AAPC CPB 2026 UPDATED QUESTIONS AND ANSWERS
SURE A+
✔✔Metabolism - ✔✔the body ability to produce energy and burn fat through proper diet,
exercise and hydration
✔✔Inferior - ✔✔lower part of the body
✔✔Efferent - ✔✔carrying away; carries nerves impulse away from the CNS
✔✔Cicatrix - ✔✔A scar remaining after healing of a wound
✔✔Neoplasm - ✔✔abnormal growth mass
✔✔Malunion - ✔✔a fracture that healed in an abnormal position
✔✔Parasympathetic - ✔✔part of the nervous system that control homeostasis and
responsible for the body rest and digest function
✔✔Meatus - ✔✔opening of the urethra where urine exit the body
✔✔Hormone - ✔✔it regulated the body temperature, sleep cycle and mood of the body
✔✔Nevus - ✔✔pigmented spot on the skin e.g. mole
✔✔Bruit - ✔✔abnormal narrowing of the artery
✔✔Interstitial - ✔✔relating to a space between or within a tissue or organ
✔✔Perforation - ✔✔cut into the skin or a hole or break in the walls or membrane of
organ or structure of the body
✔✔Proliferative - ✔✔increasing in numbers of similar forms
✔✔Transplanation - ✔✔transfer of living organs or tissue from one part of the body to
another or from one individual to another
✔✔Medicare statutorily excluded services are - ✔✔-non-covered items and services
-not reimbursed by Medicare
✔✔Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) is a program
associated with - ✔✔medicaid
,✔✔The clinical Prior Authorization (PA) Program assists in the monitoring of - ✔✔drugs
not on Medicaid's formulary
✔✔Albert has purchased a Medigap policy to supplement his Medicare benefits, To
which entity will Albert pay his monthly premium - ✔✔Medigap insurance company
✔✔The total RVU is composed of which of the following components - ✔✔physician
work, practice expense and malpractice insurance
✔✔To determine the Medicare coverage and payment policy for a service or procedure,
which of the following resources will indicate if a service or procedure is payable,
noncovered, or bundled into another service - ✔✔status codes
✔✔Medicare A
Medicare B
Medicare C
Medicare D - ✔✔Inpatient hospital stays
Outpatient hospital care
Medicare Advantage
Prescription drugs
✔✔Medicare has four categories of items and services that are not covered under the
program, they are: - ✔✔1) Services and supplies that are not medically
reasonable and necessary;
2) Non-covered items and services;
3) Services and supplies denied as bundled or included
in the basic allowance of another service; and
4) Items and services reimbursable by other
organizations or furnished without charge.
✔✔Explain incident to services and who they are preformed by - ✔✔Once the initial
physician relationship has been established, incident-to services can be billed even
when there is not a physician in the room. He or she must only be on the premises and
immediately available to assist the non-physician providers (nurse practitioners,
physician assistants, certified nurse midwives and clinical nurse specialists) provider
rendering the services
✔✔An NPI doesn't ensure - ✔✔a provider is licensed or credentialed
guarantee payment by a health plan
enroll a provider in a health plan
turn the provider into a covered provider
require a provider to conduct HIPPA transactions
,✔✔Medicare was passed into law under the title XVIII of what Act - ✔✔social security
act
✔✔The federal False Claim Act allows for claims to be reviewed for how many years
after an incident - ✔✔seven years
✔✔A practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice
used x-rays of one patient to justify services on multiple other patients' claims. The
office manager brought the civil suit. What type of case is this? - ✔✔Qui Tam
✔✔In which of the following circumstances may PHI not be disclosed without the
patient's authorization or permission? - ✔✔An office receives a call from the patient's
husband asking for information about his wife's recent office visit.
✔✔According to the Privacy Rule, what must a Business Associate and a Covered
Entity have in order to do business? - ✔✔A contract
✔✔HMO plans require the enrollee to: - ✔✔To have referrals to see a specialist that is
generated by the patient's primary care provider.
✔✔Which of the following is NOT a component of the PPO payer model? - ✔✔Require
the enrollee to maintain a Primary Care Provider.
✔✔Under the Privacy Rule a health plan, clearinghouses, and any entity transmitting
health information is considered? - ✔✔Covered entity
✔✔A request for medical records is received for a specific date of service from a
patient's insurance company with regards to a submitted claim. No authorization for
release of information is provided. What action should be taken? - ✔✔Release the
requested records to the insurance company.
✔✔Which of the following situations allows the release of PHI without authorization from
the patient? - ✔✔Workers' Compensation
✔✔HIPAA mandated what entity to adopt national standards for electronic transactions
and code sets? - ✔✔HHS
✔✔What is the standard time frame established for record retention? - ✔✔There is no
single standard for record retention; it varies by state and federal regulations.
✔✔CMS defines _______ as billing for a lower level of care than is supported in
documentation, making false statements to obtain undeserved benefits or payment from
a federal healthcare program, or billing for a service that was not performed. - ✔✔Fraud
, ✔✔A claim is submitted for a patient on Medicare with a higher fee than a patient on
Insurance ABC. What is this considered by CMS? - ✔✔Abuse
✔✔A person that files a claim for a Medicare Beneficiary knowing that the service is not
correctly reported is in violation of what statute? - ✔✔False Claims Act
✔✔Which of the following actions is considered under the False Claims Act? - ✔✔Up-
coding or unbundling services
✔✔A practice sets up a payment plan with a patient. If more than four installments are
extended to the patient, what regulation is the practice subject to that makes the
practice a creditor? - ✔✔Truth in Lending Act
✔✔Medicare was passed into law under the title XVIII of what Act? - ✔✔Social Security
Act
✔✔Which of the following statements are true regarding healthcare regulations? -
✔✔Healthcare regulations may vary by state and by payer
✔✔A physician office (covered entity) discovers that the billing company (business
associate) is in breach of their contract. What is the first step to be taken? - ✔✔Take
steps to correct the problem and end the violation
✔✔OIG, CMS, and the Department of Justice are the government agencies enforcing
______? - ✔✔Federal fraud and abuse laws
✔✔Fraud and Abuse penalties do NOT include: - ✔✔Ability to re-file claims in question
✔✔A biller at a medical practice notices that all claims contain CPT code 81002. She
questions the nurse who tells her that because they are an OB/GYN office they bill
every patient for a urinalysis. What does this violate? - ✔✔False Claims Act
✔✔Individuals have the right to review and obtain copies of the PHI. What is excluded
from the right of access? - ✔✔Psychotherapy notes
✔✔Medical Records are requested for a patient for a specific date of service. When
records are copied, multiple dates of service are copied and sent in reply to the request.
What standard does this violate? - ✔✔Minimum Necessary
✔✔Patient has questions and concerns regarding the Privacy Practices in the clinic
should be addressed by what party? - ✔✔Privacy Official
SURE A+
✔✔Metabolism - ✔✔the body ability to produce energy and burn fat through proper diet,
exercise and hydration
✔✔Inferior - ✔✔lower part of the body
✔✔Efferent - ✔✔carrying away; carries nerves impulse away from the CNS
✔✔Cicatrix - ✔✔A scar remaining after healing of a wound
✔✔Neoplasm - ✔✔abnormal growth mass
✔✔Malunion - ✔✔a fracture that healed in an abnormal position
✔✔Parasympathetic - ✔✔part of the nervous system that control homeostasis and
responsible for the body rest and digest function
✔✔Meatus - ✔✔opening of the urethra where urine exit the body
✔✔Hormone - ✔✔it regulated the body temperature, sleep cycle and mood of the body
✔✔Nevus - ✔✔pigmented spot on the skin e.g. mole
✔✔Bruit - ✔✔abnormal narrowing of the artery
✔✔Interstitial - ✔✔relating to a space between or within a tissue or organ
✔✔Perforation - ✔✔cut into the skin or a hole or break in the walls or membrane of
organ or structure of the body
✔✔Proliferative - ✔✔increasing in numbers of similar forms
✔✔Transplanation - ✔✔transfer of living organs or tissue from one part of the body to
another or from one individual to another
✔✔Medicare statutorily excluded services are - ✔✔-non-covered items and services
-not reimbursed by Medicare
✔✔Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) is a program
associated with - ✔✔medicaid
,✔✔The clinical Prior Authorization (PA) Program assists in the monitoring of - ✔✔drugs
not on Medicaid's formulary
✔✔Albert has purchased a Medigap policy to supplement his Medicare benefits, To
which entity will Albert pay his monthly premium - ✔✔Medigap insurance company
✔✔The total RVU is composed of which of the following components - ✔✔physician
work, practice expense and malpractice insurance
✔✔To determine the Medicare coverage and payment policy for a service or procedure,
which of the following resources will indicate if a service or procedure is payable,
noncovered, or bundled into another service - ✔✔status codes
✔✔Medicare A
Medicare B
Medicare C
Medicare D - ✔✔Inpatient hospital stays
Outpatient hospital care
Medicare Advantage
Prescription drugs
✔✔Medicare has four categories of items and services that are not covered under the
program, they are: - ✔✔1) Services and supplies that are not medically
reasonable and necessary;
2) Non-covered items and services;
3) Services and supplies denied as bundled or included
in the basic allowance of another service; and
4) Items and services reimbursable by other
organizations or furnished without charge.
✔✔Explain incident to services and who they are preformed by - ✔✔Once the initial
physician relationship has been established, incident-to services can be billed even
when there is not a physician in the room. He or she must only be on the premises and
immediately available to assist the non-physician providers (nurse practitioners,
physician assistants, certified nurse midwives and clinical nurse specialists) provider
rendering the services
✔✔An NPI doesn't ensure - ✔✔a provider is licensed or credentialed
guarantee payment by a health plan
enroll a provider in a health plan
turn the provider into a covered provider
require a provider to conduct HIPPA transactions
,✔✔Medicare was passed into law under the title XVIII of what Act - ✔✔social security
act
✔✔The federal False Claim Act allows for claims to be reviewed for how many years
after an incident - ✔✔seven years
✔✔A practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice
used x-rays of one patient to justify services on multiple other patients' claims. The
office manager brought the civil suit. What type of case is this? - ✔✔Qui Tam
✔✔In which of the following circumstances may PHI not be disclosed without the
patient's authorization or permission? - ✔✔An office receives a call from the patient's
husband asking for information about his wife's recent office visit.
✔✔According to the Privacy Rule, what must a Business Associate and a Covered
Entity have in order to do business? - ✔✔A contract
✔✔HMO plans require the enrollee to: - ✔✔To have referrals to see a specialist that is
generated by the patient's primary care provider.
✔✔Which of the following is NOT a component of the PPO payer model? - ✔✔Require
the enrollee to maintain a Primary Care Provider.
✔✔Under the Privacy Rule a health plan, clearinghouses, and any entity transmitting
health information is considered? - ✔✔Covered entity
✔✔A request for medical records is received for a specific date of service from a
patient's insurance company with regards to a submitted claim. No authorization for
release of information is provided. What action should be taken? - ✔✔Release the
requested records to the insurance company.
✔✔Which of the following situations allows the release of PHI without authorization from
the patient? - ✔✔Workers' Compensation
✔✔HIPAA mandated what entity to adopt national standards for electronic transactions
and code sets? - ✔✔HHS
✔✔What is the standard time frame established for record retention? - ✔✔There is no
single standard for record retention; it varies by state and federal regulations.
✔✔CMS defines _______ as billing for a lower level of care than is supported in
documentation, making false statements to obtain undeserved benefits or payment from
a federal healthcare program, or billing for a service that was not performed. - ✔✔Fraud
, ✔✔A claim is submitted for a patient on Medicare with a higher fee than a patient on
Insurance ABC. What is this considered by CMS? - ✔✔Abuse
✔✔A person that files a claim for a Medicare Beneficiary knowing that the service is not
correctly reported is in violation of what statute? - ✔✔False Claims Act
✔✔Which of the following actions is considered under the False Claims Act? - ✔✔Up-
coding or unbundling services
✔✔A practice sets up a payment plan with a patient. If more than four installments are
extended to the patient, what regulation is the practice subject to that makes the
practice a creditor? - ✔✔Truth in Lending Act
✔✔Medicare was passed into law under the title XVIII of what Act? - ✔✔Social Security
Act
✔✔Which of the following statements are true regarding healthcare regulations? -
✔✔Healthcare regulations may vary by state and by payer
✔✔A physician office (covered entity) discovers that the billing company (business
associate) is in breach of their contract. What is the first step to be taken? - ✔✔Take
steps to correct the problem and end the violation
✔✔OIG, CMS, and the Department of Justice are the government agencies enforcing
______? - ✔✔Federal fraud and abuse laws
✔✔Fraud and Abuse penalties do NOT include: - ✔✔Ability to re-file claims in question
✔✔A biller at a medical practice notices that all claims contain CPT code 81002. She
questions the nurse who tells her that because they are an OB/GYN office they bill
every patient for a urinalysis. What does this violate? - ✔✔False Claims Act
✔✔Individuals have the right to review and obtain copies of the PHI. What is excluded
from the right of access? - ✔✔Psychotherapy notes
✔✔Medical Records are requested for a patient for a specific date of service. When
records are copied, multiple dates of service are copied and sent in reply to the request.
What standard does this violate? - ✔✔Minimum Necessary
✔✔Patient has questions and concerns regarding the Privacy Practices in the clinic
should be addressed by what party? - ✔✔Privacy Official
