Certified Professional Coder UPDATED
ACTUAL Exam Questions and CORRECT
Answers
Under HIPAA, what would be a policy requirement for "minimum necessary"? - CORRECT
ANSWER - Only individuals whose job requires it may have access to protected health
information
What is true regarding ABNs? - CORRECT 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? - CORRECT ANSWER - HITECH
Which statement describes a medically necessary service? - CORRECT ANSWER - Using
the least radical service/procedure that allows for effective treatment of the patient's complaint or
condition
What document assists provider offices with the development of Compliance Manuals? -
CORRECT ANSWER - OIG Compliance Program Guidance
What document is referenced to when looking for potential problem areas identified by the
government indicating scrutiny of services? - CORRECT 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? - CORRECT 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? - CORRECT ANSWER - $100 or
25%
, Who would not be considered a covered entity under HIPAA? - CORRECT ANSWER -
Patients
What type of profession, other than coding, might skilled coders enters? - CORRECT
ANSWER - Consultants, educators, and medical auditors
What is the difference between outpatient and inpatient coding? - CORRECT ANSWER -
Inpatient coders use ICD-10-CM and ICD-10-PCS
What is a mid-level provider? - CORRECT ANSWER - Mid-level providers include
physician assistants (PA) and nurse practitioners (NP)
What are the different parts of Medicare? - CORRECT 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? - CORRECT
ANSWER - Subjective, Objective, Assessment, Plan
What is medical necessity? - CORRECT ANSWER - Refers to whether a procedure or
service is considered appropriate in a given circumstance
What is not a common reason Medicare may deny a service? - CORRECT ANSWER -
Covered service
Under the Privacy Rule, the minimum necessary standard does not apply to what type of
disclosure? - CORRECT ANSWER - Disclosures to the individual who is the subject of
the individual
Which is not one of the seven key components of an integral compliance plan? - CORRECT
ANSWER - Conduct training but not perform education on practice standards and
procedures
ACTUAL Exam Questions and CORRECT
Answers
Under HIPAA, what would be a policy requirement for "minimum necessary"? - CORRECT
ANSWER - Only individuals whose job requires it may have access to protected health
information
What is true regarding ABNs? - CORRECT 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? - CORRECT ANSWER - HITECH
Which statement describes a medically necessary service? - CORRECT ANSWER - Using
the least radical service/procedure that allows for effective treatment of the patient's complaint or
condition
What document assists provider offices with the development of Compliance Manuals? -
CORRECT ANSWER - OIG Compliance Program Guidance
What document is referenced to when looking for potential problem areas identified by the
government indicating scrutiny of services? - CORRECT 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? - CORRECT 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? - CORRECT ANSWER - $100 or
25%
, Who would not be considered a covered entity under HIPAA? - CORRECT ANSWER -
Patients
What type of profession, other than coding, might skilled coders enters? - CORRECT
ANSWER - Consultants, educators, and medical auditors
What is the difference between outpatient and inpatient coding? - CORRECT ANSWER -
Inpatient coders use ICD-10-CM and ICD-10-PCS
What is a mid-level provider? - CORRECT ANSWER - Mid-level providers include
physician assistants (PA) and nurse practitioners (NP)
What are the different parts of Medicare? - CORRECT 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? - CORRECT
ANSWER - Subjective, Objective, Assessment, Plan
What is medical necessity? - CORRECT ANSWER - Refers to whether a procedure or
service is considered appropriate in a given circumstance
What is not a common reason Medicare may deny a service? - CORRECT ANSWER -
Covered service
Under the Privacy Rule, the minimum necessary standard does not apply to what type of
disclosure? - CORRECT ANSWER - Disclosures to the individual who is the subject of
the individual
Which is not one of the seven key components of an integral compliance plan? - CORRECT
ANSWER - Conduct training but not perform education on practice standards and
procedures
