AAPC CPC Chapter 1 EXAM WITH VERIFIED Q&
A WITH RATIONALES LATEST UPDATE 100%
ACCURATE 2026
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.)
- 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
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.) - 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
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.) - 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.
B (Rationale: Medical necessity is using the least radical services/procedure that
allows for effective treatment of the patient's complaint or condition.) - Which
statement describes a medically necessary service? :
A) Performing a procedure/service based on cost to eliminate wasteful services.
B) Using the least radical service/procedure that allows for effective treatment of the
patient's complaint or condition.
C) Using the closest facility to perform a service or procedure.
D) Using the appropriate course of treatment to fit within the patient's lifestyle.
C (Rationale: According to the LCD, Chronic venous insufficiency is a systemic
condition that may result in the need for routine foot care.) - According to the example
LCD from Novitas Solutions, which of the following conditions is considered a
systemic condition that may result in the need for routine foot care? :
A) arthritis
B) chronic venous insufficiency
C) hypertension
D) muscle weakness
C (Rationale: CMS instructions stipulate, "Notifiers must make a good faith effort to
insert a reasonable estimate...the estimate should be within $100 or 25 percent of the
actual costs, whichever is greater.") - 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?
A) $25 or 10 percent
B) $100 or 10 percent
C) $100 or 25 percent
D) An exact amount
B - Which act was enacted as part of the American Recovery and Reinvestment Act
of 2009 (ARRA) and affected privacy and security? :
A) HIPAA
B) HITECH
C) SSA
D) PPACA
A (Rationale: The OIG has offered compliance program guidance to form the basis of
a voluntary compliance program for physician offices. Although this was released in
October 2000, it is still considered as active compliance guidance today.) - What
document assists provider offices with the development of Compliance Manuals?
A) OIG Compliance Plan Guidance
B) OIG Work Plan
A WITH RATIONALES LATEST UPDATE 100%
ACCURATE 2026
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.)
- 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
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.) - 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
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.) - 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.
B (Rationale: Medical necessity is using the least radical services/procedure that
allows for effective treatment of the patient's complaint or condition.) - Which
statement describes a medically necessary service? :
A) Performing a procedure/service based on cost to eliminate wasteful services.
B) Using the least radical service/procedure that allows for effective treatment of the
patient's complaint or condition.
C) Using the closest facility to perform a service or procedure.
D) Using the appropriate course of treatment to fit within the patient's lifestyle.
C (Rationale: According to the LCD, Chronic venous insufficiency is a systemic
condition that may result in the need for routine foot care.) - According to the example
LCD from Novitas Solutions, which of the following conditions is considered a
systemic condition that may result in the need for routine foot care? :
A) arthritis
B) chronic venous insufficiency
C) hypertension
D) muscle weakness
C (Rationale: CMS instructions stipulate, "Notifiers must make a good faith effort to
insert a reasonable estimate...the estimate should be within $100 or 25 percent of the
actual costs, whichever is greater.") - 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?
A) $25 or 10 percent
B) $100 or 10 percent
C) $100 or 25 percent
D) An exact amount
B - Which act was enacted as part of the American Recovery and Reinvestment Act
of 2009 (ARRA) and affected privacy and security? :
A) HIPAA
B) HITECH
C) SSA
D) PPACA
A (Rationale: The OIG has offered compliance program guidance to form the basis of
a voluntary compliance program for physician offices. Although this was released in
October 2000, it is still considered as active compliance guidance today.) - What
document assists provider offices with the development of Compliance Manuals?
A) OIG Compliance Plan Guidance
B) OIG Work Plan
