AAPC CPC Chapter 1 Exam Questions with Verified Solutions Latest Update 2025/2026
C (Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for the fiscal year
ahead. Within the Work Plan, potential problem areas with claims submissions are listed and
will be targeted with special scrutiny.) - Answers What document is referenced to when looking
for potential problem areas identified by the government indicating scrutiny of the services
within the coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan
D (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.) - Answers 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
A (Rationale: It is the responsibility of a covered entity to develop and implement policies, best
suited to its particular circumstances to meet HIPAA requirements. As a policy requirement,
only those individuals whose job requires it may have access to protected health information.) -
Answers Under HIPAA, what would be a policy requirement for "minimum necessary"? "
A) Only individuals whose job requires it may have access to protected health information.
B) Only the patient has access to his or her own protected health information.
C) Only the treating provider has access to protected health information.
D) Anyone within the provider's office can have access to protected health information.
B (Rationale: Medical necessity is using the least radical services/procedure that allows for
effective treatment of the patient's complaint or condition.) - Answers Which statement
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.
C (Rationale: According to the LCD, Chronic venous insufficiency is a systemic condition that
may result in the need for routine foot care.) - Answers According to the example LCD from
Novitas Solutions, which of the following conditions is considered a systemic condition that
may result in the need for routine foot care? :
A) arthritis
B) chronic venous insufficiency
C) hypertension
D) muscle weakness
C (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.") - Answers 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 percent
B) $100 or 10 percent
C) $100 or 25 percent
D) An exact amount
B - Answers Which act was enacted as part of the American Recovery and Reinvestment Act of
2009 (ARRA) and affected privacy and security? :
A) HIPAA
B) HITECH
C) SSA
D) PPACA
A (Rationale: The OIG has offered compliance program guidance to form the basis of a
voluntary compliance program for physician offices. Although this was released in October
2000, it is still considered as active compliance guidance today.) - Answers What document
assists provider offices with the development of Compliance Manuals?
C (Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for the fiscal year
ahead. Within the Work Plan, potential problem areas with claims submissions are listed and
will be targeted with special scrutiny.) - Answers What document is referenced to when looking
for potential problem areas identified by the government indicating scrutiny of the services
within the coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan
D (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.) - Answers 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
A (Rationale: It is the responsibility of a covered entity to develop and implement policies, best
suited to its particular circumstances to meet HIPAA requirements. As a policy requirement,
only those individuals whose job requires it may have access to protected health information.) -
Answers Under HIPAA, what would be a policy requirement for "minimum necessary"? "
A) Only individuals whose job requires it may have access to protected health information.
B) Only the patient has access to his or her own protected health information.
C) Only the treating provider has access to protected health information.
D) Anyone within the provider's office can have access to protected health information.
B (Rationale: Medical necessity is using the least radical services/procedure that allows for
effective treatment of the patient's complaint or condition.) - Answers Which statement
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.
C (Rationale: According to the LCD, Chronic venous insufficiency is a systemic condition that
may result in the need for routine foot care.) - Answers According to the example LCD from
Novitas Solutions, which of the following conditions is considered a systemic condition that
may result in the need for routine foot care? :
A) arthritis
B) chronic venous insufficiency
C) hypertension
D) muscle weakness
C (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.") - Answers 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 percent
B) $100 or 10 percent
C) $100 or 25 percent
D) An exact amount
B - Answers Which act was enacted as part of the American Recovery and Reinvestment Act of
2009 (ARRA) and affected privacy and security? :
A) HIPAA
B) HITECH
C) SSA
D) PPACA
A (Rationale: The OIG has offered compliance program guidance to form the basis of a
voluntary compliance program for physician offices. Although this was released in October
2000, it is still considered as active compliance guidance today.) - Answers What document
assists provider offices with the development of Compliance Manuals?
