AAPC CPC exam prep
Compliance and Regulatory
2025–2026 Accurate Real Exam
Questions and Verified Correct Answers
INSIDE THIS EXAM:
The AAPC CPC Exam Compliance and Regulatory
section tests knowledge of legal standards, including
OIG compliance, HIPAA privacy, NCCI edits, and
fraud/abuse regulations (e.g., False Claims Act). It
covers proper coding documentation, medical
necessity, and identifying corrective actions for coding
errors.
mailto:https://www.stuvia.com/user/Wisdoms
, 1. What document is referenced to when looking for potentialproblem
areas identified by the government indicatingscrutiny of the services within
the com- ing year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan:
Answer 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.)
2. What form is provided to a patient to indicate a servicemay 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
(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.)
mailto:https://www.stuvia.com/user/Wisdoms
, 3. 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.:
Answer 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.)
4. Which statement describes a medically necessary service? :
A) Performing a procedure/service based on cost to eliminate wasteful
ser- vices.
B) Using the least radical service/procedure that allows for effective
treatment of the patient's complaint or condition.
mailto:https://www.stuvia.com/user/Wisdoms
Compliance and Regulatory
2025–2026 Accurate Real Exam
Questions and Verified Correct Answers
INSIDE THIS EXAM:
The AAPC CPC Exam Compliance and Regulatory
section tests knowledge of legal standards, including
OIG compliance, HIPAA privacy, NCCI edits, and
fraud/abuse regulations (e.g., False Claims Act). It
covers proper coding documentation, medical
necessity, and identifying corrective actions for coding
errors.
mailto:https://www.stuvia.com/user/Wisdoms
, 1. What document is referenced to when looking for potentialproblem
areas identified by the government indicatingscrutiny of the services within
the com- ing year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan:
Answer 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.)
2. What form is provided to a patient to indicate a servicemay 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
(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.)
mailto:https://www.stuvia.com/user/Wisdoms
, 3. 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.:
Answer 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.)
4. Which statement describes a medically necessary service? :
A) Performing a procedure/service based on cost to eliminate wasteful
ser- vices.
B) Using the least radical service/procedure that allows for effective
treatment of the patient's complaint or condition.
mailto:https://www.stuvia.com/user/Wisdoms
