Cpc Final Exam Actual Tested Questions with Correct Answers
Updated 2026.
Abuse . 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 . Answer: an examination process the healthcare facility goes
through to evaluate the facilities policies, procedures, and performance to meet
higher standards.
Accredited . Answer: Having seal of approval after being evaluated and
demonstrating quality standards
Act/ Law/ Statute . Answer: Legislation passed through Congress and signed by
President or passed over his veto
Actual Charge . Answer: The amount the provider charges for medical services
or supplies. Not always paid in full.
Additional Benefits . 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 . Answer: Health Insurance Claims process at the insurance
company
, Adjusted Average Per Capita Cost (AAPCC) . Answer: Estimate of how much
Medicare will spend in a year for an average beneficiary
Administrative Code Sets . Answer: Non medical code sets that characterize a
general business situation rather than a medical condition.
Administrative Costs . Answer: Medicare, Medicaid, CMS refer to this as their
expenses to have the program, operating expenses, program management, etc.
Administrative Data . Answer: Health insurance information stored in automated
information system about enrollment, eligibility, claims, etc.
Administrative Law Judge (ALJ) . Answer: hearing officer who presides over
appeal conflicts between providers or beneficiaries, and Medicare contractors
(MAC's)
Administrative Simplification . 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 . 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 . 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 . Answer: Diagnosis code indicating patient's diagnosis at
admission
Admitting Physician . Answer: The doctor responsible for admitting a patient to
the hospital or other inpatient health facility
Advance Beneficiary Notification (ABN) . Answer: A notice from provider to
patient that Medicare may deny payment. Patient must sign before services are
provider, otherwise patient is not responsible if Medicare does not cover.
Advanced Directive . Answer: Statement written by patient on how they want
medical decisions to be made. May include a Living Will or Durable Power of
Attorney for healthcare.
Allowed Charge . Answer: Individual charge determination by carrier for a
covered service or supply.
Ambulatory Care . Answer: All types of health services that do not require an
overnight stay.
Ambulatory Care Sensitive Conditions (ACSC) . Answer: Medical condtions that
if treated immediatly and managed properly should not require hospitalization.
Updated 2026.
Abuse . 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 . Answer: an examination process the healthcare facility goes
through to evaluate the facilities policies, procedures, and performance to meet
higher standards.
Accredited . Answer: Having seal of approval after being evaluated and
demonstrating quality standards
Act/ Law/ Statute . Answer: Legislation passed through Congress and signed by
President or passed over his veto
Actual Charge . Answer: The amount the provider charges for medical services
or supplies. Not always paid in full.
Additional Benefits . 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 . Answer: Health Insurance Claims process at the insurance
company
, Adjusted Average Per Capita Cost (AAPCC) . Answer: Estimate of how much
Medicare will spend in a year for an average beneficiary
Administrative Code Sets . Answer: Non medical code sets that characterize a
general business situation rather than a medical condition.
Administrative Costs . Answer: Medicare, Medicaid, CMS refer to this as their
expenses to have the program, operating expenses, program management, etc.
Administrative Data . Answer: Health insurance information stored in automated
information system about enrollment, eligibility, claims, etc.
Administrative Law Judge (ALJ) . Answer: hearing officer who presides over
appeal conflicts between providers or beneficiaries, and Medicare contractors
(MAC's)
Administrative Simplification . 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 . 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 . 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 . Answer: Diagnosis code indicating patient's diagnosis at
admission
Admitting Physician . Answer: The doctor responsible for admitting a patient to
the hospital or other inpatient health facility
Advance Beneficiary Notification (ABN) . Answer: A notice from provider to
patient that Medicare may deny payment. Patient must sign before services are
provider, otherwise patient is not responsible if Medicare does not cover.
Advanced Directive . Answer: Statement written by patient on how they want
medical decisions to be made. May include a Living Will or Durable Power of
Attorney for healthcare.
Allowed Charge . Answer: Individual charge determination by carrier for a
covered service or supply.
Ambulatory Care . Answer: All types of health services that do not require an
overnight stay.
Ambulatory Care Sensitive Conditions (ACSC) . Answer: Medical condtions that
if treated immediatly and managed properly should not require hospitalization.
