CPC CERTIFICATION FINAL EXAM 2024 ACTUAL EXAM 2
VERSIONS (VERSION A AND B) COMPLETE ACCURATE
EXAM QUESTIONS WITH DETAILED VERIFIED ANSWERS
(100% CORRECT ANSWERS) /ALREADY GRADED A+
List the 2 kinds of payers - ANSWER: Insurance and self pay
State the 2 kinds of insurance - ANSWER: Private (or commercial) and government
List the 3 major private insurers - ANSWER: Aetna, BCBS, Cigna
List the 3 major government insurers - ANSWER: Medicaid, Medicare, TriCare
How many part does Medicare have? - ANSWER: 4
What is Medicare Part A? - ANSWER: Inpatient hospital care•
What is Medicare Part B? - ANSWER: Outpatient medical care
What is Medicare Part c? - ANSWER: Medicare Advantage
What is Medicare Part D? - ANSWER: Prescription drug coverage
[(Work RVU * Work GPCI) +
(Transitioned Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion
Factor (CF) is the formula for - ANSWER: Non-Facility Pricing Amount
[(Work RVU * Work GPCI) +
(Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF - ANSWER:
Facility Pricing Amount
There are 4 conditions/elements that services or supplies meet to be a medical
necessity. Name 1 - ANSWER: • are proper and needed for the diagnosis or
treatment of your medical conditionproper and needed for the diagnosis or
treatment of your medical condition
There are 4 conditions/elements that services or supplies meet to be a medical
necessity. Name 1 - ANSWER: They are provided for the diagnosis, direct care, and
treatment of your medical condition
There are 4 conditions/elements that services or supplies meet to be a medical
necessity. Name 1 - ANSWER: They meet the standards of good medical practice in
the local area
, There are 4 conditions/elements that services or supplies meet to be a medical
necessity. Name 1 - ANSWER: They aren't mainly for the convenience of you or your
doctor
What helps to spell out CMS policies on when Medicare will pay for items or
services? - ANSWER: National Coverage Determinations (NCD)
Who is then responsible for interpreting national policies into regional policies? -
ANSWER: Each Medicare Administrative Carrier (MAC)
Local Coverage Determinations (LCDs) only have jurisdiction within their - ANSWER:
Regional area
What is an ABN? - ANSWER: Advance Beneficiary Notice
Who is are responsible for obtaining an ABN prior to providing the service or item to
a beneficiary? - ANSWER: Providers
An ABN must be - ANSWER: The form must be filled out in its entirety
An ABN must include the cost - ANSWER: To the patient
An ABN must include the reason - ANSWER: Why Medicare may deny the service
Regarding an ABN, what is only valid? - ANSWER: The approved Form CMS-R-131
Regarding an ABN, what cannot be altered? - ANSWER: Form CMS-R-131
What do you call the national standards for electronic health care transactions and
code sets? - ANSWER: HIPPA
What do you call the national unique identifiers for providers, health plans, and
employers? - ANSWER: HIPPA
What do you call the Privacy and Security of health data? - ANSWER: HIPPA
What is HITECH? - ANSWER: The Health Information Technology for Economic and
Clinical Health Act
What is used to promote the adoption and meaningful use of health information
technology? - ANSWER: HITECH
What is used to strengthen HIPPA? - ANSWER: HITECH
What becomes the patient audit trail? - ANSWER: HITECH
VERSIONS (VERSION A AND B) COMPLETE ACCURATE
EXAM QUESTIONS WITH DETAILED VERIFIED ANSWERS
(100% CORRECT ANSWERS) /ALREADY GRADED A+
List the 2 kinds of payers - ANSWER: Insurance and self pay
State the 2 kinds of insurance - ANSWER: Private (or commercial) and government
List the 3 major private insurers - ANSWER: Aetna, BCBS, Cigna
List the 3 major government insurers - ANSWER: Medicaid, Medicare, TriCare
How many part does Medicare have? - ANSWER: 4
What is Medicare Part A? - ANSWER: Inpatient hospital care•
What is Medicare Part B? - ANSWER: Outpatient medical care
What is Medicare Part c? - ANSWER: Medicare Advantage
What is Medicare Part D? - ANSWER: Prescription drug coverage
[(Work RVU * Work GPCI) +
(Transitioned Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion
Factor (CF) is the formula for - ANSWER: Non-Facility Pricing Amount
[(Work RVU * Work GPCI) +
(Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF - ANSWER:
Facility Pricing Amount
There are 4 conditions/elements that services or supplies meet to be a medical
necessity. Name 1 - ANSWER: • are proper and needed for the diagnosis or
treatment of your medical conditionproper and needed for the diagnosis or
treatment of your medical condition
There are 4 conditions/elements that services or supplies meet to be a medical
necessity. Name 1 - ANSWER: They are provided for the diagnosis, direct care, and
treatment of your medical condition
There are 4 conditions/elements that services or supplies meet to be a medical
necessity. Name 1 - ANSWER: They meet the standards of good medical practice in
the local area
, There are 4 conditions/elements that services or supplies meet to be a medical
necessity. Name 1 - ANSWER: They aren't mainly for the convenience of you or your
doctor
What helps to spell out CMS policies on when Medicare will pay for items or
services? - ANSWER: National Coverage Determinations (NCD)
Who is then responsible for interpreting national policies into regional policies? -
ANSWER: Each Medicare Administrative Carrier (MAC)
Local Coverage Determinations (LCDs) only have jurisdiction within their - ANSWER:
Regional area
What is an ABN? - ANSWER: Advance Beneficiary Notice
Who is are responsible for obtaining an ABN prior to providing the service or item to
a beneficiary? - ANSWER: Providers
An ABN must be - ANSWER: The form must be filled out in its entirety
An ABN must include the cost - ANSWER: To the patient
An ABN must include the reason - ANSWER: Why Medicare may deny the service
Regarding an ABN, what is only valid? - ANSWER: The approved Form CMS-R-131
Regarding an ABN, what cannot be altered? - ANSWER: Form CMS-R-131
What do you call the national standards for electronic health care transactions and
code sets? - ANSWER: HIPPA
What do you call the national unique identifiers for providers, health plans, and
employers? - ANSWER: HIPPA
What do you call the Privacy and Security of health data? - ANSWER: HIPPA
What is HITECH? - ANSWER: The Health Information Technology for Economic and
Clinical Health Act
What is used to promote the adoption and meaningful use of health information
technology? - ANSWER: HITECH
What is used to strengthen HIPPA? - ANSWER: HITECH
What becomes the patient audit trail? - ANSWER: HITECH
