Certified Professional Coder PREPARATION
TEST 2026 QUESTIONS AND CORRECT
ANSWERS GRADED A+
● 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.)
● 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.)
● 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.. Answer: B (Rationale: Medical necessity is using the least
radical services/procedure that allows for effective treatment of the
patient's complaint or condition.)
● 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. Answer: B (Rationale: According to the LCD,
Chronic venous insufficiency is a systemic condition that may result in
the need for routine foot care.)
, ● 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. Answer: 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.")
● 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. Answer: B
● What document assists provider offices with the development of
Compliance Manuals?
A) OIG Compliance Plan Guidance
B) OIG Work Plan
C) OIG Suggested Rules and Regulations
TEST 2026 QUESTIONS AND CORRECT
ANSWERS GRADED A+
● 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.)
● 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.)
● 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.. Answer: B (Rationale: Medical necessity is using the least
radical services/procedure that allows for effective treatment of the
patient's complaint or condition.)
● 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. Answer: B (Rationale: According to the LCD,
Chronic venous insufficiency is a systemic condition that may result in
the need for routine foot care.)
, ● 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. Answer: 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.")
● 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. Answer: B
● What document assists provider offices with the development of
Compliance Manuals?
A) OIG Compliance Plan Guidance
B) OIG Work Plan
C) OIG Suggested Rules and Regulations
