Compliance And Regulatory Questions For CPC Exam
Hello Readers , Welcome to Medico Pediaa , Today I will explain about Top 20 Compliance And Regulatory Questions For CPC Exam. Preparing for the CPC (Certified Professional Coder) Exam is not just about mastering coding guidelines—it also requires a solid understanding of compliance and regulatory concepts. These questions are a crucial part of the exam because they test a candidate’s ability to follow ethical standards, legal requirements, and coding compliance rules in real-world healthcare scenarios.
Compliance ensures that medical coders work within the HIPAA guidelines, fraud and abuse laws, OIG regulations, and payer policies, while regulatory knowledge helps coders apply coding standards accurately. In today’s healthcare industry, even a small mistake in compliance can lead to audits, penalties, or claim denials. Compliance And Regulatory Questions For CPC Exam
In this article, we will explore the key areas of compliance and regulatory questions you can expect in the CPC Exam, along with tips to prepare effectively.
Let’s start Compliance And Regulatory Questions For CPC Exam
Q1. An ABN must be signed when ?
(a) Once the insurance company has denied payment
(b) Before the service or procedure is provided to the patient
(c) After service are rendered, but before the claim is filed
(d) Once the denied claim has been appealed at the highest level
Q2. Medical necessity means what ?
(a) Without treatment the patient will suffer permanent disability or death
(b) The service requires medical treatment
(c) The condition of the patient justified the service provided
(d) The care provided met quality standards
Q3. Which of the following statements is not true regarding medicare part A
(a) It helps cover home health care charges
(b) It helps cover skilled nursing facility charges
(c) It helps cover hospice charges
(d) It helps cover outpatient charge
Q4. How many components should be included in an effective compliance plan ?
(a) 3
(b) 4
(c) 7
(d) 9
Q5. AAPC was found in which year ?
(a) 1980
(b) 1965
(c) 1955
(d) 1988
Q6. According to AAPC code of ethics members shall use only ___ and ___ means in all professionals dealings?
(a) Private and professional
(b) Legal and ethical
(c) Efficient and inexpensive
(d) Legal and profitable
Q7. What is PHI ?
(a) Physician healthcare interchange
(b) private health insurance
(c) protected health information
(d) Provider identified incident
Q8. In what year HITECH was enacted as a part of ARRA (American Recovery and reinvestment act) ?
(a) 2007
(b) 2009
(c) 2010
(d) 2000
Q9. HIPAA stands for
(a) Health income portability and accountability act
(b) Health insurance portability and accountability act
(c) Health insurance possibility and accountability act
(d) Health income position and accountability act
Q10. If an NCD doesn’t exist for a particular procedure/ service performed on a medicare patient, who determine coverage?
(c) CPI
(b) CMS
(c) The patient
(d) MAC
Q11. Which government agency offers compliance program guidance for physician practices ?
(a) Center of medicare and Medicaid service
(b) American medical association
(c) Office of the inspector general
(d) HIPAA
Q12. Which of the following choices is not a benefit of an active compliance plan ?
(a) Eliminates risk of an audit
(b) Fewer billing mistakes
(c) Increases accuracy of provider document
(d) More accurate payment of claims
Q13. What are the different parts of medicare?
(a) Part A,B,D
(b) Part A,B,C,d
(c) Part E,F,G,H
(d) Part A and B
Q14. According to the AAPC code to ethics, which term is not listed as an ethical principle of professional conduct ?
(a) Integrity
(b) Efficiency
(c) Responsibility
(d) Commitment
Q15. Which of the following (POS) code is submitted on a claim for a professional service rendered to a patient in an urgent care facility?
(a) 11- office
(b) 22- on campus -outpatient hospital
(c) 23- Emergency room- hospital
(d) 20- urgent care facility
Q16. What is the difference between copay and coinsurance ?
(a) They mean the same thing and used by insurance companies interchangebly
(b) Coinsurance is a percent and copay is a set amount
(c) Copay is a percent and coinsurance is a set amount
(d) Coinsurance is the term used only for medicare patient
Q17. What does the abbreviation PQRS refers to in relation to medical coding ?
(a) Physical quality reporting standards
(b) Physician quality reporting system
(c) Physician quality reimbursement solution
(d) Physician quantity reporting structure
Q18. The ____ describe whether specific medical items , services , treatment procedure or technologies are considered medical necessary under medicare ?
(a) National coverage determination manual
(b) Internet only manual
(c) Medicare security – diagnosis related groups
(d) Medicare physician fee schedule
Q19. Many coding professional go on to find work as :
(a) Accountants
(b) Medical assistants
(c) Financial planning
(d) Consultants
Q20. Upcoding is considered a validation of which compliance regulation ?
(a) False claim act
(b) Anti- kickback statue
(c) Stark law
(d) OSHA
Answers
1 – B , 2– C , 3- D, 4-C , 5 – D, 6-B , 7- C, 8-B, 9-B, 10 -D ,
11-C , 12-A , 13–B , 14-B , 15-D, 16- B , 17 – B , 18 -A , 19 -D, 20-A
Medical Terminology for CPC Exam :- https://medicopediaa.com/medical-terminology-questions-for-cpc-exam/
In this Article We Cover Compliance And Regulatory Questions For CPC Exam.
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