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Certified Professional Coder Questions with
Detailed Verified Answers
Under HIPAA, what would be a policy requirement for "minimum necessary"?
Ans: Only individuals whose job requires it may have access to protected health
information
What is true regarding ABNs?
Ans: 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?
Ans: HITECH
Which statement describes a medically necessary service?
Ans: 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?
Ans: OIG Compliance Program Guidance
What document is referenced to when looking for potential problem areas identified
by the government indicating scrutiny of services?
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Ans: 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?
Ans: 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?
Ans: $100 or 25%
Who would not be considered a covered entity under HIPAA?
Ans: Patients
What type of profession, other than coding, might skilled coders enters?
Ans: Consultants, educators, and medical auditors
What is the difference between outpatient and inpatient coding?
Ans: Inpatient coders use ICD-10-CM and ICD-10-PCS
What is a mid-level provider?
Ans: Mid-level providers include physician assistants (PA) and nurse practitioners (NP)
What are the different parts of Medicare?
Ans: Part A, B, C, D
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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?
Ans: Subjective, Objective, Assessment, Plan
What is medical necessity?
Ans: 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?
Ans: Covered service
Under the Privacy Rule, the minimum necessary standard does not apply to what type
of disclosure?
Ans: 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?
Ans: Conduct training but not perform education on practice standards and
procedures
EHR stands for:
Ans: Electronic health record
What does CMS-HCC stand for?
Ans: Centers for Medicare and Medicaid Services - Hierarchical Condition Category
© Get it right 2025 Getaway - Stuvia US All rights reserved
Certified Professional Coder Questions with
Detailed Verified Answers
Under HIPAA, what would be a policy requirement for "minimum necessary"?
Ans: Only individuals whose job requires it may have access to protected health
information
What is true regarding ABNs?
Ans: 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?
Ans: HITECH
Which statement describes a medically necessary service?
Ans: 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?
Ans: OIG Compliance Program Guidance
What document is referenced to when looking for potential problem areas identified
by the government indicating scrutiny of services?
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,Click here for more: Scholars nexus
Ans: 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?
Ans: 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?
Ans: $100 or 25%
Who would not be considered a covered entity under HIPAA?
Ans: Patients
What type of profession, other than coding, might skilled coders enters?
Ans: Consultants, educators, and medical auditors
What is the difference between outpatient and inpatient coding?
Ans: Inpatient coders use ICD-10-CM and ICD-10-PCS
What is a mid-level provider?
Ans: Mid-level providers include physician assistants (PA) and nurse practitioners (NP)
What are the different parts of Medicare?
Ans: Part A, B, C, D
© Get it right 2025 Getaway - Stuvia US All rights reserved
, Click here for more: Scholars nexus
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?
Ans: Subjective, Objective, Assessment, Plan
What is medical necessity?
Ans: 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?
Ans: Covered service
Under the Privacy Rule, the minimum necessary standard does not apply to what type
of disclosure?
Ans: 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?
Ans: Conduct training but not perform education on practice standards and
procedures
EHR stands for:
Ans: Electronic health record
What does CMS-HCC stand for?
Ans: Centers for Medicare and Medicaid Services - Hierarchical Condition Category
© Get it right 2025 Getaway - Stuvia US All rights reserved
