AAPC CPC EXAM STUDY GUIDE 2026/2027
ACCURATE QUESTIONS WITH CORRECT
DETAILED SOLUTIONS ||
100% GUARANTEED PASS
<NEWEST VERSION>
1. "hold harmless clause" - ANSWER ✔ * found in some non-Medicare
health plan contracts
• prohibits billing to patient for anything beyond deductibles and co-
pays.
2. A compliance plan may offer several benefits, including: - ANSWER ✔ *
more accurate payment of claims
• fewer billing mistakes
• improved documentation and more accurate coding
• less chance of violating self-referral and anti-kickback status
3. A healthcare clearing house is a - ANSWER ✔ entity that processes
nonstandard health information they receive from another entity into a
standard format
4. A key provision in HIPAA is the Minimum Necessary requirement. this
means - ANSWER ✔ only the minimum necessary protected health
information should be shared to satisfy a particular purpose.
5. A medically necessary service is the - ANSWER ✔ least radical
service/procedure that allows for effective treatment of the patients'
complaint or condition
6. A patient sustaining an injury to her great saphenous vein would have
sustained injury to which of anatomical site? - ANSWER ✔ Leg
,7. APC - ANSWER ✔ Ambulatory Payment Classification
8. ARRA - ANSWER ✔ American Recovery and Reinvestment Act (of
2009)
9. ASC - ANSWER ✔ Ambulatory Surgical Centers
10.Abuse consists of - ANSWER ✔ payment for items or services that are
billed by providers in error that should not be paid for by Medicare.
11.An ABN protects the provider's financial interest by - ANSWER ✔
creating a paper trail that CMS requires before a provider can bill the patient
for payment if Medicare denies coverage for the stated service or procedure.
12.An entity that processes nonstandard health information they receive from
another entity into a standard format is considered what? - ANSWER ✔
Clearinghouse
13.As a part of Health Care Reform, the Affordable Care Act of 2010 amended
the definition of fraud to remove the __________ requirement - ANSWER
✔ intent
14.Which of the following has a refraction function in the eye?
macula
retina
lens
iris - ANSWER ✔ lens
15.Which of the following is a function of the pancreas?
• supplies digestive enzymes
16.manufactures melatonin
• stimulates growth
• secretes vasopressin - ANSWER ✔ supplies digestive enzymes
17.Which of the following is a renal calculus?
, • Pyelectasia
• Hydroureter
• Nephrolithiasis
• Pyonephrosis - ANSWER ✔ Nephrolithiasis
18.Who is responsible for interpreting national policies into regional polices,
called LCDs? - ANSWER ✔ each MAC
(Medicare Administrative Contractor)
19.Whose responsibility is it to develop and implement policies, best suited to
its particular circumstances, to meet HIPAA requirements. - ANSWER ✔
the entity covered by HIPAA
20.Work RVUs reflect - ANSWER ✔ The relative levels of time and intensity
associated with furnishing a Medicare PFS service and account for ~50% of
the total payment associated with a service.
21.compliance plan - ANSWER ✔ a written set of instructions outlining the
process for coding and submitting accurate claims, and what to do if
mistakes are found.
22.fraud - ANSWER ✔ to purposely bill for srevices that were never given or
to bill for a service that has a higher reimbursement than the service
provided.
23.AMA - ANSWER ✔ American Medical Association
24.The ICD-9-CM Coordination and Maintenance Committee, which is co-
chaired by the - ANSWER ✔ NCHS (National Centers for Health
Statistics) and the
CMS (Centers for Medicare & Medicaid Services)
25.What document is referenced to when looking for potential problem areas
identified by the government indicating scrutiny of the services within the
coming year?:
A) OIG Compliance Plan Guidance
, B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan - ANSWER ✔ C (Rationale: Twice a
year, the OIG releases a Work Plan outlining its priorities for
the fiscal year ahead. Within the Work Plan, potential
problem areas with claims submissions are listed and will be
targeted with special scrutiny.)
26.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?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN - ANSWER ✔ D (Rationale: An Advanced
Beneficiary Notice (ABN) is used when a Medicare
beneficiary requests or agrees to receive a procedure or
service that Medicare may not cover. This form notifies the
patient of potential out of pocket costs for the patient.)
27.Under HIPAA, what would be a policy requirement for "minimum
necessary"? "
A) Only individuals whose job requires it may have access to
protected health information.
B) Only the patient has access to his or her own protected health
information.
C) Only the treating provider has access to protected health
information.
D) Anyone within the provider's office can have access to
protected health information. - ANSWER ✔ A (Rationale: It
is the responsibility of a covered entity to develop and
implement policies, best suited to its particular circumstances
to meet HIPAA requirements. As a policy requirement, only
those individuals whose job requires it may have access to
protected health information.)
28.Which statement describes a medically necessary service? :
A) Performing a procedure/service based on cost to eliminate
wasteful services.
ACCURATE QUESTIONS WITH CORRECT
DETAILED SOLUTIONS ||
100% GUARANTEED PASS
<NEWEST VERSION>
1. "hold harmless clause" - ANSWER ✔ * found in some non-Medicare
health plan contracts
• prohibits billing to patient for anything beyond deductibles and co-
pays.
2. A compliance plan may offer several benefits, including: - ANSWER ✔ *
more accurate payment of claims
• fewer billing mistakes
• improved documentation and more accurate coding
• less chance of violating self-referral and anti-kickback status
3. A healthcare clearing house is a - ANSWER ✔ entity that processes
nonstandard health information they receive from another entity into a
standard format
4. A key provision in HIPAA is the Minimum Necessary requirement. this
means - ANSWER ✔ only the minimum necessary protected health
information should be shared to satisfy a particular purpose.
5. A medically necessary service is the - ANSWER ✔ least radical
service/procedure that allows for effective treatment of the patients'
complaint or condition
6. A patient sustaining an injury to her great saphenous vein would have
sustained injury to which of anatomical site? - ANSWER ✔ Leg
,7. APC - ANSWER ✔ Ambulatory Payment Classification
8. ARRA - ANSWER ✔ American Recovery and Reinvestment Act (of
2009)
9. ASC - ANSWER ✔ Ambulatory Surgical Centers
10.Abuse consists of - ANSWER ✔ payment for items or services that are
billed by providers in error that should not be paid for by Medicare.
11.An ABN protects the provider's financial interest by - ANSWER ✔
creating a paper trail that CMS requires before a provider can bill the patient
for payment if Medicare denies coverage for the stated service or procedure.
12.An entity that processes nonstandard health information they receive from
another entity into a standard format is considered what? - ANSWER ✔
Clearinghouse
13.As a part of Health Care Reform, the Affordable Care Act of 2010 amended
the definition of fraud to remove the __________ requirement - ANSWER
✔ intent
14.Which of the following has a refraction function in the eye?
macula
retina
lens
iris - ANSWER ✔ lens
15.Which of the following is a function of the pancreas?
• supplies digestive enzymes
16.manufactures melatonin
• stimulates growth
• secretes vasopressin - ANSWER ✔ supplies digestive enzymes
17.Which of the following is a renal calculus?
, • Pyelectasia
• Hydroureter
• Nephrolithiasis
• Pyonephrosis - ANSWER ✔ Nephrolithiasis
18.Who is responsible for interpreting national policies into regional polices,
called LCDs? - ANSWER ✔ each MAC
(Medicare Administrative Contractor)
19.Whose responsibility is it to develop and implement policies, best suited to
its particular circumstances, to meet HIPAA requirements. - ANSWER ✔
the entity covered by HIPAA
20.Work RVUs reflect - ANSWER ✔ The relative levels of time and intensity
associated with furnishing a Medicare PFS service and account for ~50% of
the total payment associated with a service.
21.compliance plan - ANSWER ✔ a written set of instructions outlining the
process for coding and submitting accurate claims, and what to do if
mistakes are found.
22.fraud - ANSWER ✔ to purposely bill for srevices that were never given or
to bill for a service that has a higher reimbursement than the service
provided.
23.AMA - ANSWER ✔ American Medical Association
24.The ICD-9-CM Coordination and Maintenance Committee, which is co-
chaired by the - ANSWER ✔ NCHS (National Centers for Health
Statistics) and the
CMS (Centers for Medicare & Medicaid Services)
25.What document is referenced to when looking for potential problem areas
identified by the government indicating scrutiny of the services within the
coming year?:
A) OIG Compliance Plan Guidance
, B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan - ANSWER ✔ C (Rationale: Twice a
year, the OIG releases a Work Plan outlining its priorities for
the fiscal year ahead. Within the Work Plan, potential
problem areas with claims submissions are listed and will be
targeted with special scrutiny.)
26.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?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN - ANSWER ✔ D (Rationale: An Advanced
Beneficiary Notice (ABN) is used when a Medicare
beneficiary requests or agrees to receive a procedure or
service that Medicare may not cover. This form notifies the
patient of potential out of pocket costs for the patient.)
27.Under HIPAA, what would be a policy requirement for "minimum
necessary"? "
A) Only individuals whose job requires it may have access to
protected health information.
B) Only the patient has access to his or her own protected health
information.
C) Only the treating provider has access to protected health
information.
D) Anyone within the provider's office can have access to
protected health information. - ANSWER ✔ A (Rationale: It
is the responsibility of a covered entity to develop and
implement policies, best suited to its particular circumstances
to meet HIPAA requirements. As a policy requirement, only
those individuals whose job requires it may have access to
protected health information.)
28.Which statement describes a medically necessary service? :
A) Performing a procedure/service based on cost to eliminate
wasteful services.
