AAPC CPC EXAM PREP COMPLIANCE AND REGULATORY QUESTONS WITH CORRECT ANSWERS 2025

AAPC CPC EXAM PREP COMPLIANCE AND
REGULATORY QUESTONS WITH CORRECT
ANSWERS 2025
WhatQdocumentQisQreferencedQtoQwhenQlookingQforQpotentialproblemQareasQidentifiedQbyQtheQgovernme
ntQindicatingscrutinyQofQtheQservicesQwithinQtheQcomingQyear?:

A)QOIGQComplianceQPlanQGuidance

B)QOIGQSecurityQSummary

C)QOIGQWorkQPlan

D)QOIGQInvestigationQPlanQ-QCORRECTQANSWERQ-
CQ(Rationale:QTwiceQaQyear,QtheQOIGQreleasesQaQWorkQPlanQoutliningQitsQprioritiesQforQtheQfiscalQyearQahea
d.QWithinQtheQWorkQPlan,QpotentialQproblemQareasQwithQclaimsQsubmissionsQareQlistedQandQwillQbeQtarget
edQwithQspecialQscrutiny.)



WhatQformQisQprovidedQtoQaQpatientQtoQindicateQaQservicemayQnotQbeQcoveredQbyQMedicareQandQtheQpati
entQmayQbeQresponsibleQforQtheQcharges?:

A)QLCD

B)QCMS-1500

C)QUB-04

D)QABNQ-QCORRECTQANSWERQ-
DQ(Rationale:QAnQAdvancedQBeneficiaryQNoticeQ(ABN)QisQusedQwhenQaQMedicareQbeneficiaryQrequestsQorQ
agreesQtoQreceiveQaQprocedureQorQserviceQthatQMedicareQmayQnotQcover.QThisQformQnotifiesQtheQpatientQo
fQpotentialQoutQofQpocketQcostsQforQtheQpatient.)



UnderQHIPAA,QwhatQwouldQbeQaQpolicyQrequirementQforQ"minimumQnecessary"?Q"

A)QOnlyQindividualsQwhoseQjobQrequiresQitQmayQhaveQaccessQtoQprotectedQhealthQinformation.

B)QOnlyQtheQpatientQhasQaccessQtoQhisQorQherQownQprotectedQhealthQinformation.

C)QOnlyQtheQtreatingQproviderQhasQaccessQtoQprotectedQhealthQinformation.

D)QAnyoneQwithinQtheQprovider'sQofficeQcanQhaveQaccessQtoQprotectedQhealthQinformation.Q-
QCORRECTQANSWERQ-

AQ(Rationale:QItQisQtheQresponsibilityQofQaQcoveredQentityQtoQdevelopQandQimplementQpolicies,QbestQsuited
QtoQitsQparticularQcircumstancesQtoQmeetQHIPAAQrequirements.QAsQaQpolicyQrequirement,QonlyQthoseQindiv

idualsQwhoseQjobQrequiresQitQmayQhaveQaccessQtoQprotectedQhealthQinformation.)

, WhichQstatementQdescribesQaQmedicallyQnecessaryQservice?Q:

A)QPerformingQaQprocedure/serviceQbasedQonQcostQtoQeliminateQwastefulQservices.

B)QUsingQtheQleastQradicalQservice/procedureQthatQallowsQforQeffectiveQtreatmentQofQtheQpatient'sQcompla
intQorQcondition.

C)QUsingQtheQclosestQfacilityQtoQperformQaQserviceQorQprocedure.

D)QUsingQtheQappropriateQcourseQofQtreatmentQtoQfitQwithinQtheQpatient'sQlifestyle.Q-QCORRECTQANSWERQ-
BQ(Rationale:QMedicalQnecessityQisQusingQtheQleastQradicalQservices/procedureQthatQallowsQforQeffectiveQtr
eatmentQofQtheQpatient'sQcomplaintQorQcondition.)



AccordingQtoQtheQexampleQLCDQfromQNovitasQSolutions,QwhichQofQtheQfollowingQconditionsQisQconsideredQ
aQsystemicQconditionQthatQmayQresultQinQtheQneedQforQroutineQfootQcare?Q:

A)Qarthritis

B)QchronicQvenousQinsufficiency

C)Qhypertension

D)QmuscleQweaknessQ-QCORRECTQANSWERQ-
BQ(Rationale:QAccordingQtoQtheQLCD,QChronicQvenousQinsufficiencyQisQaQsystemicQconditionQthatQmayQresul
tQinQtheQneedQforQroutineQfootQcare.)



WhenQpresentingQaQcostQestimateQonQanQABNQforQaQpotentiallyQnoncoveredQservice,QtheQcostQestimateQsh
ouldQbeQwithinQwhatQrangeQofQtheQactualQcost?

A)Q$25QorQ10Qpercent

B)Q$100QorQ10Qpercent

C)Q$100QorQ25Qpercent

D)QAnQexactQamountQ-QCORRECTQANSWERQ-
CQ(Rationale:QCMSQinstructionsQstipulate,Q"NotifiersQmustQmakeQaQgoodQfaithQeffortQtoQinsertQaQreasonabl
eQestimate...theQestimateQshouldQbeQwithinQ$100QorQ25QpercentQofQtheQactualQcosts,QwhicheverQisQgreate
r.")



WhichQactQwasQenactedQasQpartQofQtheQAmericanQRecoveryQandQReinvestmentQActQofQ2009Q(ARRA)QandQa
ffectedQprivacyQandQsecurity?Q:

A)QHIPAA

B)QHITECH