CPC NEWEST 2026/2027 EXAM WITH QUESTIONS AND CORRECT
ANSWERS ALREADY GRADED A+ AND 100% GUARANTEE PASS
Abstractor - ANSWER hospital employee who converts documented procedurs and diangoses into
medical codes
Abuse - ANSWER coding practices that lead to improper reimbursement by error because they do
not meet medical necessity, ex. changing diagnosis to be covered by insurance
Accreditation - ANSWER an examination process the healthcare facility goes through to evaluate the
facilities policies, procedures, and performance to meet higher standards.
Accredited - ANSWER Having seal of approval after being evaluated and demonstrating quality
standards
Act/ Law/ Statute - ANSWER Legislation passed through Congress and signed by President or passed
over his veto
Actual Charge - ANSWER The amount the provider charges for medical services or supplies. Not
always paid in full.
Additional Benefits - ANSWER Health care services not covered by Medicare and are offered through
the Medicare Advantage Organization for no additional premium. The benefits must equal the ACR
(Adjusted Community Rating)
Adjudication - ANSWER Health Insurance Claims process at the insurance company
Adjusted Average Per Capita Cost (AAPCC) - ANSWER Estimate of how much Medicare will spend in a
year for an average beneficiary
Administrative Code Sets - ANSWER Non medical code sets that characterize a general business
situation rather than a medical condition.
Administrative Costs - ANSWER Medicare, Medicaid, CMS refer to this as their expenses to have the
program, operating expenses, program management, etc.
, Administrative Data - ANSWER Health insurance information stored in automated information system
about enrollment, eligibility, claims, etc.
Administrative Law Judge (ALJ) - ANSWER hearing officer who presides over appeal conflicts between
providers or beneficiaries, and Medicare contractors (MAC's)
Administrative Simplification - ANSWER Part of HIPAA authorizing HHS (Health and Human Services)
to 1. adopt standards for transactions & code sets; 2. adopt standard identifiers for health plans; 3.
adopt standards to protect security & privacy of personally identifiable health information.
Administrative Simplification Act - ANSWER Signed 12/17/01 allows HHS (Health & Human Services)
to exclude providers from Medicare for HIPAA non-compliance of electronic claims and prohibit
paper claims except in certain situations
Admission Date - ANSWER The date the patient was admitted for inpatient care, outpatient, or start
of care.For hospice, enter effective date of election of hospice benefits.
Admitting Diagnosis - ANSWER Diagnosis code indicating patient's diagnosis at admission
Admitting Physician - ANSWER The doctor responsible for admitting a patient to the hospital or other
inpatient health facility
Advance Beneficiary Notification (ABN) - ANSWER A notice from provider to patient that Medicare
may deny payment. Patient must sign before services are provider, otherwise patient is not
responsible if Medicare does not cover.
Advanced Directive - ANSWER Statement written by patient on how they want medical decisions to
be made. May include a Living Will or Durable Power of Attorney for healthcare.
Allowed Charge - ANSWER Individual charge determination by carrier for a covered service or supply.
Ambulatory Care - ANSWER All types of health services that do not require an overnight stay.
ANSWERS ALREADY GRADED A+ AND 100% GUARANTEE PASS
Abstractor - ANSWER hospital employee who converts documented procedurs and diangoses into
medical codes
Abuse - ANSWER coding practices that lead to improper reimbursement by error because they do
not meet medical necessity, ex. changing diagnosis to be covered by insurance
Accreditation - ANSWER an examination process the healthcare facility goes through to evaluate the
facilities policies, procedures, and performance to meet higher standards.
Accredited - ANSWER Having seal of approval after being evaluated and demonstrating quality
standards
Act/ Law/ Statute - ANSWER Legislation passed through Congress and signed by President or passed
over his veto
Actual Charge - ANSWER The amount the provider charges for medical services or supplies. Not
always paid in full.
Additional Benefits - ANSWER Health care services not covered by Medicare and are offered through
the Medicare Advantage Organization for no additional premium. The benefits must equal the ACR
(Adjusted Community Rating)
Adjudication - ANSWER Health Insurance Claims process at the insurance company
Adjusted Average Per Capita Cost (AAPCC) - ANSWER Estimate of how much Medicare will spend in a
year for an average beneficiary
Administrative Code Sets - ANSWER Non medical code sets that characterize a general business
situation rather than a medical condition.
Administrative Costs - ANSWER Medicare, Medicaid, CMS refer to this as their expenses to have the
program, operating expenses, program management, etc.
, Administrative Data - ANSWER Health insurance information stored in automated information system
about enrollment, eligibility, claims, etc.
Administrative Law Judge (ALJ) - ANSWER hearing officer who presides over appeal conflicts between
providers or beneficiaries, and Medicare contractors (MAC's)
Administrative Simplification - ANSWER Part of HIPAA authorizing HHS (Health and Human Services)
to 1. adopt standards for transactions & code sets; 2. adopt standard identifiers for health plans; 3.
adopt standards to protect security & privacy of personally identifiable health information.
Administrative Simplification Act - ANSWER Signed 12/17/01 allows HHS (Health & Human Services)
to exclude providers from Medicare for HIPAA non-compliance of electronic claims and prohibit
paper claims except in certain situations
Admission Date - ANSWER The date the patient was admitted for inpatient care, outpatient, or start
of care.For hospice, enter effective date of election of hospice benefits.
Admitting Diagnosis - ANSWER Diagnosis code indicating patient's diagnosis at admission
Admitting Physician - ANSWER The doctor responsible for admitting a patient to the hospital or other
inpatient health facility
Advance Beneficiary Notification (ABN) - ANSWER A notice from provider to patient that Medicare
may deny payment. Patient must sign before services are provider, otherwise patient is not
responsible if Medicare does not cover.
Advanced Directive - ANSWER Statement written by patient on how they want medical decisions to
be made. May include a Living Will or Durable Power of Attorney for healthcare.
Allowed Charge - ANSWER Individual charge determination by carrier for a covered service or supply.
Ambulatory Care - ANSWER All types of health services that do not require an overnight stay.
