AAPC OFFICIAL CPC ACTUAL EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS/GRADE A+ ASSURED
Question 1
What type of healthcare provider undergoes approximately 26 1/2 months of graduate-level
education and is licensed to practice medicine under the supervision and oversight of a
physician?
A) Nurse Practitioner (NP)
B) Registered Nurse (RN)
C) Physician Assistant (PA)
D) Medical Assistant (MA)
E) Doctor of Osteopathy (DO)
Correct Answer: C) Physician Assistant (PA)
Rationale: Physician Assistants (PAs) are mid-level practitioners who complete a rigorous
medical program modeled after physician training, typically lasting about 26.5 months.
They are qualified to diagnose illnesses, develop treatment plans, and prescribe
medications, but their licensure requires them to work with the oversight of a supervising
physician.
Question 2
The ________ describes whether specific medical items, services, treatment procedures, or
technologies are considered medically necessary under Medicare on a national level.
A) Local Coverage Determinations (LCD)
B) National Coverage Determinations (NCD)
C) Advance Beneficiary Notice (ABN)
D) Medicare Claims Processing Manual
E) HIPAA Privacy Rule
Correct Answer: B) National Coverage Determinations (NCD)
Rationale: NCDs are developed by CMS to provide nationwide consistency in the coverage
of medical services. They outline the clinical circumstances under which a service is
considered reasonable and necessary. If an NCD does not exist for a service, the local MAC
may develop an LCD instead.
, 2
Question 3
In the context of Medicare coverage, Local Coverage Determinations (LCDs) have jurisdiction
only within their specific:
A) State lines
B) Global territories
C) Regional area
D) Hospital system
E) Practice specialty
Correct Answer: C) Regional area
Rationale: LCDs are policies developed by Medicare Administrative Contractors (MACs)
for their specific geographic regions. Because different MACs may have different
interpretations of medical necessity in the absence of an NCD, an LCD is only binding
within that MAC’s specific regional jurisdiction.
Question 4
What does the medical billing abbreviation "ABN" stand for?
A) Annual Beneficiary Notice
B) Advance Beneficiary Notice
C) Applied Billing Network
D) Approved Beneficiary Notification
E) Actual Billing Non-coverage
Correct Answer: B) Advance Beneficiary Notice
Rationale: The Advance Beneficiary Notice (ABN) is a form provided to Medicare
beneficiaries before a service is rendered if the provider has reason to believe that Medicare
will not pay for the service based on medical necessity. It allows the patient to make an
informed decision about whether to receive the service and accept financial responsibility.
Question 5
The Health Insurance Portability and Accountability Act (HIPAA), which revolutionized
healthcare privacy and electronic transactions, was signed into law in what year?
A) 1990
, 3
B) 1994
C) 1996
D) 2000
E) 2003
Correct Answer: C) 1996
Rationale: HIPAA was enacted by the U.S. Congress and signed by President Bill Clinton in
1996. Its primary goals were to improve the portability of health insurance, combat waste
and fraud, and mandate the protection of sensitive patient health information (PHI).
Question 6
According to the Office of Inspector General (OIG), the scope of an effective compliance
program for a medical facility will depend primarily on:
A) The number of patients seen per day
B) The size and resources of the physician’s practice
C) The type of insurance most patients use
D) The geographic location of the clinic
E) The software brand used for EHR
Correct Answer: B) The size and resources of the physician’s practice
Rationale: The OIG recognizes that a small individual practice cannot be expected to have
the same compliance infrastructure as a large multi-state hospital system. Therefore, the
scope and complexity of a compliance program should be scaled to fit the specific resources
and operational size of the entity.
Question 7
According to OIG guidelines, how should internal monitoring and auditing be conducted within
a healthcare organization?
A) Once every five years
B) Only when a government audit is announced
C) Through periodic audits
D) Daily for every single claim
E) Only by external consultants
, 4
Correct Answer: C) Through periodic audits
Rationale: The OIG recommends that healthcare providers conduct periodic internal audits
to ensure that their billing practices are accurate and that the medical documentation
supports the codes submitted. This proactive approach helps identify and correct errors
before they become legal or financial liabilities.
Question 8
To help members determine current industry standards for compensation, the AAPC provides
which of the following?
A) A list of local hourly rates
B) A national salary survey
C) A mandatory pay scale
D) A recruitment database
E) A federal minimum wage chart
Correct Answer: B) Salary survey
Rationale: AAPC conducts an annual salary survey of its members. This data is used to
provide insights into how variables such as certification level, years of experience, and
geographic location affect the earning potential of medical coders and billers.
Question 9
The AAPC offers over 440 local chapters across the United States and the Bahamas. What is the
primary purpose of these local chapters?
A) To process medical claims for members
B) For the purpose of networking and continuing education
C) To provide legal defense for coders
D) To sell medical equipment to physicians
E) To lobby Congress on behalf of hospitals
Correct Answer: B) Networking
Rationale: Local chapters provide a platform for AAPC members to meet, share
professional experiences, and earn Continuing Education Units (CEUs). Networking within
ANSWERS/GRADE A+ ASSURED
Question 1
What type of healthcare provider undergoes approximately 26 1/2 months of graduate-level
education and is licensed to practice medicine under the supervision and oversight of a
physician?
A) Nurse Practitioner (NP)
B) Registered Nurse (RN)
C) Physician Assistant (PA)
D) Medical Assistant (MA)
E) Doctor of Osteopathy (DO)
Correct Answer: C) Physician Assistant (PA)
Rationale: Physician Assistants (PAs) are mid-level practitioners who complete a rigorous
medical program modeled after physician training, typically lasting about 26.5 months.
They are qualified to diagnose illnesses, develop treatment plans, and prescribe
medications, but their licensure requires them to work with the oversight of a supervising
physician.
Question 2
The ________ describes whether specific medical items, services, treatment procedures, or
technologies are considered medically necessary under Medicare on a national level.
A) Local Coverage Determinations (LCD)
B) National Coverage Determinations (NCD)
C) Advance Beneficiary Notice (ABN)
D) Medicare Claims Processing Manual
E) HIPAA Privacy Rule
Correct Answer: B) National Coverage Determinations (NCD)
Rationale: NCDs are developed by CMS to provide nationwide consistency in the coverage
of medical services. They outline the clinical circumstances under which a service is
considered reasonable and necessary. If an NCD does not exist for a service, the local MAC
may develop an LCD instead.
, 2
Question 3
In the context of Medicare coverage, Local Coverage Determinations (LCDs) have jurisdiction
only within their specific:
A) State lines
B) Global territories
C) Regional area
D) Hospital system
E) Practice specialty
Correct Answer: C) Regional area
Rationale: LCDs are policies developed by Medicare Administrative Contractors (MACs)
for their specific geographic regions. Because different MACs may have different
interpretations of medical necessity in the absence of an NCD, an LCD is only binding
within that MAC’s specific regional jurisdiction.
Question 4
What does the medical billing abbreviation "ABN" stand for?
A) Annual Beneficiary Notice
B) Advance Beneficiary Notice
C) Applied Billing Network
D) Approved Beneficiary Notification
E) Actual Billing Non-coverage
Correct Answer: B) Advance Beneficiary Notice
Rationale: The Advance Beneficiary Notice (ABN) is a form provided to Medicare
beneficiaries before a service is rendered if the provider has reason to believe that Medicare
will not pay for the service based on medical necessity. It allows the patient to make an
informed decision about whether to receive the service and accept financial responsibility.
Question 5
The Health Insurance Portability and Accountability Act (HIPAA), which revolutionized
healthcare privacy and electronic transactions, was signed into law in what year?
A) 1990
, 3
B) 1994
C) 1996
D) 2000
E) 2003
Correct Answer: C) 1996
Rationale: HIPAA was enacted by the U.S. Congress and signed by President Bill Clinton in
1996. Its primary goals were to improve the portability of health insurance, combat waste
and fraud, and mandate the protection of sensitive patient health information (PHI).
Question 6
According to the Office of Inspector General (OIG), the scope of an effective compliance
program for a medical facility will depend primarily on:
A) The number of patients seen per day
B) The size and resources of the physician’s practice
C) The type of insurance most patients use
D) The geographic location of the clinic
E) The software brand used for EHR
Correct Answer: B) The size and resources of the physician’s practice
Rationale: The OIG recognizes that a small individual practice cannot be expected to have
the same compliance infrastructure as a large multi-state hospital system. Therefore, the
scope and complexity of a compliance program should be scaled to fit the specific resources
and operational size of the entity.
Question 7
According to OIG guidelines, how should internal monitoring and auditing be conducted within
a healthcare organization?
A) Once every five years
B) Only when a government audit is announced
C) Through periodic audits
D) Daily for every single claim
E) Only by external consultants
, 4
Correct Answer: C) Through periodic audits
Rationale: The OIG recommends that healthcare providers conduct periodic internal audits
to ensure that their billing practices are accurate and that the medical documentation
supports the codes submitted. This proactive approach helps identify and correct errors
before they become legal or financial liabilities.
Question 8
To help members determine current industry standards for compensation, the AAPC provides
which of the following?
A) A list of local hourly rates
B) A national salary survey
C) A mandatory pay scale
D) A recruitment database
E) A federal minimum wage chart
Correct Answer: B) Salary survey
Rationale: AAPC conducts an annual salary survey of its members. This data is used to
provide insights into how variables such as certification level, years of experience, and
geographic location affect the earning potential of medical coders and billers.
Question 9
The AAPC offers over 440 local chapters across the United States and the Bahamas. What is the
primary purpose of these local chapters?
A) To process medical claims for members
B) For the purpose of networking and continuing education
C) To provide legal defense for coders
D) To sell medical equipment to physicians
E) To lobby Congress on behalf of hospitals
Correct Answer: B) Networking
Rationale: Local chapters provide a platform for AAPC members to meet, share
professional experiences, and earn Continuing Education Units (CEUs). Networking within
