Medical Coding Training: CPC Exam
Questions and Answers 100% Solved
Which statement below 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. - ✔✔B. Using the least radical service/procedure that allows for
effective treatment of the patient's complaint or condition.
Rationale: Medical necessity is using the least radical services/procedure
that allows for effective treatment of the patient's complaint or condition.
According to the example LCD from Novitas Solutions, measurement of
vitamin D levels is indicated for patients with condition?
1
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
,A. fatigue
B. fibromyalgia
C. hypertension
D. muscle weakness - ✔✔C. hypertension
Rationale: According to the LCD, measurement of vitamin D levels is
indicated for patients with fibromyalgia.
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 - ✔✔D. ABN
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.
2
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
,Select the true statement regarding ABNs.
A. ABNs may not be recognized by non-Medicare payers.
B. ABNs must be signed for emergency or urgent care.
C. ABNs are not required to include an estimate cost for the service.
D. ABNs should be routinely signed by Medicare beneficiaries in case
Medicare does not cover a service. - ✔✔A. ABNs may not be recognized
by non-Medicare payers.
Rationale: ABNs may not be recognized by non-Medicare payers.
Providers should review their contracts to determine which payers will
accept an ABN for services not covered.
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%
B. $100 or 10%
C. $100 or 25%
D. An exact amount. - ✔✔C. $100 or 25%
3
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
, "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."
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."
Who would NOT be considered a covered entity under HIPAA?
A. Doctors
B. HMOs
C. Clearinghouse
D. Patient - ✔✔D. Patient
Rationale: Covered entities in relation to HIPAA include healthcare
providers, health plans, and healthcare clearinghouses. The patient is not
considered a covered entity although it is the patient's data that is
protected.
Under HIPAA, what would be a policy requirement for "Minimum
Necessary?"
4
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
Questions and Answers 100% Solved
Which statement below 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. - ✔✔B. Using the least radical service/procedure that allows for
effective treatment of the patient's complaint or condition.
Rationale: Medical necessity is using the least radical services/procedure
that allows for effective treatment of the patient's complaint or condition.
According to the example LCD from Novitas Solutions, measurement of
vitamin D levels is indicated for patients with condition?
1
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
,A. fatigue
B. fibromyalgia
C. hypertension
D. muscle weakness - ✔✔C. hypertension
Rationale: According to the LCD, measurement of vitamin D levels is
indicated for patients with fibromyalgia.
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 - ✔✔D. ABN
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.
2
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
,Select the true statement regarding ABNs.
A. ABNs may not be recognized by non-Medicare payers.
B. ABNs must be signed for emergency or urgent care.
C. ABNs are not required to include an estimate cost for the service.
D. ABNs should be routinely signed by Medicare beneficiaries in case
Medicare does not cover a service. - ✔✔A. ABNs may not be recognized
by non-Medicare payers.
Rationale: ABNs may not be recognized by non-Medicare payers.
Providers should review their contracts to determine which payers will
accept an ABN for services not covered.
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%
B. $100 or 10%
C. $100 or 25%
D. An exact amount. - ✔✔C. $100 or 25%
3
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
, "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."
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."
Who would NOT be considered a covered entity under HIPAA?
A. Doctors
B. HMOs
C. Clearinghouse
D. Patient - ✔✔D. Patient
Rationale: Covered entities in relation to HIPAA include healthcare
providers, health plans, and healthcare clearinghouses. The patient is not
considered a covered entity although it is the patient's data that is
protected.
Under HIPAA, what would be a policy requirement for "Minimum
Necessary?"
4
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
