AAPC CPC EXAM PREP COMPLIANCE
AND REGULATORY EXAM QUESTIONS
WITH ANSWERS
What bdocument bis breferenced bto bwhen blooking bfor bpotentialproblem bareas
bidentified bby bthe bgovernment bindicatingscrutiny bof bthe bservices bwithin bthe
bcoming byear?:
A) bOIG bCompliance bPlan bGuidance
B) bOIG bSecurity bSummary
C) bOIG bWork bPlan
D) bOIG bInvestigation bPlan b- b bcorrect banswer- bC b(Rationale: bTwice ba byear, bthe
bOIG breleases ba bWork bPlan boutlining bits bpriorities bfor bthe bfiscal byear bahead.
bWithin bthe bWork bPlan, bpotential bproblem bareas bwith bclaims bsubmissions bare
blisted band bwill bbe btargeted bwith bspecial bscrutiny.)
What bform bis bprovided bto ba bpatient bto bindicate ba bservicemay bnot bbe bcovered
bby bMedicare band bthe bpatient bmay bbe bresponsible bfor bthe bcharges?:
A) bLCD
B) bCMS-1500
C) bUB-04
D) bABN b- b bcorrect banswer- bD b(Rationale: bAn bAdvanced bBeneficiary bNotice
b(ABN) bis bused bwhen ba bMedicare bbeneficiary brequests bor bagrees bto breceive ba
bprocedure bor bservice bthat bMedicare bmay bnot bcover. bThis bform bnotifies bthe
bpatient bof bpotential bout bof bpocket bcosts bfor bthe bpatient.)
Under bHIPAA, bwhat bwould bbe ba bpolicy brequirement bfor b"minimum bnecessary"?
b"
A) bOnly bindividuals bwhose bjob brequires bit bmay bhave baccess bto bprotected
bhealth binformation.
, B) bOnly bthe bpatient bhas baccess bto bhis bor bher bown bprotected bhealth
binformation.
C) bOnly bthe btreating bprovider bhas baccess bto bprotected bhealth binformation.
D) bAnyone bwithin bthe bprovider's boffice bcan bhave baccess bto bprotected bhealth
binformation. b- b bcorrect banswer- bA b(Rationale: bIt bis bthe bresponsibility bof ba
bcovered bentity bto bdevelop band bimplement bpolicies, bbest bsuited bto bits bparticular
bcircumstances bto bmeet bHIPAA brequirements. bAs ba bpolicy brequirement, bonly
bthose bindividuals bwhose bjob brequires bit bmay bhave baccess bto bprotected bhealth
binformation.)
Which bstatement bdescribes ba bmedically bnecessary bservice? b:
A) bPerforming ba bprocedure/service bbased bon bcost bto beliminate bwasteful
bservices.
B) bUsing bthe bleast bradical bservice/procedure bthat ballows bfor beffective btreatment
bof bthe bpatient's bcomplaint bor bcondition.
C) bUsing bthe bclosest bfacility bto bperform ba bservice bor bprocedure.
D) bUsing bthe bappropriate bcourse bof btreatment bto bfit bwithin bthe bpatient's
blifestyle. b- b bcorrect banswer- bB b(Rationale: bMedical bnecessity bis busing bthe bleast
bradical bservices/procedure bthat ballows bfor beffective btreatment bof bthe bpatient's
bcomplaint bor bcondition.)
According bto bthe bexample bLCD bfrom bNovitas bSolutions, bwhich bof bthe bfollowing
bconditions bis bconsidered ba bsystemic bcondition bthat bmay bresult bin bthe bneed bfor
broutine bfoot bcare? b:
A) barthritis
B) bchronic bvenous binsufficiency
C) bhypertension
D) bmuscle bweakness b- b bcorrect banswer- bB b(Rationale: bAccording bto bthe bLCD,
bChronic bvenous binsufficiency bis ba bsystemic bcondition bthat bmay bresult bin bthe
bneed bfor broutine bfoot bcare.)
When bpresenting ba bcost bestimate bon ban bABN bfor ba bpotentially bnoncovered
bservice, bthe bcost bestimate bshould bbe bwithin bwhat brange bof bthe bactual bcost?
A) b$25 bor b10 bpercent
B) b$100 bor b10 bpercent
C) b$100 bor b25 bpercent
D) bAn bexact bamount b- b bcorrect banswer- bC b(Rationale: bCMS binstructions
bstipulate, b"Notifiers bmust bmake ba bgood bfaith beffort bto binsert ba breasonable
bestimate...the bestimate bshould bbe bwithin b$100 bor b25 bpercent bof bthe bactual
bcosts, bwhichever bis bgreater.")
Which bact bwas benacted bas bpart bof bthe bAmerican bRecovery band bReinvestment
bAct bof b2009 b(ARRA) band baffected bprivacy band bsecurity? b:
A) bHIPAA
B) bHITECH
C) bSSA
D) bPPACA b- b bcorrect banswer- bB
What bdocument bassists bprovider boffices bwith bthe bdevelopment bof bCompliance
bManuals?
AND REGULATORY EXAM QUESTIONS
WITH ANSWERS
What bdocument bis breferenced bto bwhen blooking bfor bpotentialproblem bareas
bidentified bby bthe bgovernment bindicatingscrutiny bof bthe bservices bwithin bthe
bcoming byear?:
A) bOIG bCompliance bPlan bGuidance
B) bOIG bSecurity bSummary
C) bOIG bWork bPlan
D) bOIG bInvestigation bPlan b- b bcorrect banswer- bC b(Rationale: bTwice ba byear, bthe
bOIG breleases ba bWork bPlan boutlining bits bpriorities bfor bthe bfiscal byear bahead.
bWithin bthe bWork bPlan, bpotential bproblem bareas bwith bclaims bsubmissions bare
blisted band bwill bbe btargeted bwith bspecial bscrutiny.)
What bform bis bprovided bto ba bpatient bto bindicate ba bservicemay bnot bbe bcovered
bby bMedicare band bthe bpatient bmay bbe bresponsible bfor bthe bcharges?:
A) bLCD
B) bCMS-1500
C) bUB-04
D) bABN b- b bcorrect banswer- bD b(Rationale: bAn bAdvanced bBeneficiary bNotice
b(ABN) bis bused bwhen ba bMedicare bbeneficiary brequests bor bagrees bto breceive ba
bprocedure bor bservice bthat bMedicare bmay bnot bcover. bThis bform bnotifies bthe
bpatient bof bpotential bout bof bpocket bcosts bfor bthe bpatient.)
Under bHIPAA, bwhat bwould bbe ba bpolicy brequirement bfor b"minimum bnecessary"?
b"
A) bOnly bindividuals bwhose bjob brequires bit bmay bhave baccess bto bprotected
bhealth binformation.
, B) bOnly bthe bpatient bhas baccess bto bhis bor bher bown bprotected bhealth
binformation.
C) bOnly bthe btreating bprovider bhas baccess bto bprotected bhealth binformation.
D) bAnyone bwithin bthe bprovider's boffice bcan bhave baccess bto bprotected bhealth
binformation. b- b bcorrect banswer- bA b(Rationale: bIt bis bthe bresponsibility bof ba
bcovered bentity bto bdevelop band bimplement bpolicies, bbest bsuited bto bits bparticular
bcircumstances bto bmeet bHIPAA brequirements. bAs ba bpolicy brequirement, bonly
bthose bindividuals bwhose bjob brequires bit bmay bhave baccess bto bprotected bhealth
binformation.)
Which bstatement bdescribes ba bmedically bnecessary bservice? b:
A) bPerforming ba bprocedure/service bbased bon bcost bto beliminate bwasteful
bservices.
B) bUsing bthe bleast bradical bservice/procedure bthat ballows bfor beffective btreatment
bof bthe bpatient's bcomplaint bor bcondition.
C) bUsing bthe bclosest bfacility bto bperform ba bservice bor bprocedure.
D) bUsing bthe bappropriate bcourse bof btreatment bto bfit bwithin bthe bpatient's
blifestyle. b- b bcorrect banswer- bB b(Rationale: bMedical bnecessity bis busing bthe bleast
bradical bservices/procedure bthat ballows bfor beffective btreatment bof bthe bpatient's
bcomplaint bor bcondition.)
According bto bthe bexample bLCD bfrom bNovitas bSolutions, bwhich bof bthe bfollowing
bconditions bis bconsidered ba bsystemic bcondition bthat bmay bresult bin bthe bneed bfor
broutine bfoot bcare? b:
A) barthritis
B) bchronic bvenous binsufficiency
C) bhypertension
D) bmuscle bweakness b- b bcorrect banswer- bB b(Rationale: bAccording bto bthe bLCD,
bChronic bvenous binsufficiency bis ba bsystemic bcondition bthat bmay bresult bin bthe
bneed bfor broutine bfoot bcare.)
When bpresenting ba bcost bestimate bon ban bABN bfor ba bpotentially bnoncovered
bservice, bthe bcost bestimate bshould bbe bwithin bwhat brange bof bthe bactual bcost?
A) b$25 bor b10 bpercent
B) b$100 bor b10 bpercent
C) b$100 bor b25 bpercent
D) bAn bexact bamount b- b bcorrect banswer- bC b(Rationale: bCMS binstructions
bstipulate, b"Notifiers bmust bmake ba bgood bfaith beffort bto binsert ba breasonable
bestimate...the bestimate bshould bbe bwithin b$100 bor b25 bpercent bof bthe bactual
bcosts, bwhichever bis bgreater.")
Which bact bwas benacted bas bpart bof bthe bAmerican bRecovery band bReinvestment
bAct bof b2009 b(ARRA) band baffected bprivacy band bsecurity? b:
A) bHIPAA
B) bHITECH
C) bSSA
D) bPPACA b- b bcorrect banswer- bB
What bdocument bassists bprovider boffices bwith bthe bdevelopment bof bCompliance
bManuals?
