CPC Exam UPDATED Exam Questions
and CORRECT Answers
Abstractor - CORRECT ANSWER - hospital employee who converts documented procedurs
and diangoses into medical codes
Abuse - CORRECT ANSWER - coding practices that lead to improper reimbursement by
error because they do not meet medical necessity, ex. changing diagnosis to be covered by
insurance
Accreditation - CORRECT ANSWER - an examination process the healthcare facility goes
through to evaluate the facilities policies, procedures, and performance to meet higher standards.
Accredited - CORRECT ANSWER - Having seal of approval after being evaluated and
demonstrating quality standards
Act/ Law/ Statute - CORRECT ANSWER - Legislation passed through Congress and signed
by President or passed over his veto
Actual Charge - CORRECT ANSWER - The amount the provider charges for medical
services or supplies. Not always paid in full.
Additional Benefits - CORRECT ANSWER - Health care services not covered by Medicare
and are offered through the Medicare Advantage Organization for no additional premium. The
benefits must equal the ACR (Adjusted Community Rating)
Adjudication - CORRECT ANSWER - Health Insurance Claims process at the insurance
company
Adjusted Average Per Capita Cost (AAPCC) - CORRECT ANSWER - Estimate of how much
Medicare will spend in a year for an average beneficiary
, Administrative Code Sets - CORRECT ANSWER - Non medical code sets that characterize a
general business situation rather than a medical condition.
Administrative Costs - CORRECT ANSWER - Medicare, Medicaid, CMS refer to this as their
expenses to have the program, operating expenses, program management, etc.
Administrative Data - CORRECT ANSWER - Health insurance information stored in
automated information system about enrollment, eligibility, claims, etc.
Administrative Law Judge (ALJ) - CORRECT ANSWER - hearing officer who presides over
appeal conflicts between providers or beneficiaries, and Medicare contractors (MAC's)
Administrative Simplification - CORRECT ANSWER - Part of HIPAA authorizing HHS
(Health and Human Services) to 1. adopt standards for transactions & code sets; 2. adopt
standard identifiers for health plans; 3. adopt standards to protect security & privacy of
personally identifiable health information.
Administrative Simplification Act - CORRECT ANSWER - Signed 12/17/01 allows HHS
(Health & Human Services) to exclude providers from Medicare for HIPAA non-compliance of
electronic claims and prohibit paper claims except in certain situations
Admission Date - CORRECT ANSWER - The date the patient was admitted for inpatient
care, outpatient, or start of care.For hospice, enter effective date of election of hospice benefits.
Admitting Diagnosis - CORRECT ANSWER - Diagnosis code indicating patient's diagnosis
at admission
Admitting Physician - CORRECT ANSWER - The doctor responsible for admitting a patient
to the hospital or other inpatient health facility
and CORRECT Answers
Abstractor - CORRECT ANSWER - hospital employee who converts documented procedurs
and diangoses into medical codes
Abuse - CORRECT ANSWER - coding practices that lead to improper reimbursement by
error because they do not meet medical necessity, ex. changing diagnosis to be covered by
insurance
Accreditation - CORRECT ANSWER - an examination process the healthcare facility goes
through to evaluate the facilities policies, procedures, and performance to meet higher standards.
Accredited - CORRECT ANSWER - Having seal of approval after being evaluated and
demonstrating quality standards
Act/ Law/ Statute - CORRECT ANSWER - Legislation passed through Congress and signed
by President or passed over his veto
Actual Charge - CORRECT ANSWER - The amount the provider charges for medical
services or supplies. Not always paid in full.
Additional Benefits - CORRECT ANSWER - Health care services not covered by Medicare
and are offered through the Medicare Advantage Organization for no additional premium. The
benefits must equal the ACR (Adjusted Community Rating)
Adjudication - CORRECT ANSWER - Health Insurance Claims process at the insurance
company
Adjusted Average Per Capita Cost (AAPCC) - CORRECT ANSWER - Estimate of how much
Medicare will spend in a year for an average beneficiary
, Administrative Code Sets - CORRECT ANSWER - Non medical code sets that characterize a
general business situation rather than a medical condition.
Administrative Costs - CORRECT ANSWER - Medicare, Medicaid, CMS refer to this as their
expenses to have the program, operating expenses, program management, etc.
Administrative Data - CORRECT ANSWER - Health insurance information stored in
automated information system about enrollment, eligibility, claims, etc.
Administrative Law Judge (ALJ) - CORRECT ANSWER - hearing officer who presides over
appeal conflicts between providers or beneficiaries, and Medicare contractors (MAC's)
Administrative Simplification - CORRECT ANSWER - Part of HIPAA authorizing HHS
(Health and Human Services) to 1. adopt standards for transactions & code sets; 2. adopt
standard identifiers for health plans; 3. adopt standards to protect security & privacy of
personally identifiable health information.
Administrative Simplification Act - CORRECT ANSWER - Signed 12/17/01 allows HHS
(Health & Human Services) to exclude providers from Medicare for HIPAA non-compliance of
electronic claims and prohibit paper claims except in certain situations
Admission Date - CORRECT ANSWER - The date the patient was admitted for inpatient
care, outpatient, or start of care.For hospice, enter effective date of election of hospice benefits.
Admitting Diagnosis - CORRECT ANSWER - Diagnosis code indicating patient's diagnosis
at admission
Admitting Physician - CORRECT ANSWER - The doctor responsible for admitting a patient
to the hospital or other inpatient health facility
