AAPC CPC STUDY REVIEW 2026 |
CERTIFIED PROFESSIONAL CODER
EXAM STUDY GUIDE, PRACTICE
QUESTIONS, ANSWERS &
RATIONALES
| GRADED A+ | GUARANTEED
SUCCESS
Updated 2026 Questions and Answers
100% Verified Exam Prep and Comprehensive
Rationales Included
,What form is presented to a pt. to indicate a service may D. ABN
not recovered by Medicare and the pt. may be
responsible for the charges? Explanation: The ABN (Advance Beneficiary Notice of Non-coverage) form is
given to patients to indicate that a service may not be covered by Medicare and
A. LCD the patient may need to pay for the service.
B. CMS-1500
C. UB-04
D. ABN
Select the true statement regarding ABN's. D. ABN's should be routinely signed by Medicare Beneficiaries in case Medicare
does NOT cover a service.
A. ABN's may not be recognized by non-Medicare
payers. Explanation: An Advanced Beneficiary Notice (ABN) is a form that informs a
B. ABN's must be signed for emergency or urgent care. Medicare beneficiary that a service they are requesting may not be covered by
C. ABN's are NOT required to include an estimate cost for Medicare and they will be responsible for the cost if they choose to proceed with
the service. it. It's advisable for beneficiaries to sign an ABN even if they believe the service
D. ABN's should be routinely signed by Medicare might be covered, as it protects them from unexpected charges.
Beneficiaries in case Medicare does NOT cover a service.
Charges are billed to the patient or insurance using this CMS-1500
claim form
A federal agency within the Department of Health and Center for Medicare & Medicaid Services (CMS)
Human Services (HHS) responsible for administering the
Medicare program and working in partnership with states
to administer Medicaid, the Children's Health Insurance
Program (CHIP), and health insurance portability
standards.
Covers impatient hospital care, as well as provided in Medicare Part A
skilled nursing facilities, hospice, and home health.
Covers medically-necessary doctor's services, outpatient Medicare Part B
care, & other medical services. Pt. must pay a premium,
yearly co-pay, mainly dealt in physician offices.
Managed by private insurers approved by Medicare & Medicare Part C
may include PPO's and HMO's. CMS-HCC adjusted
payments based on pt's. diseases & demographics.
Prescription drug coverage program available to all Medicare Part D
Medicare beneficiaries.
A health insurance plan where you have a network of Preferred Provider Organization (PPO)
doctors, hospitals, and other healthcare providers who
have agreed to provide services at discounted rates.
You can see any doctor in the network without a referral,
but you can also go out-of-network, though you'll pay
more for those services
,A type of health insurance plan that provides Health Maintenance Organization (HMO)
comprehensive medical care through a network of
contracted healthcare providers.
SOAP S-Subjective- The pt's statement about their health, including symptoms.
O-Objective- Provider assesses documents & pt's illness using observation,
palpation, auscultation, & percussion test & other services performed may be
documented.
A-Assessment-Evaluation & conclusion made by provider.
P-Plan-Course of action. List steps for Pt. like ordering additional test, or taking
over the counter meds, etc.
Explain when Medicare WILL pay for items or services. National Coverage Determination (NCD's)
Interpreting national policies into regional policies. Medicare Administrative Contractor (MAC)
Further define what code are needed & when an item or Local Coverage Determinations (LCD)
service will be covered. Have jurisdiction ONLY within
their region.
Is a standardized form that explains to the pt. why Advance Beneficiary Notice (ABN)
Medicare may deny the particular service or procedure.
Must be verbally reviewed with the Beneficiary or his/her
representative BEFORE the pt. signs.
When presenting a cost estimate on an ABN for a C. $100 or 25%
potentially non-covered 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.
Who would NOT be considered a covered entity under D. Patient (pt.)
HIPAA?
Explanation: Patients are not covered entities themselves. They are the subjects of
A. Doctors HIPAA regulations, but they do not have the obligations imposed on covered
B. HMO's entities
C. Clearinghouse
D. Patient (pt.)
, Under HIPPA, what would be a policy requirement for A. Only individuals whose jobs requires it may have access to protected health
"Minimum Necessary"? information.
A. Only individuals whose jobs requires it may have Explanation: The HIPAA Minimum Necessary rule mandates that healthcare
access to protected health information. providers only access and disclose the minimum amount of Protected Health
B. Only the pt. has access to protected health Information (PHI) needed to fulfill a specific purpose. This means that only
information. authorized personnel who directly need the information for their job functions
C. Only the physician has access to protected health should have access to it.
information.
D. Anyone within the provider's office can have access to
the protected health information.
Which Act with enacted as part as the American B. HITECH
Recovery and Reinvestment Act of 2009 (ARRA) and
affected privacy and security? Explanation: The Health Information Technology for Economic and Clinical Health
(HITECH) Act was enacted as part of the American Recovery and Reinvestment
A. HIPAA Act (ARRA) in 2009. HITECH specifically focuses on strengthening the privacy and
B. HIITECH security provisions of HIPAA by expanding enforcement mechanisms and
C. SSA promoting the adoption of electronic health records (EHRs).
D. FECA
What document has been created to assist physician A. OIG Compliance Plan Guidance
offices with the development of compliance manuals ?
Explanation: The OIG Compliance Plan Guidance, issued by the Office of
A. OIG Compliance Plan Guidance Inspector General (OIG), provides guidance and recommendations to healthcare
B. OIG Work Plan providers on how to establish and maintain a compliant compliance program,
C. OIG Suggested Rules and Regulations including the development of compliance manuals.
D. OIG Internal Compliance Plan
What document should be referred to when looking for C. OIG Work Plan
potential problem areas identified by the government
indicating scrutiny of the services within the coming Explanation: The OIG Work Plan, published annually by the Office of Inspector
year? General (OIG), outlines the areas the OIG intends to focus on during the
upcoming year, making it a crucial document for healthcare providers to review to
A. OIG Compliance Plan Guidance anticipate potential compliance issues.
B. OIG Security Summary
C. OIG Work Plan
D. OIG Document Planner
A professional organization representing physicians and American Medical Association (AMA)
medical students in the United States.Established in 1847,
aims to promote the art and science of medicine,
improve public health, and advocate for the interests of
its members.
A system used by the Centers for Medicare & Medicaid Ambulatory Payment Classification (APC)
Services (CMS) to reimburse hospitals for outpatient
services. They group outpatient procedures together
based on similar clinical characteristics and resource
utilization, then assign a fixed, prospective payment for
each group. This system encourages hospitals to provide
efficient and cost-effective outpatient care.
CERTIFIED PROFESSIONAL CODER
EXAM STUDY GUIDE, PRACTICE
QUESTIONS, ANSWERS &
RATIONALES
| GRADED A+ | GUARANTEED
SUCCESS
Updated 2026 Questions and Answers
100% Verified Exam Prep and Comprehensive
Rationales Included
,What form is presented to a pt. to indicate a service may D. ABN
not recovered by Medicare and the pt. may be
responsible for the charges? Explanation: The ABN (Advance Beneficiary Notice of Non-coverage) form is
given to patients to indicate that a service may not be covered by Medicare and
A. LCD the patient may need to pay for the service.
B. CMS-1500
C. UB-04
D. ABN
Select the true statement regarding ABN's. D. ABN's should be routinely signed by Medicare Beneficiaries in case Medicare
does NOT cover a service.
A. ABN's may not be recognized by non-Medicare
payers. Explanation: An Advanced Beneficiary Notice (ABN) is a form that informs a
B. ABN's must be signed for emergency or urgent care. Medicare beneficiary that a service they are requesting may not be covered by
C. ABN's are NOT required to include an estimate cost for Medicare and they will be responsible for the cost if they choose to proceed with
the service. it. It's advisable for beneficiaries to sign an ABN even if they believe the service
D. ABN's should be routinely signed by Medicare might be covered, as it protects them from unexpected charges.
Beneficiaries in case Medicare does NOT cover a service.
Charges are billed to the patient or insurance using this CMS-1500
claim form
A federal agency within the Department of Health and Center for Medicare & Medicaid Services (CMS)
Human Services (HHS) responsible for administering the
Medicare program and working in partnership with states
to administer Medicaid, the Children's Health Insurance
Program (CHIP), and health insurance portability
standards.
Covers impatient hospital care, as well as provided in Medicare Part A
skilled nursing facilities, hospice, and home health.
Covers medically-necessary doctor's services, outpatient Medicare Part B
care, & other medical services. Pt. must pay a premium,
yearly co-pay, mainly dealt in physician offices.
Managed by private insurers approved by Medicare & Medicare Part C
may include PPO's and HMO's. CMS-HCC adjusted
payments based on pt's. diseases & demographics.
Prescription drug coverage program available to all Medicare Part D
Medicare beneficiaries.
A health insurance plan where you have a network of Preferred Provider Organization (PPO)
doctors, hospitals, and other healthcare providers who
have agreed to provide services at discounted rates.
You can see any doctor in the network without a referral,
but you can also go out-of-network, though you'll pay
more for those services
,A type of health insurance plan that provides Health Maintenance Organization (HMO)
comprehensive medical care through a network of
contracted healthcare providers.
SOAP S-Subjective- The pt's statement about their health, including symptoms.
O-Objective- Provider assesses documents & pt's illness using observation,
palpation, auscultation, & percussion test & other services performed may be
documented.
A-Assessment-Evaluation & conclusion made by provider.
P-Plan-Course of action. List steps for Pt. like ordering additional test, or taking
over the counter meds, etc.
Explain when Medicare WILL pay for items or services. National Coverage Determination (NCD's)
Interpreting national policies into regional policies. Medicare Administrative Contractor (MAC)
Further define what code are needed & when an item or Local Coverage Determinations (LCD)
service will be covered. Have jurisdiction ONLY within
their region.
Is a standardized form that explains to the pt. why Advance Beneficiary Notice (ABN)
Medicare may deny the particular service or procedure.
Must be verbally reviewed with the Beneficiary or his/her
representative BEFORE the pt. signs.
When presenting a cost estimate on an ABN for a C. $100 or 25%
potentially non-covered 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.
Who would NOT be considered a covered entity under D. Patient (pt.)
HIPAA?
Explanation: Patients are not covered entities themselves. They are the subjects of
A. Doctors HIPAA regulations, but they do not have the obligations imposed on covered
B. HMO's entities
C. Clearinghouse
D. Patient (pt.)
, Under HIPPA, what would be a policy requirement for A. Only individuals whose jobs requires it may have access to protected health
"Minimum Necessary"? information.
A. Only individuals whose jobs requires it may have Explanation: The HIPAA Minimum Necessary rule mandates that healthcare
access to protected health information. providers only access and disclose the minimum amount of Protected Health
B. Only the pt. has access to protected health Information (PHI) needed to fulfill a specific purpose. This means that only
information. authorized personnel who directly need the information for their job functions
C. Only the physician has access to protected health should have access to it.
information.
D. Anyone within the provider's office can have access to
the protected health information.
Which Act with enacted as part as the American B. HITECH
Recovery and Reinvestment Act of 2009 (ARRA) and
affected privacy and security? Explanation: The Health Information Technology for Economic and Clinical Health
(HITECH) Act was enacted as part of the American Recovery and Reinvestment
A. HIPAA Act (ARRA) in 2009. HITECH specifically focuses on strengthening the privacy and
B. HIITECH security provisions of HIPAA by expanding enforcement mechanisms and
C. SSA promoting the adoption of electronic health records (EHRs).
D. FECA
What document has been created to assist physician A. OIG Compliance Plan Guidance
offices with the development of compliance manuals ?
Explanation: The OIG Compliance Plan Guidance, issued by the Office of
A. OIG Compliance Plan Guidance Inspector General (OIG), provides guidance and recommendations to healthcare
B. OIG Work Plan providers on how to establish and maintain a compliant compliance program,
C. OIG Suggested Rules and Regulations including the development of compliance manuals.
D. OIG Internal Compliance Plan
What document should be referred to when looking for C. OIG Work Plan
potential problem areas identified by the government
indicating scrutiny of the services within the coming Explanation: The OIG Work Plan, published annually by the Office of Inspector
year? General (OIG), outlines the areas the OIG intends to focus on during the
upcoming year, making it a crucial document for healthcare providers to review to
A. OIG Compliance Plan Guidance anticipate potential compliance issues.
B. OIG Security Summary
C. OIG Work Plan
D. OIG Document Planner
A professional organization representing physicians and American Medical Association (AMA)
medical students in the United States.Established in 1847,
aims to promote the art and science of medicine,
improve public health, and advocate for the interests of
its members.
A system used by the Centers for Medicare & Medicaid Ambulatory Payment Classification (APC)
Services (CMS) to reimburse hospitals for outpatient
services. They group outpatient procedures together
based on similar clinical characteristics and resource
utilization, then assign a fixed, prospective payment for
each group. This system encourages hospitals to provide
efficient and cost-effective outpatient care.
