AAPC CPC exam prep Compliance and Regulatory
Exam 2025/2026
What document is referenced to when looking for potentialproblem areas identified by
the government 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 - ANS-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.)
What form is provided to a patient to indicate a servicemay not be covered by Medicare
and the patient may be responsible for the charges?:
A) LCD
B) CMS-1500
C) UB-04
D) ABN - ANS-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.)
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. -
ANS-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.)
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. - ANS-B
(Rationale: Medical necessity is using the least radical services/procedure that allows
for effective treatment of the patient's complaint or condition.)
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?