Want to test your compliance knowledge before the CCS exam? Below are free sample flashcards from the 80-card compliance section of our 1009-card CCS (Certified Coding Specialist) deck, which covers Official Guidelines, Ethical Standards, MAC, NCD and more.
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During an inpatient audit\
Show answer →a coder notes that the ICD-10-CM Tabular List instruction Code First conflicts with a specific sequencing instruction in the Official Guidelines (OGCR). According to the hierarchy\
A private payer issues a policy that contradicts ICD-10-CM Official Guidelines. The facility's contract says to follow payer rules. How does a CCS balance this with AHIMA Ethical Standards?
Show answer →Standard 1 requires following Official Guidelines. However, AHIMA acknowledges contract requirements. The coder should document the payer-specific instruction and apply it only to that payer's claims, but must advocate for official guidelines. Strategy: On the exam, Official Guidelines almost always trump Payer Rules unless the question specifically asks about a contract-specific billing requirement. Always prioritize official rules in general scenarios.
How does CMS determine the MUE values for specific HCPCS codes, and are all MUE values published for public review?
Show answer →MUE values are based on CPT/HCPCS code descriptors, CMS national policies, nature of service, and clinical judgment. While most are public, CMS designates some as confidential to prevent gaming of the system. Key Point: If a value is not in the public table, it is a proprietary edit. In 2026, transparency is higher, but confidential edits still exist for high-fraud areas. Distractor: MUEs are NOT based on 90th percentile of billing alone; clinical logic takes precedence.
A coder finds that a specific Medicare Administrative Contractor (MAC) has a policy for a procedure, but a National Coverage Determination (NCD) also exists for the same service. Which policy takes precedence in determining coverage?
Show answer →The NCD takes precedence. National Coverage Determinations (NCDs) are developed by CMS and apply to all Medicare beneficiaries nationwide. If an NCD exists, it overrides any Local Coverage Determination (LCD) or policy created by a MAC. LCDs can only be established if there is no NCD or if the NCD explicitly allows for local MAC discretion to further define coverage criteria. Exam Tip: AHIMA often tests hierarchy; remember NCD = Federal/Nationwide, LCD = Regional/MAC.
What are the CMS requirements for the Estimated Cost section on a valid Advance Beneficiary Notice?
Show answer →The provider must provide a good faith estimate of the service cost. CMS guidelines state the estimate should generally be within $100 or 25% of the actual cost, whichever is greater. Rationale: Patients must be informed of their potential financial exposure to make an informed decision. Exam Tip: An ABN without a cost estimate, or one with a grossly inaccurate estimate, is considered defective. If the ABN is defective, the provider cannot collect payment from the patient.
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Try 30 free CCS cards firstThe full CCS deck contains 1009 flashcards, and 80 of them focus on compliance. This page shows 5 free samples.
Our CCS deck dedicates 80 of 1009 cards (8%) to compliance — always cross-check the official AHIMA exam outline for the current blueprint weighting.
Yes — the samples on this page are free, and the CCS preview page has 30 more free cards. Full access to all 1009 cards is a one-time $7.
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