AAPC-CPPM Certified Physician Practice Manager - Set 2 - Part 3

Correct Answer: Later of the date the tax becomes due or is paid

The IRS requires employers to keep all employment tax records for at least 4 years after the date the tax becomes due or is paid, whichever is later, so the later of those two dates starts the period. Option a is incorrect because disposal of property governs how long asset records are kept, which is a separate rule from the one covering employment tax records. Option b is incorrect because the return filing date anchors the period of limitations for income tax returns, while employment tax records follow their own period tied to due or payment dates. Option d is incorrect because the hire date is not the trigger; the guidance measures retention from when the tax becomes due or is paid, not from the start of employment.

Correct Answer: Reasonable and necessary for diagnosis or treatment

The statute bars payment under part A or part B for items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Option a is incorrect because the statute applies this wording to the specified preventive items and services, while the general standard concerns diagnosis or treatment of illness or injury. Option c is incorrect because this standard applies only to hospice care under the statute, not to items and services in general under part A or part B. Option d is incorrect because this describes a separate clause for clinical care items tied to research and experimentation, not the general standard governing payment for covered items or services.

Correct Answer: Use of the same method by both businesses

IRS guidance lets an owner of two or more separate and distinct businesses use a different accounting method for each. Requiring both businesses to use the same method contradicts that rule, so it is not a requirement. Option b is incorrect because IRS guidance states that no business is separate and distinct unless a complete and separate set of books and records is maintained for each one. Option c is incorrect because IRS guidance warns that using different methods to create or shift profits or losses, so income is not clearly reflected, defeats separate and distinct status. Option d is incorrect because IRS guidance allows a different method for each business only if the method used for each clearly shows its income, so this is a real requirement.

Correct Answer: Signed written notice and agreement to pay

Both the physician and the medical equipment and supplies Refund Requirements demand that knowledge be evidenced by a signed written notice and agreement to pay personally in case of denial, a stricter standard than Limitation On Liability. Option a is incorrect because this is part of the Limitation On Liability standard, which accepts other means showing the beneficiary knew or should have known, unlike the stricter refund provisions. Option b is incorrect because on appeal, such an allegation is acceptable evidence for Limitation On Liability purposes when nothing contradicts it, and it does not establish knowledge under refund provisions. Option c is incorrect because notice having been provided is a Limitation On Liability basis for knowledge; the refund provisions go further and require a signed notice plus an agreement to pay.

Correct Answer: Initiation

Medicare ABN guidance names initiations as a triggering event, covering the beginning of a new patient encounter, the start of a plan of care, or the beginning of treatment. Option a is incorrect because it is the discontinuation of certain items or services, so it marks the end of care instead of its beginning. Option b is incorrect because the guidance lists initiations, reductions and terminations as the triggering events, and renewal does not appear among them. Option d is incorrect because it describes a decrease in a component of care, such as frequency or duration, rather than the start of a plan of care.

Correct Answer: The next succeeding workday

Under the extension of period ending on a nonworkday, if the last day of the filing period falls on a Saturday, Sunday, legal holiday, or other Federal nonworkday, the time is extended to the next succeeding workday. Option a is incorrect because that length applies to specific exceptions, such as retroactive entitlement notice or recovery of a Medicaid payment, not to a deadline ending on a nonworkday. Option b is incorrect because the regulation moves the deadline forward, not backward, so the claim is not due earlier than the nonworkday. Option c is incorrect because a full calendar month is not the nonworkday extension; the regulation moves the deadline only to the next workday, not a month.

Correct Answer: Limitations in the separate drug coverage regulation

The incident-to regulation's Limitations paragraph states that drugs and biologicals are also subject to the limitations in the separate drug coverage regulation, in addition to the general incident-to conditions. Option b is incorrect because State law is a separate incident-to condition for services and supplies; it is not the stated limitation for drugs and biologicals, which carry their own cross-referenced rule. Option c is incorrect because the regulation says drugs used to refill an implanted DME item are not payable to a pharmacy or supplier as DME, but only to the physician. Option d is incorrect because those provisions govern physical therapy, occupational therapy and speech-language pathology furnished incident to a physician's services, not drugs and biologicals, which the regulation ties to a different rule.

Correct Answer: Dismiss the request

When a redetermination request is not filed within the required time limit and the contractor finds no good cause for the failure to file timely, the contractor should dismiss the request. Option a is incorrect because the QIC is the next level, which reviews a redetermination already issued, so an untimely request is not passed along to it. Option b is incorrect because de novo describes a new, thorough evaluation of a claim at a level of appeal, which an untimely request does not receive. Option d is incorrect because reopening revises a prior decision; here the contractor is told to dismiss a late request when no good cause is found.

Correct Answer: Revocation of enrollment for up to one year per act

The Social Security Act lets the Secretary revoke enrollment, for not more than one year for each act, when a physician or supplier fails to maintain and give access to documentation of written orders, certifications or referrals. Option a is incorrect because the statute caps revocation at not more than one year for each act, so a three-year period exceeds the limit it sets. Option c is incorrect because the claim filing provisions set a period ending 1 calendar year after the date of service, and they do not address missing order documentation. Option d is incorrect because the statute adds ordering, referring and certifying to the OIG permissive exclusion authority, which is permissive rather than mandatory, and it names revocation of enrollment for this failure.

Correct Answer: Comparing the claim denial rate to other practices

OIG guidance states that one method for improving documentation quality is to compare the practice's claim denial rate to the rates of other practices in the same specialty, to the extent the carrier supplies that information. Option b is incorrect because the guidance does not hand coding decisions to the carrier; the carrier is only a possible source of comparison data for the practice. Option c is incorrect because submitting fewer claims does nothing to measure documentation quality, and the guidance does not offer it as a way to improve it. Option d is incorrect because fee schedule changes are not described as a documentation quality method; the guidance points to comparison of denial rates with same-specialty practices.