule
    and method for implementing the provisions of the
    regulations.
  3. An Exposure Control Plan must be in writing.
  4. The input of non-managerial employees who are responsible
    for direct patient care and are potentially
    exposed to injuries from contaminated sharps must be
    solicited in the identifi cation, evaluation and selection of effective engineering and work practice
  5. An Exposure Control Plan must include the telephone
    number and address of OSHA’s closest regional offi ce.
A
  1. Answer: A (1,2, & 3)
    Explanation:
    An Exposure Control Plan must be in writing and contain at least the following elements: (1) an exposure
    determination, (2) the procedures for evaluating the
    circumstances surrounding an exposure incident and (3) a
    schedule of how and when other provisions of the
    regulations will be implemented, including methods of
    compliance, hepatitis B vaccination and post-exposure
    follow-up, communication of hazards to employees, and
    recordkeeping. The standard also requires employers to
    solicit and document in the Exposure Control Plan input
    of non-managerial employees who are responsible for
    direct patient care and are potentially exposed to injuries
    from contaminated sharps with regard to the
    identifi cation, evaluation and selection of effective
    engineering and work practice controls. The telephone
    number and address of OSHA’s offi ce is not a required
    element of the Exposure Control Plan,although it could be
    included and may be required to be posted elsewhere
    in theworkplace.The Exposure Control Shall must be
    reviewed and updated annually and whenever necessary to
    refl ect new or modifi ed tasks and procedures which affect
    occupational exposure and to refl ect new or revised
    employee positions with occupational exposure.
    Source: 29 CFR 1910.1030(c).
    Source: Erin Brisbay McMahon, JD, Sep 2005
457
Q
  1. Which of the following statements apply to an Advanced
    Benefi ciary Notice (ABN)?
  2. A physician may use an ABN when a benefi ciary is
    under great duress and requires a non-covered treatment.
    Great duress is when the benefi ciary’s condition
    requires urgent and/or emergency care.
  3. An ABN is a written notice a physician gives to a Medicare
    benefi ciary before providing a specifi c item or
    service that the physician believes Medicare probably or
    certainly will not pay for.
  4. A physician can have a Medicare Benefi ciary sign an
    ABN on his/her fi rst visit and it will cover any future
    item or service that Medicare denies as non- covered.
  5. Medicare charge limits do not apply to either assigned or
    unassigned claims when collection from the benefi ciary
    is permitted on the basis of an ABN.
A
  1. Answer: C (2 & 4)
    Explanation:
    The purpose of an ABN is to inform a Medicare
    benefi ciary before h/she receives specifi ed items or services
    that otherwise might be paid for, that Medicare probably
    will not pay for them on that particular occasion.The ABN
    allows the benefi ciary to make an informed decision
    whether nor not to receive the items or services since h/she
    may have to pay out of pocket or, if available, through
    other insurance.
    Medicare does not limit the amount which the physician
    or supplier, participating or nonparticipating, may collect
    from the benefi ciary in such a situation. Medicare charge
    limits do not apply to either assigned or unassigned claims
    when collection from the benefi ciary is permitted on the
    basis of an ABN.
    Source: Program Memorandum Intermediaries/Carriers,
    Transmittal AB-02-114, July 31, 2002, ABN’s and
    DMEPOS Refund Requirements – Implementation of
    Form CMS-R-131 Advanced Benefi ciary Notice (ABN),
    and of Limits of Benefi ciary Liability or Medical
    Equipment and Supplies.
    Source: Joanne Mehmert, CPC, Sep 2005
458
Q
  1. You suspect your employees are spending unauthorized
    time on your computer system sending jokes to each
    other, playing games, and visiting porn sites. What can
    you do to get the situation under control?
  2. Give your employees a warning that unauthorized use of
    your offi ce equipment will not be tolerated.
  3. Install software on the computers to identify employees
    engaging in unauthorized computer use. Continue to
    monitor employees on a regular basis
  4. Discipline employees who violate the computer use
    policy.
  5. None of the above. It is an invasion of the employees’
    right of privacy to monitor computer use, or to attempt
    to restrict their computer use. They have a right to unrestricted
    use of the computer at lunch and on breaks.
A
  1. Answer: A (1,2, & 3)

Source: Judith Homes, Sep 2005

459
Q
  1. Select all statements that are correct.
  2. Medicare does not require an NDC number be included
    on the claim for drugs; however some non-Medicare
    payers do require this number
  3. Compounded drugs are drugs mixed to meet a specifi c
    prescription order that is not sold by a manufacturer in
    the strength or mixture that the patient requires
  4. The “J” codes that are listed in the HCPCS manual do
    not describe the compounded medications since they
    are “mixed to order” by a compounding pharmacist.
  5. Claims to all payers must include the NDC number and
    the “J “code from the Healthcare Common Procedure
    Coding System (HCPCS) book
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Currently Medicare does not require an NDC number; the
    “J” code is all that is required. There are some non-
    Medicare carriers that do require the NDC number. The
    billing staff should watch the EOB’s carefully to be sure
    that the drugs are paid appropriately.
    There is much confusion in the industry relative to the
    appropriate method to bill for compounded medications.
    The basic coding principle that applies to procedures and
    other services pertains to coding for compounded drugs.
    When the code doesn’t describe the item or service, use an
    unlisted code and tell the insurer what it is. The “J” codes
    do not represent compounded, specially mixed, drugs.
    Source: Correct Coding Conventions; various Medicare
    Carrier Policies
    Source: Correct Coding Conventions; various Medicare
    Carrier Policies
460
Q
  1. What method does CMS use to pay for drugs?
  2. Every Medicare Carrier prices drugs based on the cost in
    its geographic region
  3. Medicare pays the Average Wholesale Price for drugs
  4. Payment for drugs is published in the Medicare Physician’s
    Fee Schedule (MPFS) in November of each year
  5. Medicare pays on the basis of Average Sales Price
    (ASP).
A
  1. Answer: D (4 Only)
    Explanation:
    Drug manufacturers are required to submit their average
    sales price to CMS every quarter. The data will include
    almost all Medicare Part B drugs not paid on a cost or
    prospective payment basis. Medicare’s payment to the
    provider is equal to the lesser of 106 percent of the average
    sales price or 106 percent of the wholesale acquisition cost
    of the Health Care Common Procedure Coding System
    (“HCPCS”) drug. Physicians can download a complete
    list of the drugs and the payment for each every quarter.
    Source: CMS web site www.cms.gov. Medicare Program;
    Revisions to Payment Policies Under the Physician Fee
    Schedule for Calendar Year 2005 – CMS-1429-FC, on
    display at the Offi ce of the Federal Register November 2,
    2004.
    Source: Joanne Mehmert, CPC, Sep 2005
461
Q
  1. Do non-Medicare payers allow separate payment for
    supplies such as needles, syringes and/or surgical trays
    used for nerve blocks and injections when they are
    performed in the offi ce, place of service (POS) 11?
  2. Private payers do not allow additional payment for
    supplies
  3. Payment for supplies used for nerve blocks and injections
    is payer specifi c.
  4. Private payers will pay an additional fee for all supplies
    used in the offi ce
  5. Payment for supplies is an issue that should be addressed
    in the fee schedule section of the contractual
    agreement.
A
  1. Answer: C (2 & 4)
    Explanation:
    Payer fee schedules seldom address the payment of
    supplies nor are there any codes listed for surgical trays
    and/or supplies. Unless the contractual agreement
    specifi cally prohibits the physician from reporting
    supplies, it is appropriate to bill separately for the
    supplies. More expensive equipment and supplies should
    be carved out to ensure adequate reimbursement.
    Source: Manchikanti L, Principles and Practice of
    Documentation, Billing, Coding, and Practice
    Management 2005
    Source: Joanne Mehmert, CPC, Sep 2005
462
Q
  1. What expenses listed below does a physician practice
    have to incur to report Place of Service 11, (POS 11)?
  2. All fi xed expenses such as rent and utilities
  3. Administrative, billing, nursing and technical staff costs
  4. Supplies and equipment
  5. Laboratory Expenses
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Medicare and an increasing number of non-Medicare
    payers allow a higher payment for procedures and services
    performed in POS 11. Medicare calculates the higher
    payment based on a component called “practice expense”.
    A physician must incur the entire expense of the practice
    to justifi ably report POS 11 as the site of service.
    Source: Source: Manchikanti L, Principles and Practice of Documentation, Billing, Coding, and Practice
    Management 2005; Medicare Physician’s Fee Schedule
    (MPFS)
    Source: Joanne Mehmert, CPC, Sep 2005
463
Q
  1. What are the true statements in selection of eligible
    investors in ASCs:
  2. Physicians in position to use facility
  3. Employed by the facility or any investor
  4. Group practices composed exclusively of physicians to
    use facility
  5. In position to make or infl uence referrals
A
  1. Answer: B ( 1 & 3)
    Explanation:
    Eligible Investors
    Physicians in position to use facility
    Group practices composed exclusively of such physicians
    Others who are not –
    Employed by the facility or any investor
    In position to provide services to facility
    In position to make or infl uence referrals
    Source: Ron Wiser, JD
464
Q
  1. In an offi ce setting; place of service (POS) 11: Dr.
    Ken is across the street (available by telephone) at the
    ambulatory surgical center and a Medicare benefi ciary
    arrives an hour early for his pump refi ll. The offi ce nurse,
    an R.N., who usually refi lls the pumps when the doctor is
    in the offi ce, refi lls the pump. How is this service reported
    to Medicare?
  2. Report code 95990, Refi lling & maintenance of implantable
    pump or reservoir for drug delivery; spinal
    (intrathecal, epidural or brain), when performed by
    the nurse under Dr. Ken’s name and Medicare provider
    identifi cation number (PIN);
  3. Report code 95990, under Dr. Ken’s PIN and the nurse’s
    name on the claim in the “signature” space
  4. Report code 96530, refi lling and maintenance of implantable
    pump or reservoir for drug delivery, systemic
    (eg, intravenous, intra-arterial) under Dr. Ken’s name
    and PIN
  5. Medicare may not be billed for this service
A
  1. Answer: D (4 Only)
    Explanation:
    The service may not be reported as an “incident to” service
    since the physician is not in the offi ce. When the doctor’s
    PIN is on a claim sent to Medicare, it represents that the
    service was provided by the physician or incident to a
    physician service, the nurse’s name on the form will not
    mitigate having the doctor’s PIN listed. Code 96530 has
    not been used for morphine pump refi lls for pain control
    since 2003, when code 95990 was added to CPT.
    No charge may be reported to Medicare for the nurse’s
    service in this circumstance.
    Source: Centers for Medicare and Medicaid,
    www.cms.gov, Incident to reporting guidelines.
    Source: Joanne Mehmert, CPC, Sep 2005
465
Q
  1. Select the reason(s) that it is important for a practice
    to report services within the context of CPT coding
    instructions, guidelines and conventions, even if the
    medical provider disagrees with the AMA instructions?
  2. Deliberately reporting codes that are contrary to CPT
    coding instructions may be considered by CMS and/or
    third party payers as knowingly submitting a false claim
    to obtain payment for a service that was not provided
    - a criminal offense
  3. The most important step toward solving the problem of
    health insurer’s use of “black box edits” and downcoding
    claims is to gain the confidence of the insurer(s) by
    submitting claims that follow CPT instructions
  4. When the government brings a criminal indictment for
    submission of false claims against a provider, the provider
    may be sentenced to prison
  5. Loss of payer confi dence in the physician community.
A
  1. Answer: E (All)
    Source: www.cms.gov. ; Manchikanti L, Principles and
    Practice of Documentation, Billing, Coding, and Practice
    Management 2005
466
Q
  1. When the practice is making a decision whether to bill
    a drug and/or how to bill for the drug, it should consider
    which of the following?
  2. Is the drug an expense to the practice?
  3. Does the “J” code descriptor accurately describe the
    drug administered?
  4. What is the specifi c dosage described by the drug and
    how much was given?
  5. Does the local Medicare carrier have an LCD regarding
    coding/billing requirements for this particular drug (or
    compound)?
A
  1. Answer: E (All)
    Explanation:
    The drug must be an expense to the practice; a physician
    practice may not bill a drug for which it did not pay.When
    the patient “brown bags” the drug, it is not billable. Brown
    bagging is when a patient brings the drug that h/she paid
    for, or the pharmacy billed to the insurer. Drugs furnished
    by a manufacturer to be used for clinical trials or drug
    samples are other examples of non-billable drugs.
    When the “J” code does not accurately describe the drug
    administered, an unlisted code should be reported such as
    for a compounded drug. The practice should also be
    familiar with its local Medicare Carrier coverage
    decisions relative the conditions for which drugs are
    covered. Some Medicare carriers do not cover Botulinum
    toxin (Bo-Tox) injections that are administered for
    headache pain. In this circumstance, neither the drug nor
    the injection will be covered.
    Several of the Medicare carriers also have policies where
    they require the practice to report an unlisted drug when a
    compound medication is used for a pump refi ll. Close
    attention should be given to all aspects of billing for drugs.
    Source: Medicare Contractors Manual, 100-04, Chapter
    14; Manchikanti L, Principles and Practice of
    Documentation, Billing, Coding, and Practice
    Management 2005
    Source: Joanne Mehmert, CPC, Sep 2005
467
Q
  1. A physician performed stellate ganglion block under
    fl uoroscopy – What is the correct coding?
  2. CPT 64510 - cervical sympathetic block
  3. CPT 64505 – sphenopalatine ganglion block
  4. CPT 76003 – fl uoroscopic guidance
  5. CPT 76005 - fl uoroscopic guidance
A
  1. Answer: B ( 1 & 3)
    Explanation:
    Reference: Manchikanti L (ed). Principles of
    Documentation, Billing, Coding & Practice Management
    for the Interventional Pain Professional, ASIPP
    Publishing, Paducah KY 2004.
    Source: Laxmaiah Manchikanti, MD
468
Q
  1. Choose accurate statement(s) of fair market value under
    the Stark regulations on a physician referral:
  2. Fair market value is tied into a number of defi nitions
    and exceptions under Stark Law
  3. Fair market value means the price that willing buyer
    gives to a willing seller
  4. For rentals and leases, fair market value is the value of
    rental property for general commercial purposes without
    taking into account the property’s intended use
  5. Under Stark Law, there are no fair market value exceptions
A
  1. Answer: B (1 & 3)
469
Q
  1. Designated Health Services providers that furnish 20
    or more Part A and Part B services during the year must
    maintain certain information in the form, manner and
    at the times that the Centers for Medicare and Medicaid
    Services or the Offi ce of Inspector General specifi es. The
    information required to be kept does NOT include the
    following:
  2. The name and unique identifi cation number (“UPIN”)
    of each physician who has a reportable fi nancial relationship
    with the entity.
  3. The name and unique identifi cation number of each
    physician who has a family member who has a reportable
    fi nancial relationship with the entity.
  4. The covered services furnished by the entity.
  5. The name and social security number of each physician’s
    immediate family members.
A
  1. Answer: D (4 Only)
    Explanation:
    Answer (4) is wrong; it is not a required reporting
    element.
    Source: 42 CFR 411.361.
    Source: Erin Brisbay McMahon, JD, Sep 2005
470
Q
  1. What are the examples of “unbundling?”
  2. Fragmenting one service into component parts and
    coding each component part as if it were a separate
    service.
  3. Reporting separate codes for related services when one
    comprehensive code includes all relates services.
  4. Breaking out bilateral procedures when one code is appropriate.
  5. Downcoding a service in order to use an additional
    code when one high-level, more comprehensive code
    is appropriate.
A
  1. Answer: E (All)
    Explanation:
    Unbundling is when a provider bills separately for items,
    services or procedures that should be billed together under
    one code. This practice also sometimes is called
    fragmenting or exploding.
  2. Separate procedures: If provided as a more
    comprehensive procedure, “separate procedure” codes
    should be submitted with their related and more
    comprehensive codes.
  3. Most extensive procedures: When CPT descriptors
    designate several procedures of increasing complexity,
    only the code describing the most extensive procedure
    actually performed should be submitted.
  4. With/without services: Certain code designate several
    procedures performed with or without other services.
    Submit only the code for the service actually performed.
  5. Sex designation: When code descriptors identify
    procedures requiring a designation for male or female,
    submit only the appropriate code.
  6. Standards of medical practice: For Medicare, all services necessary to perform a given procedure are
    considered included in that procedure. Even if
    independent CPT codes exist for these ancillary services,
    Medicare considers billing for these independent CPT
    codes “unbundling,” so don’t do it.
  7. Laboratory panels: When a codes exists for a grouping
    or panel of lab tests, bill it – don’t submit codes for
    individual lab tests.
  8. Sequential procedures: If a doctor fi nds it necessary to
    attempt several procedures in direct succession to
    accomplish the same end in a patient encounter, bill for
    only the procedure that was successfully accomplished.
    (This applies mainly to limited procedures that are
    unsuccessful, showing the need for more comprehensive
    procedure.) However, procedures performed at the same
    session that are diagnostic in nature and establish the
    decision to perform the more comprehensive service may
    be separately billed.
  9. Modifi er -59: This modifi er is used to indicate a
    distinct procedural service done on the same day as other
    services. However, it does not replace modifi ers -25, -51,
    -76 or -79. The -59 modifi er is used only after the other
    modifi ers are analyzed and no other modifi er fi ts the
    service.
  10. Anesthesia performed during medical/surgical
    procedures: Medicare prohibits payment of a separate fee
    for anesthesia when the same doctor provides anesthesia
    and performs the medical/surgical procedure. So don’t
    submit codes describing anesthesia services necessary to
    provide anesthesia with primary procedure/service codes.
    Source: Laxmaiah Manchikanti, MD
471
Q

2392.What item(s) listed below does Medicare consider
“incident to” a physician’s service and may be reported
and paid separately when services are provided in an
offi ce setting, place of service (POS) 11?
1. Needles and syringes used to perform an injection/nerve
block
2. Lidocaine that is used to anesthetize the area
3. Pulse oximetry
4. A substance such as Depo Medrol that is injected when a
lumbar epidural steroid injection is performed

A
  1. Answer: D (4 Only)
    Explanation:
    Needles, syringes, and local anesthetic (lidocaine), are
    supplies that are bundled into the majority of the surgical
    procedure codes. Supplies are considered to be included in
    the payment for the procedure, i.e., the “global surgical
    fee”.
    Pulse oximetry is pre, intra, and post operative care that is
    bundled into the procedure, i.e., paid in the global fee.
    A drug or substance (Depo Medrol) that a patient cannot
    self administer is separately paid and is considered
    “incident to” the physician’s service.
    Source: Medicare Carrier Manual, 100-4, Chapter 12
    Source: Joanne Mehmert, CPC, Sep 2005
472
Q
  1. The following statements are true with reference to types
    of muscular contractions and strength.
  2. Isometric muscular contractions involve no motion
    despite muscular activity.
  3. Concentric muscular contractions include increased
    muscular length during a contraction.
  4. Isokinetic muscular contraction involves muscular contraction
    at a constant velocity, with very little proven
    relevance to real conditions.
  5. Isometric contraction is useful during motions that do
    not require stabilization.
A
  1. Answer: B (1 & 3)

Source: Manchikanti L, Board Review 2005

473
Q
  1. What are the principles of reimbursement governing the
    Medicare fee schedule?
  2. Controlled by Congress and Centers for Medicare &
    Medicaid Services (CMS)
  3. Based on sustainable growth rate formula
  4. May be based on performance
  5. Becoming basis for payment by private payors
A
  1. Answer: E (All)

Source: Laxmaiah Manchikanti, MD

474
Q
  1. What are the true statements about Correct Coding
    Policies?
  2. A new patient is the one who has not received any professional
    services from the physician or another physician
    of the same specialty who belongs to the same
    group practice, within the past 3 years.
  3. If a patient received anesthesia 3 months prior by the
    same group, the patient becomes an established patient.
  4. An established patient is the one who has received professional
    services from the physician or another physician
    of the same specialty who belongs to the same
    group practice, within the past 3 years.
  5. If a patient develops a different problem, the patient
    automatically becomes a new patient.
A
  1. Answer: B (1 & 3)

Source: Laxmaiah Manchikanti, MD

475
Q
  1. A consultation consists of some of the following
    elements:
  2. An opinion is requested
  3. Request for opinion is received
  4. The service/opinion is rendered and reported back
  5. Patient is referred
A
2396. Answer: A (1,2, & 3)
Explanation:
Consultation
An opinion is requested
Patient is not referred
3 R’s
Request for opinion is received
Render the service/opinion
Report back
Source: Laxmaiah Manchikanti, MD
476
Q
  1. Identify true statements differentiating consultation and
    referral visit:
  2. Written request for opinion or advice received from
    attending physician, including the specifi c reason the
    consultation is requested.
  3. Patient appointment made for the purpose of providing
    treatment or management or other diagnostic or
    therapeutic services.
  4. Only opinion or advice is sought. Subsequent to the
    opinion, treatment may be initiated in the same encounter
    if criteria are fulfi lled.
  5. Transfer of total patient care for management of the
    specifi ed condition.
A
  1. Answer: B (1 & 3)
    Explanation:
    Consultation vs. Referral Visit
  2. Problem
    Consultation
    Suspected
    Referral visit
    Known
  3. Request language
    Consultation
    “Please examine patient and provide me with your
    opinion and recommendation on his/her
    condition.”
    Referral visit
    “Patient is referred for treatment or management of
    his/her condition.”
  4. Request
    Consultation
    Written request for opinion or advice received from
    attending physician, including the specifi c reason the
    consultation is requested.
    Referral visit
    Patient appointment made for the purpose of providing
    treatment or management or other diagnostic or
    therapeutic services.
  5. Report language
    Consultation
    “I was asked to see Mr. Jones in consultation by Dr.
    Johnson.”
    Referral visit
    “Mr. Jones was seen following a referral from Dr.
    Johnson.”
  6. Patient care
    Consultation
    Only opinion or advice sought. Subsequent to the
    opinion, treatment may be initiated in the same encounter
    Referral visit
    Transfer of total patient care for management of the specifi ed condition.
  7. Treatment
    Consultation
    Undetermined course
    Referral visit
    Prescribed and known course
  8. Correspondence
    Consultation
    Written opinion returned to attending physician.
    Referral visit
    No further communication (or limited contact) with
    referring physician is required.
  9. Diagnosis
    Consultation
    Final diagnosis is probably unknown.
    Referral visit
    Final diagnosis is typically known at the time of referral.
  10. Follow-up
    Consultation
    Patient advised to follow up with attending physician.
    Referral visit
    Patient advised to return for additional discussion, testing,
    treatment, or continuation of treatment and management.
  11. Further follow-up
    Consultation
    Confi rmatory or follow-up consultation or established
    patient based on specifi c situation.
    Referral visit
    Always established patient for three years.
    Source: Laxmaiah Manchikanti, MD
477
Q
  1. Local Medical Review Policy (LMRP) or Local Coverage
    Determination (LCD) are utilized in all states. What are
    true statements?
  2. LMRP or LCD is developed to assure benefi ciary access
    to care
  3. Frequent denials indicate a need for development of
    LMRP or LCD
  4. A need for development of LMRP or LCD includes a
    validated widespread problem
  5. LMRPs or LCDs are those policies used to make coverage
    and coding decisions in the absence of: Specifi c statute,
    Regulations, National coverage policy, National coding
    policy or as an adjunct to a national coverage policy.
A
  1. Answer: E (All)
    Explanation:
    Local Medical Review Policy or Local Coverage
    Determination
    LMRPs or LCDs are those policies used to make coverage
    and coding decisions in the absence of:
    Specifi c statute
    Regulations
    National coverage policy
    National coding policy
    As an adjunct to a national coverage policy.
    Development of LMRP - Identifi cation of Need
    * A validated widespread problem
    Identifi ed or potentially high dollar and/or high volume
    services
    * To assure benefi ciary access to care
    * LMRP development across its multiple jurisdictions by a
    single carrier
    * Frequent denials are issued or anticipated
    LMRP’s reduce utilization and Save money
    Source: Laxmaiah Manchikanti, MD
478
Q
  1. Your administrative assistant has threatened to fi le an
    EEOC Charge against you and the clinic for allowing
    a hostile work environment because she overheard a
    sexually explicit joke being told by a coworker to another
    coworker. When you talk to the coworkers, they insist
    your assistant has repeatedly told them very sexually
    explicit jokes and that she always laughs more than
    anyone else. Are you in big trouble?
  2. No. One joke is not “severe” or “pervasive” conduct and
    does not alone create a “hostile work environment.”
  3. No. The conduct must be considered harassing to a
    reasonable person AND to the complaining employee.
    If she has a history of telling raunchy jokes, it will be
    diffi cult to prove she was personally offended.
  4. Either way, you need to get control of your employees
    and insist they stop telling inappropriate jokes
  5. Yes. An employer is strictly liable to his or her employees
    for sexually explicit jokes at the office.
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Explanation: One of the elements of a sexual harassment
    claim is that the alleged victim is personally offended.
    That is not enough – the conduct or incidents must also be
    offensive to a “reasonable person.” The lesson from this
    situation is that the physician is getting a wake up call and
    must rid the offi ce of inappropriate conduct through
    adopting appropriate policies, training and disciplinary
    procedures.
    Source: Judith Homes, Sep 2005
479
Q
  1. There are some items and services for which Medicare
    will not pay because they are not Medicare benefi ts and
    for which a provider will furnish a form known as a
    Notice of Excluded Medicare Benefi ts, (NEMB) instead of
    an ABN. Which one of the following services, although
    never covered, requires an ABN?
  2. Vaccinations
  3. Routine eye care, eyeglasses and examinations
  4. Services under a physician’s private contract
  5. Acupuncture
A
  1. Answer: D (4 Only)
    Explanation:
    CMS denies acupuncture as not reasonable and necessary
    under §1862(a)(1) of the Social Security Act (SSA). This
    service has commonly been thought to be “non covered”
    and many providers did not have an ABN signed for
    acupuncture services provided to a Medicare Benefi ciary.
    At present all acupuncture services are denied as not
    reasonable and necessary and require an ABN.
    Source: Joanne Mehmert, CPC, Sep 2005
480
Q

2401.What are some of the true statements about bilateral
codes?
1. Bilateral codes include transforaminal, facet joint interventions,
and SI joint injections
2. Facet joint neurolysis codes may not be billed as bilateral,
and require modifi ers 59 and 51
3. Unlisted codes may not be used as bilateral codes
4. Bilateral codes include intercostal nerve blocks, sympathetic
blocks, and occipital nerve blocks

A
2401. Answer: B (1 & 3)
Explanation:
Bilateral Codes
Transforaminal
Facet Joint Blocks
Facet Neurolysis
SI Joint Injection
Not Bilateral:
Intercostal Nerve Blocks
Sympathetic Blocks
Occipital Nerve Blocks, etc
Source: Laxmaiah Manchikanti, MD
481
Q

2402.Under the Health Insurance Portability and
Accountability Act of 1996 (HIPAA) which third party
payers are required to use the National Correct Coding
Initiative (NCCI) bundling edits to determine claim
payment?
1. All of the private payers that have insured lives in all
regions of the United States such as United Health Care,
(UHC), Cigna, Aetna and Blue Cross Blue Shield.
2. All State Worker’s Compensation payers.
3. All Federal and third party payers regardless of size of
plan or location of insured lives
4. Medicare Part B Contractors are the only payers that are
mandated by CMS

A
  1. Answer: D (4 Only)
    Explanation:
    Although a number of private payers use the NCCI to edit
    claims, it is not a mandatory requirement. HIPAA does not
    regulate private payer policy benefi ts and claims payment.
    Source: CMS website www.cms.gov. Manchikanti L,
    Principles and Practice of Documentation, Billing,
    Coding, and Practice Management 2005.
    Source: Joanne Mehmert, CPC, Sep 2005
482
Q

2403.The following are the true statements explaining the
mechanisms of increased opioid requirements.
1. Tolerance
2. Tachyphylaxis
3. Physical dependence
4. Psychological dependence

A
  1. Answer: E (All)
483
Q
  1. What constitutes an electronic “clean claim”?
  2. A claim that doesn’t have any modifi ers appended to the
    procedure codes
  3. A claim that has includes the physician’s telephone
    number
  4. A claim that links only one diagnosis per procedure
    line item
  5. A Claim that is compliant with the HIPAA Transactions
    and Code Sets Rule and has accurate information about
    the patient and insured party
A
  1. Answer: D (4 only)
    Explanation:
    In addition to compliance with the Transaction and Code Sets Rule, a clean claim should have the CPT and/or
    HCPCS code(s) that accurately represents the service the
    provider rendered, it should not have unbundled codes
    following CPT coding conventions, and it should have the
    ICD-9 code that correctly identifi es the condition for
    which the service was rendered.
    Source: L, Principles and Practice of Documentation,
    Billing, Coding, and Practice Management 2005
    Source: Joanne Mehmert, CPC, Sep 2005
484
Q

2405.When a physician practice receives an adverse
determination for all or part of a claim for services
from a payer with whom h/she is contracted, it should
immediately
1. Write to the State Insurance Commission to complain
and ask for intervention
2. Call the payer provider information line to ask why the
claim was not paid
3. Resubmit the claim with a different CPT procedure code
and/or a different ICD-9 diagnosis code
4. Review the reason for denial, documentation, payers
Medicare policy, and any pre authorization.

A
  1. Answer: D (4 Only)
    Explanation:
    The fi rst step when a claim denial is received is to review
    the EOB and the denial reason. When the claim denial is
    “medical necessity” or “bundled services”, CPT coding
    conventions, instructions in the CPT Manual, articles
    published in the CPT Assistant, NCCI and the payer’s
    medical policy, (if available), should be reviewed to ensure
    that an accurate claim was submitted. When claim
    accuracy is confi rmed, proceed with an appeal following
    the payer’s procedure.
    Source: Manchikanti L, Principles and Practice of
    Documentation, Billing, Coding, and Practice
    Management 2005. AMA Model Contract
    Source: Joanne Mehmert, CPC, Sep 2005
485
Q
  1. Medicare benefi ciaries now have Medicare HMO options
    known as Medicare+Choice (M+C). With regard to a
    provider and/or benefi ciary’s appeal rights, choose all
    that apply.
  2. The right to request an expedited reconsideration of a
    denied service
  3. The right to request and receive appeal data from M+C
    organizations
  4. The right to receive notice when an appeal is forwarded
    to an Independent Review Entity (IRE)
  5. The right to request Administrative Law Judge (ALJ)
    hearing if the IRE entity upholds the original adverse
    determination and the remaining amount in controversy
    is $100 or more.
A
  1. Answer: E (All)
    Explanation:
    Medicare +Choice organizations must have a process that
    is very similar to the appeal process that applies to
    Medicare Part B carriers. Complete information may be
    found on the CMS web site.
    Source: www.cms.hhs.gov/healthplans/appeals
    Source: Joanne Mehmert, CPC, Sep 2005
486
Q
  1. Some of the true statements include:
  2. Global period for major procedures is 90 days
  3. Procedures with a 10-day global period include adhesiolysis
    and facet joint neurolysis
  4. Global period for minor procedures is day of the procedure
    or 10 days
  5. Implantables and disc decompression procedures fall
    into category of 10-day global period
A
2407. Answer: A (1,2, & 3)
Explanation:
Global Period
Major day prior, day of, and 90 days after
Minor day of or day of and ten days after
Major Procedures
DISC Decompression
Nucleoplasty®
DekompressorTM
IDET®
Spinal endoscopy ??
Implantables
Minor Procedures
One-day global period
Spinal puncture
Epidurals
Facet blocks
Intercostal blocks
Discography
Sympathetic blocks
Ten-day global period
Lysis of adhesions
Facet radiofrequency
Neurolytic blocks
Source: Laxmaiah Manchikanti, MD
487
Q
  1. Select the most import item(s), (in the following
    list), that a practice specializing in the treatment of
    interventional pain management needs to know before it
    signs a managed care contract
  2. How important this contract is to its practice
  3. Whether or not all of the pain management specialists in
    the city or region are members of the plan
  4. What the reimbursement is for the services the practice
    currently provide or anticipate adding to its practice in
    the future, by CPT procedure code
  5. How much the insurer pays for the list of CPT codes that
    it provides as an Exhibit or an Attachment
A
  1. Answer: B ( 1 & 3)
    Explanation:
    The practice should have a general idea of the cost to
    provide its specifi c services and whether or not the insurer
    will compensate it beyond the practice expense. When an
    insurer attaches a list of codes it will often include many
    codes that an interventional pain specialist seldom or
    never performs. It is not unusual for a practice to lose
    money when it signs a “blank contract”.
    A physician practice can and should say “no” when a
    contractual agreement does not pay enough to addrevenue
    to the practice. The practice should carefully review its
    patient demographics and understand the economic
    impact of every contract before signing.
    Source: AMA Model contract, Fourth Edition 2005; 15
    Questions to ask before signing a managed care contract.
    Source: Joanne Mehmert, CPC, Sep 2005
488
Q
  1. Incorrect coding may be defi ned as:
  2. Intentional billing of multiple procedure codes for a
    group of procedures that are covered by a single, comprehensive
    code.
  3. Utilizing a comprehensive code for a group of procedures.
  4. Unintentional billing of multiple procedure codes for a
    group of procedures that are covered by a single, comprehensive
    code.
  5. Complying with CMS guidelines.
A
  1. Answer: B ( 1 & 3)
    Explanation:
    The defi nition of incorrect coding encompasses items #1
    and #3. Items #2 and #4 refl ect correct coding principles.
    Source: James A. Mirazita, MD, Sep 2005
489
Q
  1. What are some of the true statements about modifi ers?
  2. A modifi er indicates that an encounter or procedure
    has been altered by some specifi c circumstance, but not
    changed in its basic defi nition or code
  3. A modifi er indicates that an encounter or procedure has
    been altered in its basic defi nition and code.
  4. Common modifi ers for interventionalist include modifi
    er -50 bilateral procedure, and -51 multiple procedures
  5. Common modifi ers for interventionalist include -52
    -reduced procedure, -59 - distinct procedure, and -25
    - separate E & M service on the same day of procedure
A
2410. Answer: B ( 1 & 3)
Explanation:
Modifi ers
Means to indicate that an encounter or procedure has been
altered by some specifi c circumstance, but not changed in
its basic defi nition or code.
Common Modifi ers
-21 prolonged E & M services
-22 unusual procedure services
-24 unrelated E & M by same physician in post-op period
-25 separate E & M on same day of procedure
-50 bilateral procedure
-51 multiple procedure
-52 reduced services
-53 discontinued procedure
-59 distinct procedural service
-76 repeat procedure by same physician
Source: Laxmaiah Manchikanti, MD
490
Q

2411.Choose the accurate statement(s) of fair market value
under the Stark regulations on a physician referral:
1. Fair market value is tied into a number of prohibitions
and exceptions under stark law
2. Fair market value means the price that willing buyer gives to a willing seller
3. For rental and leases, fair market value is the value of
rental property without taking into account the property’s
intended use
4. Under Stark Law, there are no fair market value exceptions

A
  1. Answer: B (1 & 3)
491
Q
  1. What are some of the important aspects of
    documentation of medical necessity?
  2. Medicare will reimburse. Irrespective of the procedure,
    furnished, not for improvement function, but 20% pain
    relief.
  3. The physician practice should be able to provide
    documentation such as a patient’s medical records and
    physician’s orders, to support the appropriateness of a
    service that the physician has provided.
  4. Medicare concurs with physician opinion and patient
    request with respect to duration, frequency, and setting
    a procedure performed.
  5. The physician practice should only bill those services
    that meet the Medicare standard of being reasonable
    and necessary for the diagnosis and treatment of a
    patient
A
  1. Answer: C (2 & 4)
    Explanation:
    Reasonable and Necessary
    Service must be:
    Safe and effective
    Not experimental or investigational
    Appropriate, including the duration and frequency that is
    considered appropriate for the service, in terms of
    whether it is:
    • Furnished in accordance with accepted standards of
    medical practice for the diagnosis or treatment of the
    patient’s condition or to improve the function
    • Furnished in a setting appropriate to the patient’s
    medical needs and condition
    • Ordered and/or furnished by qualifi ed personnel
    • One that meets, but does not exceed, the patient’s
    medical need.
    Documenting Medical Necessity
    The physician practice should be able to provide
    documentation such as a patient’s medical
    records and physician’s orders, to support the
    appropriateness of a service that the physician has
    provided
    Only bill those services that meet the Medicare standard
    of being reasonable and necessary for
    the diagnosis and treatment of a patient
    Source: Laxmaiah Manchikanti, MD
492
Q
  1. A clinical psychologist saw Mrs. Smith today. The
    Clinical Psychologist (CP) did a health assessment which
    took 45 minutes, called the patient’s psychiatrist to discuss
    Mrs. Smith’s current status (15 minutes), interpreted the
    MMPI report (20 minutes) and spent 45 minutes writing
    the report of the MMPI fi ndings. The CP can be expected
    to get reimbursed when billing for:
  2. Provision of direct services to patients.
  3. The length of time it takes to coordinate care with other
    healthcare providers.
  4. The time it takes to interpret the MMPI
  5. The time it takes to complete the writing of a report
    when psychometric testing is performed.
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Clinical Psychologists will be reimbursed for providing
    direct services to patients, interpreting psychometric
    testing and time it takes to write the report. CP generally
    do not bill for coordination of care or other types of case
    management services, and would not generally be
    expecting to get reimbursed for these services if they did
    bill for them.
    CPT 2005 Manual
    Principles of Documentation, Billing, Coding, and
    Practice Management for the Interventional Pain
    Professional (ed by) Laxmaiah Manchikanti, ASIPP
    Publishing: Paducah, KY.
    Source: Marsha Thiel, RN, MA, Sep 2005
493
Q
  1. It is recommended that a physician practice identify
    a compliance offi cer, a compliance committee or key
    compliance contacts within the practice. The duties of
    such an offi cer, committee or contact might entail . . .
  2. Answering billing questions.
  3. Participation in the development of Practice Standards.
  4. Developing a process to communicate with and disseminate
    information to individuals within the practice.
  5. Conducting a baseline audit of the practice’s operations.
A
  1. Answer: E (All)
    Explanation:
    Explanation: Compliance personnel should participate in
    developing the Practice Standards, developing a process to
    communicate with and disseminate information to the
    individuals in the practice, answering billing questions,
    and conducting a baseline audit.
    Reference: 65 Fed. Reg. at 59442.
    Source: Erin Brisbay McMahon, JD, Sep 2005
494
Q

2415.Components of Physical Examination if the planned
anesthesia includes intravenous sedation, regional or
general anesthesia should include the following:
1. An assessment of the patient’s mental status
2. An examination specifi c to the proposed procedure
3. Documentation of the results of an auscultatory examination
of the heart and lungs
4. An assessment and written statement about the patient’s
general health

A
  1. Answer: E (All)
    Explanation:
    Physical Examination - II
    If the planned anesthesia includes intravenous sedation,
    regional or general anesthesia, there should be:
    * An assessment of the patient’s mental status
    * An examination specifi c to the proposed procedure
    * An examination specifi c to any co-morbid conditions
    * Documentation of the results of an auscultatory
    examination of the heart and lungs, and
    * An assessment and written statement about the patient’s
    general health.
495
Q
  1. What are the components of Medical Decision Making?
  2. Review of records/investigations
  3. Chronological description of development of patient’s
    symptoms
  4. Risk of signifi cant complications, morbidity, mortality
  5. Insurance coverage
A
2416. Answer: B (1 & 3)
Explanation:
MEDICAL DECISION MAKING - THREE
COMPONENTS
* Review of Records/Investigations
Requested , Obtained, Reviewed, Analyzed
* Diagnoses/Mgmt Options
Minimal, Limited, Multiple, Extensive
* Risk of signifi cant complications, morbidity, mortality
Associated with presenting problems, diagnostic
procedures, management options
496
Q
  1. The purpose of documentation is:
  2. To record information
  3. To communicate information
  4. To obtain proper reimbursement
  5. To document level of service
A
  1. Answer: E (All)
497
Q
  1. Identify accurate statements about clinical policies
  2. They are expensive and labor intensive to develop and
    maintain
  3. The actual impact on the quality of care is nearly impossible
    to determine
  4. There are probable multiple indirect positive benefi ts
    of this effort with improved patient care and decreased
    practice variation
  5. They provide an inordinate amount of restrictions
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Conclusions: Clinical Policies
    Expensive and labor intensive to develop and maintain
    Actual impact on the quality of care is nearly impossible
    to determine
    Probable indirect positive benefi ts of this effort
    Increased acceptance of concept of “standards”
    Increased attention to our individual practices of
    medicine, especially over time
    Decreased practive variation
    Pay for performance
    Source: Laxmaiah Manchikanti, MD
498
Q
  1. What are the principles and objectives of pay for
    performance for physicians?
  2. Encourage coordination of Part A and Part B services
  3. Discourage effi ciency through investment in administrative
    structure and process
  4. Reward physicians for improving health outcomes
  5. Encourage upcoding
A
  1. Answer: B (1 & 3)
    Explanation:
    Objectives of Physician Program Encourage coordination of Part A and Part B Services
    Promote effi ciency through investment in
    administrative structure and process
    Reward physicians for improving health outcomes
499
Q
  1. Landmarks in regulations in healthcare in the United
    States include:
  2. 1965 - Health Care Law
  3. 1992 - Addition of Medicaid
  4. 1993 - Health Security Act of Clinton
  5. 1976 - Health Insurance Portability and Accountability
    Act
A
2420. Answer: B (1 & 3)
Explanation:
1965 - Health Care Law
Called for by Theodore Roosevelt in 1912
Signed by Lyndon Johnson in 1965
1972 - Addition of Medicaid
1983 - PPS, DRG’s
1993 - Health Security Act of Clinton
- Failed because it was ‘not credible’
1992 - RBRVS
2000 - HOPD – PPS
1995 - Balanced Budget Act
1996 - Health Insurance Portability and Accountability Act
2003 - Medicare prescription drug, improvement and
modernization act of 2003
500
Q
  1. Identify all Accurate Statements
  2. The Emergency Medical Treatment and Active Labor
    Act (EMTALA) only applied to patients who are physically
    in a hospital’s Emergency Department.
  3. Physicians in a group practice may receive productivity
    bonuses without violating the Stark Self-referral rules if
    the bonuses are based on a physician’s total number of
    patient encounters or Relative Value Units (RVUs).
  4. You purchase a medical practice that is currently subject
    to a corporate integrity agreement (CIA), and the transfer
    of ownership will void the CIA
  5. According to the HHS Offi ce of Inspector General, having
    a compliance program without appropriate, ongoing
    monitoring is worse than not having a compliance
    program
A
  1. Answer: C (2 & 4)
    Explanation:
  2. EMTALA, also known as the patient anti-dumping law
    applies to an individual who requests examination or
    treatment and who is on hospital property (including offcampus
    clinics and hospital-owned ambulances that are
    not on hospital grounds). An individual in a non-hospitalowned
    ambulance on hospital property is also considered
    to have come to the hospital’s emergency department.
  3. Profi t shares and productivity bonuses are permitted if
    they meet certain conditions. Physicians in a group
    practice, including independent contractors,may get shares
    of “overall profi ts” of the group or receive bonuses for
    services they personally perform – including incident-toservices
    – if such rewards are not based on referrals for any
    of the designated health services.
    Regardless of which type of reward is given,
    documentation that verifi es how much was given and on
    what basis must be made available to investigators if
    requested.
    Overall profi ts are the profi ts from designated health
    services for the entire group or any part of the group that
    has at least fi ve physicians. The profi ts are not based on
    referrals if only one of the following conditions is met:
    The profi ts are divided per capita (per member or per
    physician, for example).
    Designated health services revenue is distributed based on
    the way non-designated health services revenue is
    distributed.
    Designated health service revenue is both less than 5% of
    the group’s of the group’s total income and is less than 5%
    of any physician’s total compensation from the group.
    Overall profi ts are distributed in a reasonable and
    verifi able way that is unrelated to designated health service
    referrals.
    Productivity bonuses are not based on referrals if:
    It is based on a physician’s total number of patient
    encounters or Relative Value Units (RVUs).
    It is not based in any way on designated health services.
    Designated health service revenue is both less than 5% of
    the group’s total income and is less than 5% of any
    physician’s total compensation from the group.
    It is distributed in a reasonable and verifi able way
    unrelated to designated health services DHS referrals.
  4. Corporate integrity agreements (CIAs) are typically
    large, detailed and restrictive compliance plans that
    companies enter into as part of a deal with theDepartment
    of Health and Human Services Offi ce of Inspector General
    (OIG). CIAs are intended to make sure that a company
    never again commits the kind of offenses against the
    Medicare program that landed it in trouble in the fi rst
    place. There are strict reporting requirements and other
    rules a company must live up to once it agrees on a plan
    with OIG, but on the plus side, OIG allows the company to
    continue to do business with Medicare.
    CIAs typically contain provisions requiring any third
    parties that acquire covered entities to adhere to the
    guidelines outlined in the CIA. These clauses transfer any
    obligations for independent review, continued compliance
    program administration and exclusion from the original
    owners to the new owners.
  5. Implementation of an effective compliance program
    requires a substantial commitment of time, energy and
    resources by senior management and a health care
    provider’s governing body. Superfi cial programs that
    simply purport to comply with the elements described in
    this guidance or programs that are hastily constructed and
    implemented without appropriate ongoing monitoring
    will likely be ineffective and could expose the organization
    to greater liability than no program at all.
    Nothing is worse than adopting a compliance plan and,
    then, failing to implement it properly. That would be the
    equivalent of telling regulators that, yes, you knew what to
    do, but you chose not to do it. In such cases, a compliance
    plan would be seen to have been designed to cover up
    problems the organization had no intention of correcting.
    Source: Manchikanti L, Board Review 2005
501
Q
  1. Identify the true statements describing functional
    restoration
  2. Functional restoration is a monotherapy intended to
    return patients to work.
  3. Functional restoration includes an interdisciplinary approach with physical therapy, occupational therapy,
    vocational rehabilitation, psychology, nursing, and
    physician
  4. Indications for functional restoration include temporary
    disability and ability to return to work following
    exercise program.
  5. Phases of rehabilitation and functional restoration include
    initial reconditioning, comprehensive phase, and
    follow up phase
A
  1. Answer: C (2 & 4)
    Explanation:
    Source: Cole and Herring. Low Back Pain Handbook.
    Functional Restoration
    Functional restoration is a comprehensive,
    multidisciplinary program intended primarily to correct
    disability in the patient with chronic low back pain who
    has demonstrated multiple barriers to recovery, including deconditioning, lack of motivation, psychologic
    dysfunction, and secondary gain issues.
    An interdisciplinary approach integrates physical therapy,
    occupational therapy, vocational rehabilitation,
    psychology, nursing, and the physician.
    Indications
    Persistent disability despite completion of proper primary
    and secondary work-up and treatment
    Presence of barriers to recovery
    Deconditioning
    Lack of motivation
    Psychological dysfunction
    Secondary gain issues
    Willingness to participate
    Willingness to comply
    Elements
    Quantifi cation of physical function
    Physical reconditioning of injured functional unit
    Work simulation and whole body coordination training
    Cognitive-behavioral disability management
    Fitness maintenance program with outcome assessment
    using objective criteria
    Program Content
    Initial medical evaluation
    Quantifi cation of physical function
    Trunk range of motion
    Trunk strength
    Whole body task performance
    Assessment of symptom self-reports – pain and disability
    Psychological evaluation
    Vocational assessment
    Phases of Rehabilitation
    Initial reconditioning phase
    Focus: improving mobility, overcoming neuromuscular
    inhibition and pain sensitivity, and measuring
    cardiovascular endurance·- Up to 12 appointments over 4-
    6 weeks
    Supervised stretching, aerobic and light work simulation
    exercises for 2 hours twice/week
    Comprehensive Phase
    10 hours/day, 5 days/week, 3 weeks
    Vigorous stretching and aerobics classes
    Progressive resistive exercises twice a day under
    supervision of physical therapist
    Daily work – simulation of tasks, lifting drills, and
    position-tolerance training exercises similar to work
    hardening
    Classes on goal setting, work issues, stress management,
    and interpersonal skills development under direction of
    psychologist
    Active return-to-work planning monitored by vocational
    therapist
    Patient will not be permitted to complete this phase of
    functional restoration without a work plan and will be
    terminated if he or she refuses to make such a plan.
    Follow-up Phase
    1 and ½ days/week, up to 6 weeks
    Reconditioning, work hardening, and vocational
    counseling continue.
    Allows integration of improvement and behavioral
    changes generated during intense phase with return-towork
    At end of follow-up, patient receives appropriate work
    release from medical director with functional limitations
    as indicated
    Source: Manchikanti L, Board Review 2005
502
Q
  1. All of the following statements are true with regards
    to the Controlled Substances Act of the Comprehensive
    Drug Abuse Prevention and Control Act of 1970.
  2. It is the legal foundation of the government’s fi ght
    against the abuse of drugs and other substances.
  3. It is a consolidation of numerous laws regulating the
    manufacture and distribution of narcotics, stimulants,
    depressants, hallucinogens, anabolic steroids and
    chemicals used in the illicit production of controlled
    substances.
  4. All the substances that are regulated under existing federal
    law are placed into I of V schedules.
  5. Schedule I is reserved for the least dangerous drugs that
    have the highest recognized medical use.
A
  1. Answer: A ( 1, 2, & 3)
    Explanation:
    The Controlled Substances Act (CSA), title 2 of the
    Comprehensive Drug Abuse Prevention and Control Act
    of 1970 is the legal foundation of the government’s fi ght
    against the abuse of drugs and other substances. This law
    is a consolidation of numerous laws regulating the
    manufacture and distribution of narcotics, stimulants,
    depressants, hallucinogens, anabolic steroids, and
    chemicals used in the illicit production of controlled
    substances.
    All the substances that are regulated under existing federal
    law are placed into I of V schedules. This placement is
    based upon the substances’ medicinal value, harmfulness,
    and potential for abuse or addiction.
    Schedule I is reserved for the most dangerous drugs that
    have no recognized medical use.
    Schedule V is the classifi cation used for the least
    dangerous drugs.
    The Act also provides a mechanism for substances to be
    controlled, added to a schedule, decontrolled, removed
    from control, rescheduled, or transferred from one
    schedule to another.
    Source: Manchikanti L, Board Review 2005
503
Q
  1. Identify elements of a compliance program:
  2. Written standards of conduct and policies and procedures
  3. Occasional education and training
  4. Process to receive complaints and protect them
  5. Elimination of monitoring and auditing
A
  1. Answer: B (1 & 3)
    Explanation:
    Effective Compliance Program
    Seven Minimum Elements
  2. Standards of conduct and policies and procedures
  3. Chief Compliance Offi cer
  4. Regular effective education and training
  5. Process to receive complaints and protect them
  6. Disciplinary guidelines
  7. Periodic Monitoring and auditing
  8. Procedures to detect, respond to, and correct problems
504
Q
  1. The benefi ts of implementing a compliance program in a
    physician practice include which of the following?
  2. Avoiding confl icts with the self-referral and anti-kickback
    statutes
  3. The enhancement of patient care through increased accuracy
    in documentation
  4. Minimizes billing mistakes and optimizes proper payment
    of claims
  5. A cap on the amount of damages the government can
    recover from the practice in a civil False Claims action
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Explanation: Voluntary implementation of a compliance program can benefi t a physician practice in many ways;
    however, there is no cap on damages the government can
    recover.
    Source: OIG Supplemental Compliance Program
    Guidance for Hospitals, 70 Fed. Reg. 4858 (January 31,
    2005).
    Source: Erin Brisbay McMahon, JD, Sep 2005
505
Q
  1. The Health Insurance Portability and Accountability
    Act in 1996 (HIPAA) states that to meet compliance, the
    practice must:
  2. Follow all federally mandated codes regarding billing
    and collections practices
  3. Adopt specifi c security and privacy policies
  4. Allow patient access to medical records
  5. Develop an audit trail for medical record access.
A
  1. Answer: C (2 & 4)
    Explanation:
    HIPAA is not specifi cally interested in the details of a
    medical practice beyond elements of security and privacy.
    The goal of HIPAA is not to either assist or impair billing
    and collecting,but to hold accountable medical practices to
    specifi c policy and procedures, and develop their own to
    ensure medical record access, and accountability to audit,
    security, and privacy. Security and privacy policies are
    usually developed in conjunction with health law counsel.
    The role of the EMR is to enhance compliance and
    security.
    Source: Hans C. Hansen, MD
506
Q
  1. Impairment is correctly characterized by the following
    defi nition(s)
  2. A loss, loss of use, or derangement of any body part,
    organ system, or organ function
  3. An alteration of an individual’s capacity to meet personal,
    social, or occupational demands because of an
    impairment.
  4. An anatomical, physiological, or psychological abnormality
    that can be shown by medically acceptable clinical
    and laboratory diagnostic techniques.
  5. A barrier to full functional activity that may be overcome
    by compensating in some way for the causative
    impairment.
A
  1. Answer: B (1 & 3)
    Explanation:
    Source: AMA Guides to the Evaluation of Permanent
    Impairment, 2001.
    Impairment Defi nitions
    Guides to the Evaluation of Permanent Impairment:
    A loss, loss of use, or derangement of any body part, organ
    system, or organ function
    World Health Organization (WHO):
    Problems in body function or structure as a signifi cant
    deviation or loss. Impairments of structure can involve an
    anomaly, defect, loss, or other signifi cant deviation in body
    structures.
    Social Security Administration (SSA):
    An anatomical, physiological, or psychological
    abnormality that can be shown by medically acceptable
    clinical and laboratory diagnostic techniques.
    State Workers’ Compensation Law:
    Permanent impairment” is any anatomic or functional loss
    after maximal medical improvement has been achieved
    and which abnormality or loss, medically, is considered
    stable or nonprogressive at the time of evaluation.
    Permanent impairment is a basic consideration in the
    evaluation of permanent disability and is a contributing
    factor to, but not necessarily an indication of, the entire
    extent of permanent disability.
    Source: Manchikanti L, Board Review 2005
507
Q
  1. A new patient evaluation, outpatient visit, requires the
    following:
  2. Initial professional services from the physician.
  3. Provider of same specialty belonging in same group
    practice.
  4. A patient who has not been seen in the past three years.
  5. An opinion or advice regarding patient condition.
A
  1. Answer: C

Source: Manchikanti L, Board Review 2005

508
Q
  1. The Social Security Administration uses a number of
    criteria for determination of eligibility for disability
    benefi ts. The sequential evaluation for determination
    of benefi ts includes which of the following factors?
    nonexertional factors (evaluation of the applicant’s
    cognitive capabilities) are part of the evaluation of
    residual functional capacity.
  2. Age
  3. Educational background
  4. Previous work history
  5. Residual functional capacity
A
  1. Answer: E (All)
    Explanation:
    Source: AMA Guides to the Evaluation of Permanent
    Impairment, 2001
    To determine eligibility for Social Security funds, the
    applicant must undergo a sequential evaluation process
    that considers the applicant’s ability to perform work
    despite any functional restrictions associated with physical
    impairment. Medical and psychological variables are
    considered, along with the applicant’s age, educational
    background, and previous work history. The applicant
    must undergo a medical evaluation to determine residual
    functional capacity. Both exertional factors (evaluation of
    the applicant’s ability to perform work functions in several
    different work environments) and nonexertional factors
    (evaluation of the applicant’s cognitive capabilities) are
    part of the evaluation of residual functional capacity.
    Source: Manchikanti L, Board Review 2005
509
Q
  1. The following statements are true to describe the
    purposes of rehabilitation:
  2. To resolve deconditioning syndrome, which is developed
    from prolonged bedrest with loss of muscle strength,
    decreased fl exibility, and increased stiffness.
  3. To optimize outcome by restoring function and returning
    to activity.
  4. To minimize potential or recurrence or re-injury.
  5. Short periods of rest between activities helps to exacerbate
    the deleterious effects of inactivity.
A
  1. Answer: A (1, 2 & 3)
    Explanation:
    Source: Cole and Herring. Low Back Pain Handbook.
    Purposes of Rehabilitation
    To resolve deconditioning syndrome:
    Prolonged bedrest
    Flexibility
    Stiffness (loss of intrinsic muscle strength muscle
    strength, 10-15% per week, 70% in 6 months)
    Cardiovascular fi tness
    Disc nutrition
    Depression
    Short periods of rest between activities helps to minimize
    the deleterious effects of inactivity.
    To optimize outcome by:
    Restoring function
    Returning to activity
    Minimize potential recurrence or re-injury
    (Rehabilitation continues beyond resolution of symptoms)
    To minimize need for surgical intervention
    Failure of conservative care is the most common
    indication for surgery
    Source: Manchikanti L, Board Review 2005
510
Q

2431.Paymdecesionent for clinical services based on
the Medicare RBRVS includes all of the following
components:
1. Physician work
2. Malpractice
3. Clinically-related practice expenses
4. Physician availability for emergency care

A
  1. Answer: D (4 only)

Source: Manchikanti L, Board Review 2005

511
Q
  1. What are the elements of a training program for needle
    stick safety?
  2. General explanation of epidemiology and symptoms of
    bloodborne diseases
  3. Explanation of modes of transmission of bloodborne
    pathogens
  4. Explanation of appropriate methods for recognizing
    tasks/activities involving exposure
  5. Explanation of methods to prevent or reduce exposure
A
  1. Answer: E (All)
    Explanation:
    12 Elements of Training Program
    * Accessible copy of regulatory text and explanation of its
    contents
    * General explanation of epidemiology and symptoms of
    bloodborne diseases
    * Explanation of modes of transmission of bloodborne
    pathogens
    * Explanation of Employer’s Exposure Control Plan and
    how employee may obtain copy * Explanation of appropriate methods for recognizing
    tasks/activities involving exposure
    * Explanation of methods to prevent or reduce exposure
    * Information on decontamination and disposal of
    personal protective equipment
    * Appropriate actions and persons to contact in emergency
    * Procedures to follow if exposure occurs
    * Information post-exposure evaluation and follow-up
    * Explanation of signs and labels and color-coding for biohazard
    * Opportunity for interactive questions
512
Q
2433.Enforcement weapons against fraud and abuse may
include the following:
1. Anti-kickback statute
2. Needle stick safety
3. Stark Law
4. Americans with Disabilities Act
A
2433. Answer: B (1 & 3)
Explanation:
Enforcement Weapons
Anti-Kickback Statute
HIPAA
Stark Law
False Claims Act
Administrative Sanctions
QUITAM (Whistle blower Act).
State Law(s)
513
Q
  1. What are permitted disclosures under privacy regulation
    without the individual’s permission?
  2. Public health activities
  3. Judicial and administrative proceedings
  4. Health oversight activities and government benefi t
  5. A request from prosecution in a liability case
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Permitted Disclosures - Without the Individual’s
    Permission
    * Uses and Disclosures Required by Law
    * Public Health Activities
    * Violence or Elder Abuse
    * Health Oversight Activities and Government Benefi t
    * Judicial and Administrative Proceedings
    * Law Enforcement
    * Disclosure to Coroners and Medical Examiners
    * Organ procurement organizations
    * Research purposes if IRB makes certain determinations
    * Specialized government functions (military)
    * Workers’ compensation
    - Only to extent required by state law
514
Q

2435.True statements about Federal Health Care Offense
under HIPAA are as follows:
1. Offense of “health care fraud” added to criminal statute
2. Only Medicare
3. Fines ($10,000), forfeiture, 10 years imprisonment
4. It is synonymous with Balanced Budget Act

A
  1. Answer: B (1 & 3)
    Explanation:
    Federal Health Care Offense Under HIPAA
    * Offense of “health care fraud” added to criminal statute
    * Any health care program - public or private, affecting
    commerce
    * Fines ($10,000), forfeiture, 10 years imprisonment
515
Q
  1. Many provider activities during a given procedure
    are integral to the procedure and termed as “generic
    activities.” Some generic services integral to standard
    medical/surgical services include:
  2. Draping of the patient
  3. Insertion of intravenous access.
  4. Cleansing, shaving and prepping the skin.
  5. Referring the patient to a different physician.
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Items 1, 2, and 3 are all considered generic services
    integral to standard procedures. Referral to a different
    physician may occur outside the provision of a procedure,
    but is not integral to it.
    Source: James A. Mirazita, MD, Sep 2005
516
Q
  1. Exclusion means the following for a provider:
  2. A prohibition from providing health care services for a
    period of time
  3. A prohibition from billing federal health programs for
    items or services
  4. A prohibition from practicing as a physician for a period
    of time
  5. A prohibition from receiving reimbursement from federal
    health care programs for items or services
A
  1. Answer: C (2 & 4)
    Explanation:
    Source: Manchikanti L, Principles of Documentation,
    Billing, Coding & Practice Management 2004
    Exclusion means a provider is barred from receiving
    reimbursement from Medicare, Medicaid or other federal
    health care programs. There are two types of exclusion:
    Mandatory and permissive. Under mandatory exclusion,
    HHS must exclude – it has no choice. Under permissive
    exclusion, HHS has some discretion.
    Source: Manchikanti L, Board Review 2005
517
Q
  1. OIG guidance on disciplinary guidelines includes:
  2. Written policies which may be discriminatory
  3. Written scope of sanctions
  4. Not essential to publish standards and guidelines
  5. Background investigations for new employees
A
2438. Answer: C (2 & 4)
Explanation:
Disciplinary Guidelines
* Written policies - nondiscriminatory
* Scope of sanctions
* Range of responsibility
* Publication of standards and guidelines
* Background investigations for new employees
518
Q
  1. The largest risks for physicians are identifi ed under the
    False Claims Act surround coding and billing. Which
    statement regarding coding and billing under False
    Claims Act regulations are accurate?
  2. In some regions, billing patients for “no shows”, i.e.,
    billing Medicare for services which were not actually
    furnished because the patients failed to keep their appointments,
    is an indicator of fraud and abuse.
  3. Duplicate bills submitted to third party payors under
    the mistaken belief that the original claim has been lost
    or misplaced may indicate a reckless disregard of the
    problem and give rise to false claim liability.
  4. Upcoding, or billing for a more expensive service than
    the one actually performed, can lead to false claim allegations.
  5. Clustering, which is the practice of coding and charging
    one or two middle levels of service codes exclusively,
    under the reasoning that some will be higher, some
    lower, and the charges will average out over an extended
    period, is not considered a practice
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Explanation:
    1) The CMS region covering Kansas, Nebraska and
    Northwest Missouri specifi cally states on its website that
    billing Medicare for “no shows” is an indicator of fraud
    and abuse.
    2) Duplicate bills are often submitted to third party payors
    under the mistaken belief that the original claim has been
    lost or misplaced. Although double billing can occur due
    to simple error, systematic double billing may indicate a
    reckless disregard of the problem and give rise to false
    claim liability.
    3) Upcoding can lead to false claim allegations and should
    not be tolerated within the physician practice.
    4) Clustering can lead to false claim allegations and
    should not be tolerated within the physician practice.
    Source:
    See Medicare: Fraud and Abuse
    (www.nebraskamedicare.com/policy/fraud.htm); see also
    65 Fed. Reg. at 59439.
    Source: Erin Brisbay McMahon, JD, Sep 2005
519
Q
  1. When the focus of treatment for an individual patient
    is a medical problem, as opposed to a mental health
    problem, the psychologist should use the following CPT
    code:
  2. Diagnostic interview (90801).
  3. Individual psychotherapy (90806).
  4. Individual behavioral health assessment (96150).
  5. Individual behavioral health intervention (96152).
A
  1. Answer: D (4 Only)
    Explanation:
    1) This response is incorrect as it is generally used for the
    assessment of mental health disorders.
    2) This response is incorrect, as it is generally used to
    designate individual services of a psychologist whose
    treatment is designed to ameliorate a mental health problem.
    3) This response is incorrect, as it is generally used for a
    psychosocial assessment of a medical problem.
    4) This response is correct. Individual behavioral health
    intervention is the code to use when the focus of a
    psychologist’s services is the amelioration of an
    individual’s medical problem.
    CPT 2005 Manual
    Principles of Documentation, Billing, Coding, and
    Practice Management for the Interventional Pain
    Professional (ed by) Laxmaiah Manchikanti, ASIPP
    Publishing: Paducah, KY. p. 163
    Source: Marsha Thiel, RN, MA, Sep 2005
520
Q
  1. True statements about QUI TAM (Whistleblower Act)
    are as follows:
  2. Suits are usually brought by employees
  3. If the government proceeds with the suit, the whistleblower
    receives 50 to 60% of settlement.
  4. Individuals can bring suit against violators of Federal
    laws on their own behalf as well as the government’s
  5. If the government does not proceed and the individual
    continues, the individual receives 100% of the settlement
A
  1. Answer: B (1 & 3)
    Explanation:
    QUI TAM (Whistleblower Act)
    1Suits are usually brought by employees
    2 If the government proceeds with the suit, the
    whistleblower receives 15 to 25% of settlement.
    3 Individuals can bring suit against violators of Federal
    laws on their own behalf as well as the government’s
    4 If the government does not proceed and the individual
    continues, he receives 25 to 30% of the settlement
    Source: Laxmaiah Manchikanti, MD
521
Q
2442. A psychological assessment generally consists of the
following:
1. Psychometric testing.
2. Review of the medical record
3. Diagnostic interview
4. Physical exam
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Psychologist assessment generally consists psychometric
    testing, review of the medical record and diagnostic
    interview. Psychologists do not perform physical exams
    when performing psychological assessments.
    Principles of Documentation, Billing, Coding, and
    Practice Management for the Interventional Pain
    Professional (ed by) Laxmaiah Manchikanti, ASIPP
    Publishing: Paducah, KY.
    Source: Marsha Thiel, RN, MA, Sep 2005
522
Q
  1. Roles of a clinical psychologist within a pain clinic are
    the following:
  2. Direct services to patients
  3. Direct services to patients, consultation, supervision
  4. Direct services to patients, consultation, management
  5. Direct services to physicians
A
  1. Answer: A (1,2, & 3)
    Explanation:
    The roles listed are legitimate roles of a psychologist
    within a pain clinic.
    Principles of Documentation, Billing, Coding, and
    Practice Management for the Interventional Pain
    Professional (ed by) Laxmaiah Manchikanti, ASIPP
    Publishing: Paducah, KY.
    Source: Marsha Thiel, RN, MA, Sep 2005
523
Q
2444.Multiple factors leading to introduction of OIG
Compliance Plan include:
1. Runaway healthcare costs
2. Balanced Budget Act
3. Operation Restore Trust
4. Successful Healthcare Reform
A
2444. Answer: A (1,2, & 3)
Explanation:
Social/Economic Climate
- Fraud and Abuse Headlines
- Runaway Healthcare Costs
- Failed Healthcare Reform
- Aging Baby Boomers
- Balanced Budget
Operation Restore Trust
- In 1995 the DHHS OIG, DOJ and others began a
demonstration project in 5 states to fi ght fraud and abuse.
- Result - for every $1 spent - $23 recovered
Laws - Old and New
- Enforcement Weapons
Source: Alan Reider, JD
524
Q
  1. Sedentary work is characterized by the following
    criteria:
  2. Lifting a maximum of 10 lbs.
  3. Carrying objects weighing up to 10 lbs.
  4. Requirement of occasional walking and standing, but
    mostly sitting
  5. Pushing and pulling of arm or leg controls
A
  1. Answer: B (1 & 3)
525
Q
  1. When preparing to hire a psychologist, it is essential to
    determine:
  2. How to add the psychologist to the clinic’s liability
    insurance.
  3. How much psychologist can guarantee in income
  4. The employment screening needs that are required by
    the psychology state and provincial licensing boards.
  5. How much profi t the clinic would make
A
  1. Answer: B ( 1 & 3)
    Explanation:
    An example of screening requirements are the following
    form the state of Minnesota.
    http://www.revisor.leg.state.mn.us/stats/148A/
    Source: Marsha Thiel, RN, MA, Sep 2447. Answer: D (4 Only)
    Explanation:
    Per Medicare “There must have been a direct, personal
    professional service furnished by the physician to initiate
    the course of treatment of which the service being
    performed by the non-physician is an incidental part”
    Source: Marsha Thiel, RN, MA, Sep 2005
526
Q

2447.To ensure compliant “incident to” physician service billing in a clinical setting, it is important to keep in mind
which of the following?
1. No other procedures may be performed on the patient
in the same day as an E&M service billed incident to the
physician performing the procedure.
2. The supervising MD must be present in the same exam
room during subsequent visits
3. A modifi er must be attached to the billed code to
designate the service is being billed as incident to the
physician.
4. There must be a direct personal service furnished by the
physician to initiate the course of treatment

A
  1. Answer: D (4 Only)
    Explanation:
    Per Medicare “There must have been a direct, personal
    professional service furnished by the physician to initiate
    the course of treatment of which the service being
    performed by the non-physician is an incidental part”
    Source: Marsha Thiel, RN, MA, Sep 2005
527
Q
  1. You have been provided with multiple reasons to
    establish a compliance plan: Choose accurate statements
  2. Physicians and other practitioners often do not have
    the financial means to employ a compliance specialist,
    therefore may be more vulnerable to unintentional
    violations.
  3. Fewer errors, accurate reimbursement and less chance
    of a CMS audit.
  4. Lends weight to bill procedures
  5. Provides “total immunity” against any wrong doing.
A
  1. Answer: A (1,2, & 3)
    Explanation:
    WHY HAVE A COMPLIANCE PLAN?
    Physicians and other practitioners often do not have the
    fi nancial means to employ a compliance specialist,
    therefore may be more vulnerable to unintentional
    violations.
    Fewer errors, accurate reimbursement and less chance of a
    CMS audit.
    Now Medicaid, WC, MVA and private payors
    Lends weight to billing procedures
    Demonstrates “good faith efforts” to perform in
    accordance with the laws.
    WHY OIG COMPLIANCE PLAN?
    The only thing worse than not having a compliance
    program, is creating a plan without implementation
    The single most important step in practicing appropriately
    To minimize the risk of a criminal prosecution and to
    lower the risk of civil penalties
    Creating an inference of good faith
528
Q
  1. What are true statements about criminal penalties?
  2. Health care fraud faces - fi nes, up to 10 years in jail, or
    both.
  3. Theft or embezzlement in connection with health care
    faces - fi nes, up to 10 years in jail, or both
  4. Obstruction of criminal investigations of health offenses
    faces - fi nes, up to 5 years in jail, or both
  5. False statements and relating to health care matters faces
    - fi nes, up to 5 years in jail, or both
A
  1. Answer: E (All)
    Explanation:
    Health Care Fraud
    Fines, up to 10 years in jail, or both
    Theft or Embezzlement in connection with Health Care
    Fines, up to 10 years in jail, or both
    Obstruction of Criminal Investigations of Health Offenses
    Fines, up to 5 years in jail, or both
    False Statements and Relating to Health Care Matters
    Fines, up to 5 years in jail, or both
    Mail and Wire Fraud
    Fines, up to 5 years in jail, or both
    False Statements and kickbacks Involving Federal Health
    Care Programs
    Fines up to $25,000, up to 5 years in jail, or both
    Exclusion from Participation in federal health care
    programs
529
Q
  1. What are true statements about fraud in medicine in
    U.S.A.?
  2. Medicare fee for service error rate was 8% in 2004.
  3. A GAO audit reported that in the U.S. approximately
    10% of every health care dollar is lost to fraud annually.
  4. Estimated net improper payments of CMS for 2004
    exceeded $50 billion
  5. Fraud and abuse cases include 60% public and 40%
    private.
A
  1. Answer: C (2 & 4)
    Explanation:
    A GAO Audit reported that in the U.S. approximately 10%
    of every Health Care dollar is lost to fraud annually.
    10% = $100 Billion of one Trillion or 100,000
    Million
    2004 - 10%= $179.3 Billion of 1.7934 of Trillion or
    1,793.4 Million
    2010 - 10%=$263.74 Billion of $2.6374 Trillion or
    263,740 Million
    Fraud and Abuse cases
    Public 60%
    Private 40%
    Source: Laxmaiah Manchikanti, MD
530
Q
2451. Compliance offi cer is providing the annual report.
What are indications of non-compliance?
1. Claim problems
2. Staff problems
3. Accounting issues
4. Your documentation had 1% error rate
A
2451. Answer: A (1,2, & 3)
Explanation:
Indications of Non-Compliance
1. Claim problems
- paid slowly
- frequent problems
- problem claims unresolved
- cash fl ow problems
2. Staff problems
- rapid turnover
- staff takes work home
- poor morale
- disgruntled staff
- staff not loyal
- staff disrespectful
- staff questioning about charges
3. Accounting issues
- cash fl ow
- keep borrowing
- no real accounting
4. 1% Error Rate is Acceptable
-You are under scrutiny
- by Medicare, Medicaid, Tricare
- by W/C and personal injury insurances
- by third party payer
- your own staff
- your partners or superiors
531
Q
  1. Possible punishments for violating the Self Referral
    Laws (Stark) include . . .
  2. Civil money penalties of up to $15,000 per claim
  3. Civil money penalties of up to $100,000 per scheme
  4. Exclusion from Medicare and Medicaid
  5. A term of imprisonment of not more than fi ve years
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Explanation: Violations of the Self-Referral Laws are
    punishable with civil money penalties of up to $15,000 per
    claim, $100,000 per scheme, and exclusion from federallyfunded
    health care programs such as Medicare and
    Medicaid.
    Source: 42 U.S.C. 1395nn.
    Source: Erin Brisbay McMahon, JD, Sep 2005
532
Q
  1. What are the penalties under the False Claims Act?
  2. Three times the amount of damages suffered by the
    government
  3. A mandatory civil penalty of at least $5,500 and no more
    than $11,000 per claim.
  4. Submit 50 false claims for $50 each (liability between
    $282,500 and $557,500 in damages)
  5. Program exclusion
A
  1. Answer: E (All)
    Explanation:
    Pentalties under False Claims Act:
    Three times the amount of damages suffered by the
    government
    A mandatory civil penalty of at least $5,500 and no more
    than $11,000 per claim.
    Submit 50 false claims for $50 each
    - Liability between $282,500 and $557,500 in damages.
    Program Exclusion
    Source: Laxmaiah Manchikanti, MD
533
Q
  1. What are OIG identifi ed risk areas?
  2. Billing for items or services not actually rendered
  3. Providing medically unnecessary services
  4. Joint ventures
  5. Physician self-referrals
A
2454. Answer: E (All)
Explanation:
RISK AREAS
* Billing for items or services not actually rendered
* Providing medically unnecessary Services
* Upcoding
* DRG Creep
* Unbundling
* Double Billing
* Duplicate Billing
* Teaching physicians and residents
* Hospital Incentives
* Joint Ventures
* Physician Self-referrals
POLICIES AND PROCEDURES
* Documentation
- For claims and billing proper and timely
documentation of services
- Claims submitted only when documentation is
maintained and available for audit
- Legible
- Appropriately organized - Diagnosis and procedures be based on documentation
which is available to the coding staff
* Compensation
- No incentive to upcode claims
534
Q
  1. Identify true statements of benefi ts of coding
    compliance:
  2. Improvement of quality of data
  3. Creation of effi cient medical practice
  4. Improved and correct reimbursement
  5. Increased risk of fraud and abuse investigations
A
  1. Answer: A (1,2, & 3)
    Explanation:
  2. Improvement of quality of data
  3. Improvement of knowledge
  4. Creation of effi cient medical practice
  5. Improved relations between staff
  6. Improved and correct reimbursement
  7. Protection against fraud and abuse
  8. Availability of proper data for evaluation purposes
  9. Improved quality management and improvement with
    enhanced availability of data.
  10. Improved relations with public and payors
  11. Peace of mind and comfort with enhanced medical
    practice.
    Source: Laxmaiah Manchikanti, MD
535
Q
  1. The performance of a comprehensive baseline audit of
    the practice’s operations is the initial step in developing
    an effective compliance program. The steps of an audit
    include:
  2. A review of key documents
  3. A review of coding and billing practices
  4. The performance of a physician practice walk-through
  5. Interviews of the staff
A
  1. Answer: E (All)
    Explanation:
    The initial step in developing an effective compliance
    program is the performance of a comprehensive baseline
    audit of the practice’s operations. The purpose is to
    ascertain whether the practice’s current practices and
    procedures conform to all pertinent legal requirements.
    The steps of an audit include: (1) review the key
    documents, (2) review coding and billing practices, (3)
    perform a physician practice walk-through, (4) interview
    staff, and (5) review medical charts.
    Source: 65 Fed. Reg. 59434.
    Source: Erin Brisbay McMahon, JD, Sep 2005
536
Q
  1. What are some of the common reasons for denials?
  2. Arbitrary denial
  3. Wrong coding
  4. Misinterpretation of the coding
  5. Incorrect coding
A
2457. Answer: E (All)
Explanation:
* Reasons for denial
- Misinterpretation of the coding
- Arbitrary denial
- Repeated incorrect coding leads to auditing
Source: Laxmaiah Manchikanti, MD
537
Q
  1. Tasks performed by the EMR include:
  2. Transcription
  3. Clinical decision making and support
  4. Chart documentation
  5. Patient data retrieval for personal use
A
  1. Answer: B ( 1 & 3)
    Explanation:
    The tasks performed by the EMR do not necessarily allow
    for direct patient access to the records. That is a potentially
    desirable feature, but should be controlled at the front and
    back offi ce. The tasks performed by the EMR include:
    chart documentation, transcription, prescription writing
    and database, order entry, and results reporting inpatient
    reports, triage of telephone communications, and secure
    messaging systems. Furthermore, the software should be
    able to interface with other systems, assisting in support,
    and capability of multiple users. A very strong advantage
    of the EMR is remote data access.
    Source: Hans C. Hansen, MD
538
Q
  1. The EMR stores information as:
  2. Text fi le
  3. Alphanumeric fi le
  4. A structured database for data retrieval
  5. HEDON file
A
  1. Answer: A (1,2, & 3)
    Explanation:
    A HEDON fi le is not relevant to the EMR data storage.
    The advantage of an EMR is data retrieval, and the access
    to understanding this data is important to the provider,
    and to the front offi ce. It should be in an easily
    understood
    formulation.
    Source: Hans C. Hansen, MD
539
Q
  1. What are the true statements about CPT history?
  2. In 1956 the fi rst edition of CPT was published
  3. In 1960 the fi rst edition of CPT was published
  4. In 1965 Health Care Financing Administration adopted
    (HCFA) CPT
  5. In 1988 AMA released minibooks
A
2460. Answer: D (4 Only)
Explanation:
* CPT History
1966 – First edition
1970 – Second edition
1973 – Third edition
1977 – Fourth edition
1983 – HCFA adopts CPT
1983 – CPT- editorial page
1983 – Annual updates
1988 – Minibooks
Source: Laxmaiah Manchikanti, MD
540
Q

2461.What does Health Insurance Portability and
Accountability Act compliance administrative
simplifi cation do?
1. Increases costs associated with administrative and
claims related transactions
2. Establishes a national uniform standards for 8 electronic
transactions, and claims attachments
3. Eliminates unique provider identifi ers
4. Establishes protections for the privacy and security of
individual health information

A
  1. Answer: C (2 & 4)
    Explanation:
    HIPAA COMPLIANCE - Administrative Simplifi cation
  2. Reduces costs associated with administrative and claims
    related transactions
    - Over $30 billion in savings over 10 years
  3. Establishes a national uniform standards for 8 electronic
    transactions, and claims attachments
  4. Established unique provider identifi ers
  5. Establishes protections for the privacy and security of
    individual health information
    Implementation costs
    - Over $500 billion over 10 years
    Source: Laxmaiah Manchikanti, MD
541
Q
  1. What are the steps to compliance of security standards?
  2. Administrative safeguards
  3. Physical safeguard
  4. Technical safeguard
  5. Financial viability safeguard
A
  1. Answer: A (1,2, & 3)
    Explanation:
    Three steps to compliance
    The new rule on the security of electronic patient records
    boils down to three sets of standards that practices will
    need to implement step-by-step.
  2. Administrative safeguards
    Assess computer systems
    Train staff on procedures
    Prepare for aftermath of hackers or catastrophic events
    Develop contracts for business associates
  3. Physical safeguard
    Set procedures for workstation use and security
    Set procedures for electronic media reuse and disposal 3. Technical Safeguard
    Control staff computer log-in and log-off.
    Monitor access of patient information
    Set up computers to authenticate users.
  4. There is no fi nancial viability safeguard
    Source: Laxmaiah Manchikanti, MD
542
Q
  1. Identify accurate statements?
  2. A false claim is “knowingly” failing to make inquiry
    regarding the accuracy of the claim
  3. A false claim is prosecuted by district attorney
  4. A false claim is when claimant knows or should know
    that the claim was false
  5. A false-claim applies only for claims over $10,000
A
  1. Answer: B (1 & 3)
543
Q
  1. Pursuant to the Federal Anti-Kickback Law, physician
    practices should not have arrangements with which of
    the following entities unless the arrangement is within
    a Safe Harbor?
  2. Ambulatory surgery centers
  3. Clinical laboratories
  4. Hospitals
  5. Durable medical equipment suppliers
A
  1. Answer: E (All)
    Explanation:
    Many common business arrangements have the potential
    to violate state or federal anti-kickback laws. Physician
    practices should not have any arrangement with hospitals,
    ambulatory surgery centers, durable medical equipment
    suppliers, diagnostic imaging centers, clinical
    laboratories, billing companies, or others that provide any
    form of payment or remuneration for referrals of patients
    for services that may be covered by a federally-funded
    health care program, unless the arrangement falls squarely
    and appropriately within one of the anti-kickback law safe
    harbors.
    Source: 42 CFR 1001.952 (1991).
    Source: Erin Brisbay McMahon, JD, Sep 2005
544
Q
2465.What sections are utilized in Interventional Pain
Management Coding?
1. Evaluation and Management Section
2. Nervous System of Surgery Section
3. Radiology Section
4. Chiropractic Section
A
2465. Answer: A (1,2, & 3)
Explanation:
Interventional Pain Management Coding
1. Evaluation and Management
2. Surgery
General
Pelvis and hip joint
Nervous system
Spine and spinal cord
Extracranial nerves, peripheral nerves and autonomic
nervous system
3. Radiology (needle placement, fl uoroscopy)
Spine and pelvis
Lower extremities (si joint)
Other procedures
4. Medicine
Physical medicine & Rehab
Psychiatry
Source: Laxmaiah Manchikanti, MD
545
Q
  1. Which of the following is a true statement with regard to
    the Federal Self-Referral Law (Stark)?
  2. Stark rules prohibit physicians from referring patients to
    hospitals where physicians work.
  3. Stark rules prohibit physicians from personally performing
    the designated health service which they order
    for their patients.
  4. Stark rules prohibit investments in publicly traded companies
    and mutual funds.
  5. Stark rules prohibit physicians from making referrals to
    a designated health service entity in which the physician
    has a fi nancial relationship, unless an exception
    applies.
A
  1. Answer: D (4 Only)
    Explanation:
  2. Stark Law prohibits a physician from making referrals
    for certain designated health services to entities where (a)
    the physician has a direct or indirect fi nancial relationship
    and (b) the service is billed to Medicare or Medicaid.
  3. Physicians who personally perform the DHS which they
    order for their patients are covered by an exception to
    Stark Law.
  4. Investments in publicly traded companies and mutual
    funds are protected as an exception to Stark Law.
  5. Stark referral rules do not prohibit physician referrals
    to hospitals.
    Sources:
    42 U.S.C. 1395nn; 42 CFR 411.355, .357.
    Source: Erin Brisbay McMahon, JD, Sep 2005