AAPC CPC 2025 MEDICAL CODING
CERTIFICATION EXAM COMPLETE QUESTIONS
AND VERIFIED ANSWERS
◉ According to the example LCD from Novitas Solutions,
measurement of vitamin D levels is indicated for patients with
condition?
A. fatigue
B. fibromyalgia
C. hypertension
D. muscle weakness Answer: 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 Answer: 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.
◉ 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. Answer: 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. Answer: C. $100 or 25%
"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 Answer: 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?"
A. Only individuals whose job requires it may have access to
protected health information.
B. Only the patient has access to protected health information.
C. Only the treatment physician has access to protected health
information.
D. Anyone within the provider's office can have access to protected
health information. Answer: A. Only individuals whose job requires
it may have access to protected health information.
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.
CERTIFICATION EXAM COMPLETE QUESTIONS
AND VERIFIED ANSWERS
◉ According to the example LCD from Novitas Solutions,
measurement of vitamin D levels is indicated for patients with
condition?
A. fatigue
B. fibromyalgia
C. hypertension
D. muscle weakness Answer: 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 Answer: 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.
◉ 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. Answer: 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. Answer: C. $100 or 25%
"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 Answer: 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?"
A. Only individuals whose job requires it may have access to
protected health information.
B. Only the patient has access to protected health information.
C. Only the treatment physician has access to protected health
information.
D. Anyone within the provider's office can have access to protected
health information. Answer: A. Only individuals whose job requires
it may have access to protected health information.
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.
