AAPC Official CPC Certification Study Guide
Notes 2026–2027 | Complete Solutions, Exam
Prep & Review
"hold bharmless bclause" b- b bcorrect banswer- b* bfound bin bsome bnon-Medicare
bhealth bplan bcontracts
* bprohibits bbilling bto bpatient bfor banything bbeyond bdeductibles band bco-pays.
A bcompliance bplan bmay boffer bseveral bbenefits, bincluding: b- b bcorrect banswer- b*
bmore baccurate bpayment bof bclaims
* bfewer bbilling bmistakes
* bimproved bdocumentation band bmore baccurate bcoding
* bless bchance bof bviolating bself-referral band banti-kickback bstatus
A bhealthcare bclearing bhouse bis ba b- b bcorrect banswer- bentity bthat bprocesses
bnonstandard bhealth binformation bthey breceive bfrom banother bentity binto ba
bstandard bformat
A bkey bprovision bin bHIPAA bis bthe bMinimum bNecessary brequirement. bthis bmeans
b- b bcorrect banswer- bonly bthe bminimum bnecessary bprotected bhealth binformation
bshould bbe bshared bto bsatisfy ba bparticular bpurpose.
A bmedically bnecessary bservice bis bthe b- b bcorrect banswer- bleast bradical
bservice/procedure bthat ballows bfor beffective btreatment bof bthe bpatients' bcomplaint
bor bcondition
A bpatient bsustaining ban binjury bto bher bgreat bsaphenous bvein bwould bhave
bsustained binjury bto bwhich bof banatomical bsite? b- b bcorrect banswer- bLeg
APC b- b bcorrect banswer- bAmbulatory bPayment bClassification
ARRA b- b bcorrect banswer- bAmerican bRecovery band bReinvestment bAct b(of b2009)
ASC b- b bcorrect banswer- bAmbulatory bSurgical bCenters
Abuse bconsists bof b- b bcorrect banswer- bpayment bfor bitems bor bservices bthat bare
bbilled bby bproviders bin berror bthat bshould bnot bbe bpaid bfor bby bMedicare.
An bABN bprotects bthe bprovider's bfinancial binterest bby b- b bcorrect banswer-
bcreating ba bpaper btrail bthat bCMS brequires bbefore ba bprovider bcan bbill bthe
bpatient bfor bpayment bif bMedicare bdenies bcoverage bfor bthe bstated bservice bor
bprocedure.
, An bentity bthat bprocesses bnonstandard bhealth binformation bthey breceive bfrom
banother bentity binto ba bstandard bformat bis bconsidered bwhat? b- b bcorrect banswer-
bClearinghouse
As ba bpart bof bHealth bCare bReform, bthe bAffordable bCare bAct bof b2010 bamended
bthe bdefinition bof bfraud bto bremove bthe b__________ brequirement b- b bcorrect
banswer- bintent
By bstatute, ball bwork bRVUs, bmust bbe bexamined bno bless boften bthan b- b bcorrect
banswer- bevery b5 byears
CF b- b bcorrect banswer- bCoversion bFactor b- bfixed bdollar bamount bused bto
btranslate bthe bRVUs binto bfees
CMS b- b bcorrect banswer- bCenters bfor bMedicare band bMedicaid
CMS bdeveloped bpolices bregarding bmedical bnecessity bare bbased bon bregulations
bfound bin btitle bXVIII, b$1862(a) bof bthe b- b bcorrect banswer- bSocial bSecurity bAct
CMS bwill baccept bthe b____________ bfor beither ba b"potentially bnon=covered"
bservice bor bfor ba bstatutorily bexcluded bservice b- b bcorrect banswer- bCMS-R-131
CMS-R-131 b- b bcorrect banswer- bABN bform b
or
Advance bBeneficiary bNotice bwhich bexplains bto bthe bpatient bwhy bMedicare bmay
bdeny bthe bparticular bservice bor bprocedure.
CPT b- b bcorrect banswer- bCurrent bProcedural bTerminology
CY b2013 bConversion bFactor b- b bcorrect banswer- b$25.0008
Commercial b(non-Medicare) bmay bdevelop btheir bown bmedical bpolicies bwhich bdo
bnot bfollow bMedicare bguidelines band bare bspecified bin b- b bcorrect banswer- bprivate
bcontracts bbetween bthe bpayer band bpractice bor bprovider
DRG b- b bcorrect banswer- bDiagnosis bRelated bGroup
Does bMedicare bPart bB bgenerally brequire ba byearly bdeductable band bcopayment?
b- b bcorrect banswer- byes
E/M bOR bE&M b- b bcorrect banswer- bEvaluation band bManagement
EHR b- b bcorrect banswer- bElectronic bHealth bRecord
Formula bfor bCalculating bFacility bPayment bamounts b- b bcorrect banswer- b[(Work
bRVU b* bWork bGPCI) b+ b(Transitioned bFacility bPE bRVU b* bPE bGPCI) b+ b(MP
bRVU b* bMP bGPCI)] b* bCF
Notes 2026–2027 | Complete Solutions, Exam
Prep & Review
"hold bharmless bclause" b- b bcorrect banswer- b* bfound bin bsome bnon-Medicare
bhealth bplan bcontracts
* bprohibits bbilling bto bpatient bfor banything bbeyond bdeductibles band bco-pays.
A bcompliance bplan bmay boffer bseveral bbenefits, bincluding: b- b bcorrect banswer- b*
bmore baccurate bpayment bof bclaims
* bfewer bbilling bmistakes
* bimproved bdocumentation band bmore baccurate bcoding
* bless bchance bof bviolating bself-referral band banti-kickback bstatus
A bhealthcare bclearing bhouse bis ba b- b bcorrect banswer- bentity bthat bprocesses
bnonstandard bhealth binformation bthey breceive bfrom banother bentity binto ba
bstandard bformat
A bkey bprovision bin bHIPAA bis bthe bMinimum bNecessary brequirement. bthis bmeans
b- b bcorrect banswer- bonly bthe bminimum bnecessary bprotected bhealth binformation
bshould bbe bshared bto bsatisfy ba bparticular bpurpose.
A bmedically bnecessary bservice bis bthe b- b bcorrect banswer- bleast bradical
bservice/procedure bthat ballows bfor beffective btreatment bof bthe bpatients' bcomplaint
bor bcondition
A bpatient bsustaining ban binjury bto bher bgreat bsaphenous bvein bwould bhave
bsustained binjury bto bwhich bof banatomical bsite? b- b bcorrect banswer- bLeg
APC b- b bcorrect banswer- bAmbulatory bPayment bClassification
ARRA b- b bcorrect banswer- bAmerican bRecovery band bReinvestment bAct b(of b2009)
ASC b- b bcorrect banswer- bAmbulatory bSurgical bCenters
Abuse bconsists bof b- b bcorrect banswer- bpayment bfor bitems bor bservices bthat bare
bbilled bby bproviders bin berror bthat bshould bnot bbe bpaid bfor bby bMedicare.
An bABN bprotects bthe bprovider's bfinancial binterest bby b- b bcorrect banswer-
bcreating ba bpaper btrail bthat bCMS brequires bbefore ba bprovider bcan bbill bthe
bpatient bfor bpayment bif bMedicare bdenies bcoverage bfor bthe bstated bservice bor
bprocedure.
, An bentity bthat bprocesses bnonstandard bhealth binformation bthey breceive bfrom
banother bentity binto ba bstandard bformat bis bconsidered bwhat? b- b bcorrect banswer-
bClearinghouse
As ba bpart bof bHealth bCare bReform, bthe bAffordable bCare bAct bof b2010 bamended
bthe bdefinition bof bfraud bto bremove bthe b__________ brequirement b- b bcorrect
banswer- bintent
By bstatute, ball bwork bRVUs, bmust bbe bexamined bno bless boften bthan b- b bcorrect
banswer- bevery b5 byears
CF b- b bcorrect banswer- bCoversion bFactor b- bfixed bdollar bamount bused bto
btranslate bthe bRVUs binto bfees
CMS b- b bcorrect banswer- bCenters bfor bMedicare band bMedicaid
CMS bdeveloped bpolices bregarding bmedical bnecessity bare bbased bon bregulations
bfound bin btitle bXVIII, b$1862(a) bof bthe b- b bcorrect banswer- bSocial bSecurity bAct
CMS bwill baccept bthe b____________ bfor beither ba b"potentially bnon=covered"
bservice bor bfor ba bstatutorily bexcluded bservice b- b bcorrect banswer- bCMS-R-131
CMS-R-131 b- b bcorrect banswer- bABN bform b
or
Advance bBeneficiary bNotice bwhich bexplains bto bthe bpatient bwhy bMedicare bmay
bdeny bthe bparticular bservice bor bprocedure.
CPT b- b bcorrect banswer- bCurrent bProcedural bTerminology
CY b2013 bConversion bFactor b- b bcorrect banswer- b$25.0008
Commercial b(non-Medicare) bmay bdevelop btheir bown bmedical bpolicies bwhich bdo
bnot bfollow bMedicare bguidelines band bare bspecified bin b- b bcorrect banswer- bprivate
bcontracts bbetween bthe bpayer band bpractice bor bprovider
DRG b- b bcorrect banswer- bDiagnosis bRelated bGroup
Does bMedicare bPart bB bgenerally brequire ba byearly bdeductable band bcopayment?
b- b bcorrect banswer- byes
E/M bOR bE&M b- b bcorrect banswer- bEvaluation band bManagement
EHR b- b bcorrect banswer- bElectronic bHealth bRecord
Formula bfor bCalculating bFacility bPayment bamounts b- b bcorrect banswer- b[(Work
bRVU b* bWork bGPCI) b+ b(Transitioned bFacility bPE bRVU b* bPE bGPCI) b+ b(MP
bRVU b* bMP bGPCI)] b* bCF
