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.) - (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.) - (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
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.) - (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.) - (ANSWER)Which statement describes a medically
necessary service? :
A) Performing a procedure/service based on cost to eliminate wasteful services.
, AAPC CPC CHAPTER 1 EXAM QUESTIONS AND ANSWERS 2025
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.
C (Rationale: According to the LCD, Chronic venous insufficiency is a systemic condition that may result
in the need for routine foot care.) - (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.") -
(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
B - (ANSWER)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
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.) - (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.) - (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
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.) - (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.) - (ANSWER)Which statement describes a medically
necessary service? :
A) Performing a procedure/service based on cost to eliminate wasteful services.
, AAPC CPC CHAPTER 1 EXAM QUESTIONS AND ANSWERS 2025
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.
C (Rationale: According to the LCD, Chronic venous insufficiency is a systemic condition that may result
in the need for routine foot care.) - (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.") -
(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
B - (ANSWER)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
