CBIC A-IPC COMPREHENSIVE TEST PAPER
2026 FULL 227 QUESTIONS SOLVED ANSWERS
EXPERT REVIEW
◉ Abuse. Answer: coding practices that lead to improper reimbursement
by error because they do not meet medical necessity, ex. changing
diagnosis to be covered by insurance
◉ Accreditation. Answer: an examination process the healthcare facility
goes through to evaluate the facilities policies, procedures, and
performance to meet higher standards.
◉ Accredited. Answer: Having seal of approval after being evaluated
and demonstrating quality standards
◉ Act/ Law/ Statute. Answer: Legislation passed through Congress and
signed by President or passed over his veto
◉ Actual Charge. Answer: The amount the provider charges for medical
services or supplies. Not always paid in full.
◉ Additional Benefits. Answer: Health care services not covered by
Medicare and are offered through the Medicare Advantage Organization
for no additional premium. The benefits must equal the ACR (Adjusted
Community Rating)
,◉ Adjudication. Answer: Health Insurance Claims process at the
insurance company
◉ Adjusted Average Per Capita Cost (AAPCC). Answer: Estimate of
how much Medicare will spend in a year for an average beneficiary
◉ Administrative Code Sets. Answer: Non medical code sets that
characterize a general business situation rather than a medical condition.
◉ Administrative Costs. Answer: Medicare, Medicaid, CMS refer to this
as their expenses to have the program, operating expenses, program
management, etc.
◉ Administrative Data. Answer: Health insurance information stored in
automated information system about enrollment, eligibility, claims, etc.
◉ Administrative Law Judge (ALJ). Answer: hearing officer who
presides over appeal conflicts between providers or beneficiaries, and
Medicare contractors (MAC's)
◉ Administrative Simplification. Answer: Part of HIPAA authorizing
HHS (Health and Human Services) to 1. adopt standards for transactions
& code sets; 2. adopt standard identifiers for health plans; 3. adopt
, standards to protect security & privacy of personally identifiable health
information.
◉ Administrative Simplification Act. Answer: Signed 12/17/01 allows
HHS (Health & Human Services) to exclude providers from Medicare
for HIPAA non-compliance of electronic claims and prohibit paper
claims except in certain situations
◉ Admission Date. Answer: The date the patient was admitted for
inpatient care, outpatient, or start of care.For hospice, enter effective
date of election of hospice benefits.
◉ Admitting Diagnosis. Answer: Diagnosis code indicating patient's
diagnosis at admission
◉ Admitting Physician. Answer: The doctor responsible for admitting a
patient to the hospital or other inpatient health facility
◉ Advance Beneficiary Notification (ABN). Answer: A notice from
provider to patient that Medicare may deny payment. Patient must sign
before services are provider, otherwise patient is not responsible if
Medicare does not cover.
2026 FULL 227 QUESTIONS SOLVED ANSWERS
EXPERT REVIEW
◉ Abuse. Answer: coding practices that lead to improper reimbursement
by error because they do not meet medical necessity, ex. changing
diagnosis to be covered by insurance
◉ Accreditation. Answer: an examination process the healthcare facility
goes through to evaluate the facilities policies, procedures, and
performance to meet higher standards.
◉ Accredited. Answer: Having seal of approval after being evaluated
and demonstrating quality standards
◉ Act/ Law/ Statute. Answer: Legislation passed through Congress and
signed by President or passed over his veto
◉ Actual Charge. Answer: The amount the provider charges for medical
services or supplies. Not always paid in full.
◉ Additional Benefits. Answer: Health care services not covered by
Medicare and are offered through the Medicare Advantage Organization
for no additional premium. The benefits must equal the ACR (Adjusted
Community Rating)
,◉ Adjudication. Answer: Health Insurance Claims process at the
insurance company
◉ Adjusted Average Per Capita Cost (AAPCC). Answer: Estimate of
how much Medicare will spend in a year for an average beneficiary
◉ Administrative Code Sets. Answer: Non medical code sets that
characterize a general business situation rather than a medical condition.
◉ Administrative Costs. Answer: Medicare, Medicaid, CMS refer to this
as their expenses to have the program, operating expenses, program
management, etc.
◉ Administrative Data. Answer: Health insurance information stored in
automated information system about enrollment, eligibility, claims, etc.
◉ Administrative Law Judge (ALJ). Answer: hearing officer who
presides over appeal conflicts between providers or beneficiaries, and
Medicare contractors (MAC's)
◉ Administrative Simplification. Answer: Part of HIPAA authorizing
HHS (Health and Human Services) to 1. adopt standards for transactions
& code sets; 2. adopt standard identifiers for health plans; 3. adopt
, standards to protect security & privacy of personally identifiable health
information.
◉ Administrative Simplification Act. Answer: Signed 12/17/01 allows
HHS (Health & Human Services) to exclude providers from Medicare
for HIPAA non-compliance of electronic claims and prohibit paper
claims except in certain situations
◉ Admission Date. Answer: The date the patient was admitted for
inpatient care, outpatient, or start of care.For hospice, enter effective
date of election of hospice benefits.
◉ Admitting Diagnosis. Answer: Diagnosis code indicating patient's
diagnosis at admission
◉ Admitting Physician. Answer: The doctor responsible for admitting a
patient to the hospital or other inpatient health facility
◉ Advance Beneficiary Notification (ABN). Answer: A notice from
provider to patient that Medicare may deny payment. Patient must sign
before services are provider, otherwise patient is not responsible if
Medicare does not cover.
