CPC (ANATOMY & MEDICAL TERMINOLOGY) ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS/GRADE A+ ASSURED

CPC (ANATOMY & MEDICAL TERMINOLOGY) ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS/GRADE A+ ASSURED


Question 1
Which part of Medicare covers inpatient hospital care, skilled nursing facility care, hospice, and
home healthcare?
A) Medicare Part A
B) Medicare Part B
C) Medicare Part C
D) Medicare Part D
E) Medicare Part E

Correct Answer: A) Medicare Part A
Rationale: Medicare Part A is considered "Hospital Insurance." It covers the costs
associated with being admitted to a facility, such as a hospital or skilled nursing facility
(SNF). It also covers end-of-life care through hospice and certain home healthcare services
following a hospital stay. Most individuals do not pay a premium for Part A if they or their
spouse paid Medicare taxes while working.

Question 2
Which part of Medicare is an optional benefit that requires the patient to pay a monthly premium
and covers medically necessary physician services and outpatient care?
A) Medicare Part A
B) Medicare Part B
C) Medicare Part C
D) Medicare Part D
E) Medigap

Correct Answer: B) Medicare Part B
Rationale: Medicare Part B is "Medical Insurance." Unlike Part A, it is optional and
requires a monthly premium, a yearly deductible, and typically a 20% coinsurance. It
covers outpatient services, doctor visits, durable medical equipment (DME), and preventive
services. It is designed to cover services provided by clinicians rather than the facility room
and board.

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Question 3
What is another name for Medicare Advantage, which combines Part A and Part B coverage and
is managed by private insurers?
A) Medicare Supplement
) Medicare Part C
C) Medicare Part D
D) Medicare Part F
E) Medicaid

Correct Answer: B) Medicare Part C
Rationale: Medicare Part C, or Medicare Advantage, is an alternative to Original Medicare.
These plans are offered by private companies approved by Medicare. They must provide
all the coverage of Parts A and B, and often include Part D (prescription drugs) as well as
extra benefits like vision and dental. The patient still has Medicare but receives it through a
private plan.

Question 4
Which Medicare program provides prescription drug coverage through private insurers approved
by Medicare?
A) Medicare Part A
B) Medicare Part B
C) Medicare Part C
D) Medicare Part D
E) The HITECH Act

Correct Answer: D) Medicare Part D
Rationale: Medicare Part D is the federal government's prescription drug program. It is
handled by private insurance companies that offer "stand-alone" drug plans for those on
Original Medicare or integrated plans for those on Medicare Advantage. It was established
by the Medicare Modernization Act of 2003.

Question 5
What is the purpose of a medical "Compliance Plan" in a coding and billing office?

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A) To ensure all employees receive high salaries
B) A written set of instructions for submitting accurate claims and correcting mistakes
C) To bypass the OIG Work Plan
D) To ensure the facility is always accredited by the AHA
E) To allow for the intentional billing of services not provided

Correct Answer: B) A written set of instructions for submitting accurate claims and
correcting mistakes
Rationale: A Compliance Plan is a proactive program designed to prevent fraud, waste, and
abuse. It outlines standard operating procedures for coding, documentation, and billing. It
provides a roadmap for internal auditing and establishes a "self-reporting" mechanism if
errors or overpayments are discovered, thereby reducing the risk of federal penalties.

Question 6
Which document sets forth the OIG’s priorities for the fiscal year and identifies potential areas
that will receive special scrutiny?
A) The Federal Register
B) The OIG Work Plan
C) The CPT Assistant
D) The National Coverage Determination
E) The HIPAA Privacy Rule

Correct Answer: B) The OIG Work Plan
Rationale: The Office of Inspector General (OIG) Work Plan is released annually (and
updated monthly) to inform the healthcare industry about the specific types of claims,
providers, or services that the OIG intends to audit. Coders use this to identify high-risk
areas in their own practices to ensure their documentation is bulletproof.

Question 7
A National Coverage Determination (NCD) that is interpreted at the Medicare Administrative
Contractor (MAC) level for a specific region is known as:
A) A Statutorily Excluded Service
B) A Regional Medical Policy

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C) A Local Coverage Determination (LCD)
D) An Advance Beneficiary Notice
E) A Stark Law Exemption

Correct Answer: C) A Local Coverage Determination (LCD)
Rationale: While NCDs apply nationwide, LCDs are policies developed by the local MAC
(the entity that processes claims for a specific region). LCDs provide more specific guidance
on medical necessity, such as which ICD-10-CM diagnosis codes support a particular CPT
procedure code in that specific jurisdiction.

Question 8
When providing an estimate on an Advance Beneficiary Notice (ABN), the amount should be
within ________ or ________ of the actual cost to the patient.
A) $20; 10%
B) $50; 15%
C) $100; 25%
D) $200; 50%
E) $500; 75%

Correct Answer: C) $100; 25%
Rationale: CMS requires that the cost estimate provided on an ABN be as accurate as
possible so the patient can make an informed financial decision. A "good faith" estimate is
considered valid if it falls within $100 or 25% of the final cost. If the cost is significantly
higher than the estimate, the ABN may be challenged as invalid.

Question 9
Under HIPAA, an entity that processes nonstandard health information into a standard format (or
vice versa) is called a:
A) Covered Provider
B) Health Plan
C) Clearinghouse
D) Business Associate
E) CMS Agent