AAPC CPC EXAM PREP COMPLIANCE AND
REGULATORY QUESTONS WITH CORRECT
ANSWERS 2026
What document is referenced to when looking for potentialproblem areas identified by the governme
nt indicatingscrutiny of the services within the coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan - CORRECT ANSWER -
C (Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for the fiscal year ahea
d. Within the Work Plan, potential problem areas with claims submissions are listed and will be target
ed with special scrutiny.)
What form is provided to a patient to indicate a servicemay not be covered by Medicare and the pati
ent may be responsible for the charges?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN - CORRECT 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 o
f 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. -
CORRECT 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 indiv
iduals 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 compla
int 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. - CORRECT ANSWER -
B (Rationale: Medical necessity is using the least radical services/procedure that allows for effective tr
eatment of the patient's complaint or condition.)
Accordingz toz thez examplez LCDz fromz Novitasz Solutions,z whichz ofz thez followingz conditionsz isz considered
az systemicz conditionz thatz mayz resultz inz thez needz forz routinez footz care?z :
A)z arthritis
B)z chronicz venousz insufficiency
C)z hypertension
D)z musclez weaknessz -z CORRECTz ANSWERz -
Bz (Rationale:z Accordingz toz thez LCD,z Chronicz venousz insufficiencyz isz az systemicz conditionz thatz mayz resul
tz inz thez needz forz routinez footz care.)
Whenz presentingz az costz estimatez onz anz ABNz forz az potentiallyz noncoveredz service,z thez costz estimatez s
h
ouldz bez withinz whatz rangez ofz thez actualz cost?
A)z $25z orz10z percent
B)z $100z orz10z percent
C)z $100z orz25z percent
D)z Anz exactz amountz -z CORRECTz ANSWERz -
Cz (Rationale:z CMSz instructionsz stipulate,z "Notifiersz mustz makez az goodz faithz effortz toz insertz az reasonab
l
ez estimate...thez estimatez shouldz bez withinz $100z orz25z percentz ofzthez actualz costs,z whicheverz isz great
e
r.")
Whichz actz wasz enactedz asz partz ofz thez Americanz Recoveryz andz Reinvestmentz Actz ofz 2009z (ARRA)z andz
a
ffectedz privacyz andz security?z :
A)z HIPAA
B)z HITECH
REGULATORY QUESTONS WITH CORRECT
ANSWERS 2026
What document is referenced to when looking for potentialproblem areas identified by the governme
nt indicatingscrutiny of the services within the coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan - CORRECT ANSWER -
C (Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for the fiscal year ahea
d. Within the Work Plan, potential problem areas with claims submissions are listed and will be target
ed with special scrutiny.)
What form is provided to a patient to indicate a servicemay not be covered by Medicare and the pati
ent may be responsible for the charges?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN - CORRECT 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 o
f 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. -
CORRECT 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 indiv
iduals 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 compla
int 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. - CORRECT ANSWER -
B (Rationale: Medical necessity is using the least radical services/procedure that allows for effective tr
eatment of the patient's complaint or condition.)
Accordingz toz thez examplez LCDz fromz Novitasz Solutions,z whichz ofz thez followingz conditionsz isz considered
az systemicz conditionz thatz mayz resultz inz thez needz forz routinez footz care?z :
A)z arthritis
B)z chronicz venousz insufficiency
C)z hypertension
D)z musclez weaknessz -z CORRECTz ANSWERz -
Bz (Rationale:z Accordingz toz thez LCD,z Chronicz venousz insufficiencyz isz az systemicz conditionz thatz mayz resul
tz inz thez needz forz routinez footz care.)
Whenz presentingz az costz estimatez onz anz ABNz forz az potentiallyz noncoveredz service,z thez costz estimatez s
h
ouldz bez withinz whatz rangez ofz thez actualz cost?
A)z $25z orz10z percent
B)z $100z orz10z percent
C)z $100z orz25z percent
D)z Anz exactz amountz -z CORRECTz ANSWERz -
Cz (Rationale:z CMSz instructionsz stipulate,z "Notifiersz mustz makez az goodz faithz effortz toz insertz az reasonab
l
ez estimate...thez estimatez shouldz bez withinz $100z orz25z percentz ofzthez actualz costs,z whicheverz isz great
e
r.")
Whichz actz wasz enactedz asz partz ofz thez Americanz Recoveryz andz Reinvestmentz Actz ofz 2009z (ARRA)z andz
a
ffectedz privacyz andz security?z :
A)z HIPAA
B)z HITECH
