AAPC Cheat Sheet 2026

The 30 highest-yield AAPC facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. The False Claims Act (FCA) penalizes providers who: → Knowingly submit false or fraudulent claims for payment to the federal government
2. An insurance policy's 'coordination of benefits' (COB) provision prevents: → Overpayment when a patient has more than one insurance plan
3. What is a sliding fee scale used for in healthcare? → Setting patient fees based on income and ability to pay
4. Which guideline emphasizes coding only the conditions that affect patient care? → Only conditions treated or addressed during the encounter are coded
5. What is a credit balance on a patient account? → An amount owed back to the patient or payer because they were overcharged or overpaid
6. What is the purpose of exclusions in an insurance policy? → To identify services not covered by the policy
7. When a patient has both a primary and secondary insurance plan, the secondary plan's payment is typically based on: → The patient's remaining liability after primary payment
8. In CPT, the 'global surgery package' typically includes all of the following EXCEPT: → Complications requiring return to the OR
9. What is a 'corrected claim'? → A resubmission of a previously processed claim with corrections to specific data elements
10. A provider contract includes a 'clean claim' definition requiring specific data elements. If a claim is missing a required element, the payer may: → Pend or deny the claim for additional information
11. What is a Diagnosis-Related Group (DRG) payment system used for? → A prospective payment system for inpatient hospital stays based on diagnosis
12. A payer issues an Explanation of Benefits (EOB) showing 'CO-45.' What does this adjustment reason code mean? → Charges exceed the fee schedule/maximum allowable amount
13. Which document is most important to include when appealing a claim denied for 'medical necessity'? → Physician's clinical documentation and supporting medical records
14. What does the prefix 'hyper-' mean in medical terminology? → Excessive or above normal
15. A provider who performs medically unnecessary services and bills for them may be liable under: → The False Claims Act
16. The term 'allowed amount' in an insurance contract refers to: → The maximum the insurer will pay for a specific service
17. Which National Uniform Claim Committee (NUCC) form is used by professional providers to submit paper claims? → CMS-1500
18. A biller receives a denial for 'missing or invalid modifier.' What is the correct course of action? → Review the procedure code, determine the correct modifier, and resubmit a corrected claim
19. Which provision in a commercial insurance contract specifies how long after a service date the provider has to submit a claim? → Timely filing provision
20. Which document outlines the insurance company's payment decision? → Explanation of Benefits (EOB)
21. An insurer denies a claim citing 'duplicate submission.' The provider confirms only one claim was sent. What is the next best step? → Send a reconsideration request with proof that only one claim was submitted
22. The term 'subcutaneous' means: → Beneath the skin
23. What does the HIPAA Security Rule specifically protect? → Electronic Protected Health Information (ePHI)
24. What is the role of a clearinghouse in medical billing? → It acts as an intermediary that scrubs and transmits claims between providers and payers
25. What is the purpose of internal audits in billing compliance? → To improve billing accuracy and detect errors
26. Under ICD-10-CM Official Guidelines, a 'code first' note instructs the coder to: → Report an underlying condition or etiology code before the manifestation code
27. What is the purpose of a claim attachment in the adjudication process? → To provide supporting documentation that justifies the billed service
28. A provider who signs a participation agreement with Medicare must accept assignment, which means they agree to: → Accept Medicare's allowed amount as payment in full
29. Which coding system is primarily used for outpatient procedures? → CPT
30. When a claim is adjusted after initial payment and the payer recoups funds, what document typically accompanies this action? → An adjusted or voided Remittance Advice with the recoupment details