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AAPC CPC CHAPTER 1 EXAM
QUESTIONS AND ANSWERS 2025
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.) - correct
answer- What document is referenced to when looking for
potential problem areas identified by the government indicating
scrutiny of the services within the coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan
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.) - correct answer- What form is provided to a patient to
indicate a service may not be covered by Medicare and the
patient may be responsible for the charges?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN
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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.) - correct answer-
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.
B (Rationale: Medical necessity is using the least radical
services/procedure that allows for effective treatment of the
patient's complaint or condition.) - correct answer- 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.
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C (Rationale: According to the LCD, Chronic venous
insufficiency is a systemic condition that may result in the need
for routine foot care.) - correct answer- 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
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.") - correct answer- 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
AAPC CPC CHAPTER 1 EXAM
QUESTIONS AND ANSWERS 2025
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.) - correct
answer- What document is referenced to when looking for
potential problem areas identified by the government indicating
scrutiny of the services within the coming year?:
A) OIG Compliance Plan Guidance
B) OIG Security Summary
C) OIG Work Plan
D) OIG Investigation Plan
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.) - correct answer- What form is provided to a patient to
indicate a service may not be covered by Medicare and the
patient may be responsible for the charges?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN
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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.) - correct answer-
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.
B (Rationale: Medical necessity is using the least radical
services/procedure that allows for effective treatment of the
patient's complaint or condition.) - correct answer- 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.
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C (Rationale: According to the LCD, Chronic venous
insufficiency is a systemic condition that may result in the need
for routine foot care.) - correct answer- 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
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.") - correct answer- 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
