CERTIFIED PROFESSIONAL CODER CODING TEST
2025 PREP TEST BANK WITH 1000+ QUESTIONS AND
CORRECT DETAILED ANSWERS| CERTIFIED
PROFESSIONAL CODER STUDY GUIDE TEST BANK|
CERTIFIED CODING SPECIALIST PRACTICE TEST #1
EXAM LATEST UPDATE [BRAND NEW!!]
Certified Professional Coder
What type of profession, other than coding, might skilled coders enters? - ANSWER ✔✔-
Consultants, educators, and medical auditors
What is the difference between outpatient and inpatient coding? - ANSWER ✔✔- Inpatient
coders use ICD-10-CM and ICD-10-PCS
Under HIPAA, what would be a policy requirement for "minimum necessary"? - ANSWER ✔✔-
Only individuals whose job requires it may have access to protected health information
What is medical necessity? - ANSWER ✔✔- Refers to whether a procedure or service is
considered appropriate in a given circumstance
What is true regarding ABNs? - ANSWER ✔✔- ABNs may not be recognized by non-Medicare
payers.
Which act was enacted as part f the American Recovery and Reinvestment Act of 2009 (ARRA)
and affected privacy and security? - ANSWER ✔✔- HITECH
Which statement describes a medically necessary service? - ANSWER ✔✔- Using the least
radical service/procedure that allows for effective treatment of the patient's complaint or
condition
1|Page
,What document assists provider offices with the development of Compliance Manuals? -
ANSWER ✔✔- OIG Compliance Program Guidance
What document is referenced to when looking for potential problem areas identified by the
government indicating scrutiny of services? - ANSWER ✔✔- OIG Work Plan
What form is provided to a patient to indicate a service may not be covered by Medicare and
the patient may be responsible for the charges? - ANSWER ✔✔- ABN
When presenting a cost estimate on an ABN for a potentially noncovered service, the cost
estimate should be within what range of the actual cost? - ANSWER ✔✔- $100 or 25%
Who would not be considered a covered entity under HIPAA? - ANSWER ✔✔- Patients
What is a mid-level provider? - ANSWER ✔✔- Mid-level providers include physician assistants
(PA) and nurse practitioners (NP)
What are the different parts of Medicare? - ANSWER ✔✔- Part A, B, C, D
Evaluation and management (E/M) services are often provided and documented in a standard
format. One such format is SOAP notes. What does SOAP represent? - ANSWER ✔✔- Subjective,
Objective, Assessment, Plan
What is not a common reason Medicare may deny a service? - ANSWER ✔✔- Covered service
Under the Privacy Rule, the minimum necessary standard does not apply to what type of
disclosure? - ANSWER ✔✔- Disclosures to the individual who is the subject of the individual
2|Page
,Which is not one of the seven key components of an integral compliance plan? - ANSWER ✔✔-
Conduct training but not perform education on practice standards and procedures
EHR stands for: - ANSWER ✔✔- Electronic health record
What does CMS-HCC stand for? - ANSWER ✔✔- Centers for Medicare and Medicaid Services -
Hierarchical Condition Category
When are providers responsible for obtaining an ABN for a service not considered medically
necessary? - ANSWER ✔✔- Prior to providing a service or item to a beneficiary
Local Coverage Determinations are administered by whom? - ANSWER ✔✔- Each regional MAC
When reviewing operative reports, which one of the following is a TRUE statement? - ANSWER
✔✔- Additional details about the procedure can be found in the body of the report
Which CMS product describes whether specific medical items, services, treatment procedures
or technologies are considered medically necessary under Medicare? - ANSWER ✔✔- National
Coverage Determination Manual
The Medicare program is made up of several parts. Which part covers provider fees without the
use of a private insurer? - ANSWER ✔✔- Part C
HIPAA stands for? - ANSWER ✔✔- Health Insurance Portability and Accountability Act
What is not considered a covered entity under HIPAA? - ANSWER ✔✔- Workers' Compensation
What is the purpose of National Coverage Determinations? - ANSWER ✔✔- To explain CMS
policies on when Medicare will pay for items or services
3|Page
, LCDs only have jurisdiction in their ______ - ANSWER ✔✔- region
What type of health insurance provides coverage for low-income families? - ANSWER ✔✔-
Medicaid
The OIG recommends that provider practices enforce disciplinary actions through well
publicized compliance guidelines to ensure actions that are _______. - ANSWER ✔✔-
Consistent and appropriate
Which statement is true regarding the Merit-Based incentive Program (MIPS)? - ANSWER ✔✔-
Providers are excluded from MIPS if they are enrolled in a qualifying APM program
What does the abbreviation MAC stand for? - ANSWER ✔✔- Medicare Administrative
Contractor
A covered entity does not include: - ANSWER ✔✔- Patients
A covered entity may obtain consent from an individual to use or disclose protected health
information to carry out all of the following except: - ANSWER ✔✔- Research
Which of the following is not. component of the MIPS program? - ANSWER ✔✔- Readmission
Rates
The OIG releases a _____ outlining its priorities for the fiscal year and beyond. - ANSWER ✔✔-
Work Plan
What si PHI? - ANSWER ✔✔- Protected Health Information
4|Page
2025 PREP TEST BANK WITH 1000+ QUESTIONS AND
CORRECT DETAILED ANSWERS| CERTIFIED
PROFESSIONAL CODER STUDY GUIDE TEST BANK|
CERTIFIED CODING SPECIALIST PRACTICE TEST #1
EXAM LATEST UPDATE [BRAND NEW!!]
Certified Professional Coder
What type of profession, other than coding, might skilled coders enters? - ANSWER ✔✔-
Consultants, educators, and medical auditors
What is the difference between outpatient and inpatient coding? - ANSWER ✔✔- Inpatient
coders use ICD-10-CM and ICD-10-PCS
Under HIPAA, what would be a policy requirement for "minimum necessary"? - ANSWER ✔✔-
Only individuals whose job requires it may have access to protected health information
What is medical necessity? - ANSWER ✔✔- Refers to whether a procedure or service is
considered appropriate in a given circumstance
What is true regarding ABNs? - ANSWER ✔✔- ABNs may not be recognized by non-Medicare
payers.
Which act was enacted as part f the American Recovery and Reinvestment Act of 2009 (ARRA)
and affected privacy and security? - ANSWER ✔✔- HITECH
Which statement describes a medically necessary service? - ANSWER ✔✔- Using the least
radical service/procedure that allows for effective treatment of the patient's complaint or
condition
1|Page
,What document assists provider offices with the development of Compliance Manuals? -
ANSWER ✔✔- OIG Compliance Program Guidance
What document is referenced to when looking for potential problem areas identified by the
government indicating scrutiny of services? - ANSWER ✔✔- OIG Work Plan
What form is provided to a patient to indicate a service may not be covered by Medicare and
the patient may be responsible for the charges? - ANSWER ✔✔- ABN
When presenting a cost estimate on an ABN for a potentially noncovered service, the cost
estimate should be within what range of the actual cost? - ANSWER ✔✔- $100 or 25%
Who would not be considered a covered entity under HIPAA? - ANSWER ✔✔- Patients
What is a mid-level provider? - ANSWER ✔✔- Mid-level providers include physician assistants
(PA) and nurse practitioners (NP)
What are the different parts of Medicare? - ANSWER ✔✔- Part A, B, C, D
Evaluation and management (E/M) services are often provided and documented in a standard
format. One such format is SOAP notes. What does SOAP represent? - ANSWER ✔✔- Subjective,
Objective, Assessment, Plan
What is not a common reason Medicare may deny a service? - ANSWER ✔✔- Covered service
Under the Privacy Rule, the minimum necessary standard does not apply to what type of
disclosure? - ANSWER ✔✔- Disclosures to the individual who is the subject of the individual
2|Page
,Which is not one of the seven key components of an integral compliance plan? - ANSWER ✔✔-
Conduct training but not perform education on practice standards and procedures
EHR stands for: - ANSWER ✔✔- Electronic health record
What does CMS-HCC stand for? - ANSWER ✔✔- Centers for Medicare and Medicaid Services -
Hierarchical Condition Category
When are providers responsible for obtaining an ABN for a service not considered medically
necessary? - ANSWER ✔✔- Prior to providing a service or item to a beneficiary
Local Coverage Determinations are administered by whom? - ANSWER ✔✔- Each regional MAC
When reviewing operative reports, which one of the following is a TRUE statement? - ANSWER
✔✔- Additional details about the procedure can be found in the body of the report
Which CMS product describes whether specific medical items, services, treatment procedures
or technologies are considered medically necessary under Medicare? - ANSWER ✔✔- National
Coverage Determination Manual
The Medicare program is made up of several parts. Which part covers provider fees without the
use of a private insurer? - ANSWER ✔✔- Part C
HIPAA stands for? - ANSWER ✔✔- Health Insurance Portability and Accountability Act
What is not considered a covered entity under HIPAA? - ANSWER ✔✔- Workers' Compensation
What is the purpose of National Coverage Determinations? - ANSWER ✔✔- To explain CMS
policies on when Medicare will pay for items or services
3|Page
, LCDs only have jurisdiction in their ______ - ANSWER ✔✔- region
What type of health insurance provides coverage for low-income families? - ANSWER ✔✔-
Medicaid
The OIG recommends that provider practices enforce disciplinary actions through well
publicized compliance guidelines to ensure actions that are _______. - ANSWER ✔✔-
Consistent and appropriate
Which statement is true regarding the Merit-Based incentive Program (MIPS)? - ANSWER ✔✔-
Providers are excluded from MIPS if they are enrolled in a qualifying APM program
What does the abbreviation MAC stand for? - ANSWER ✔✔- Medicare Administrative
Contractor
A covered entity does not include: - ANSWER ✔✔- Patients
A covered entity may obtain consent from an individual to use or disclose protected health
information to carry out all of the following except: - ANSWER ✔✔- Research
Which of the following is not. component of the MIPS program? - ANSWER ✔✔- Readmission
Rates
The OIG releases a _____ outlining its priorities for the fiscal year and beyond. - ANSWER ✔✔-
Work Plan
What si PHI? - ANSWER ✔✔- Protected Health Information
4|Page
