AAPC CPB Objective Assessment Comprehensive
Resource To Help You Ace 2026-2027 Includes
Frequently Tested Questions With ELABORATED
100% Correct COMPLETE SOLUTIONS
Guaranteed Pass First Attempt!!
Current Update!!
1. How many standard EDI transactions were adopted under HIPAA? - Correct Answer: 8
2. What are the standard EDI transactions adopted under HIPAA? - Correct Answer: 1.
Claims and encounter info
2. Payment and remittance advice
3. Claim status
4. Eligibility for a health plan
5. Enroll / Dis-enrollment in a health plan
6. Referrals and authorizations
7. COB
8. Premium payments
3. In addition to the standardization of the codes what other identifier is used on all claims? -
Correct Answer: A unique identifier for employers and providers
4. The federal false claims act allows for claims to be reviewed for how many years after an
incident? - Correct Answer: Seven years
,5. Entities that have been identified as having improper billing practices are defined by CMS as
a violation of what standard? - Correct Answer: Abuse
6. What penalties can be imposed for Fraud and / or abuse related to the US code? -
Correct Answer: Monetary penalties ranging from $10k to $50k (before inflation) for each
item or service, imprisonment, and exclusion from federal healthcare programs.
7. How long after being identified should a practice return medicare over payments? (days) -
Correct Answer: 60 days
8. A private practice hires a consultant to come in and audit some medical records. Under the
Privacy Rule, what is this consultant considered? - Correct Answer: A covered entity
9. According to the privacy rule, what health information *may not* be de-identified? -
Correct Answer: The physician provider number
10. A hospital records transporter is moving medical records from the hospital to an off-site
building. During the transport, a chart falls from the box on the street. It is discovered when
the transporter arrives at the off-site building and the number of charts is not correct. What
type of violation is this? - Correct Answer: A breach
11. A practice allows patients to pay large balances over a six month time period with a finance
charge applied. The patient receives a statement every month that only shows the unpaid
balance. What does this violate? - Correct Answer: TILA
12. When a practice sends an electronic claim to a commercial health plan for payment, what is
this considered? - Correct Answer: A transaction
,13. While working in a large practice, medicare over-payments are found in several patient
accounts. The manager states that the practice will keep the money until medicare asks for it
back. What does this action constitute? - Correct Answer: Fraud
14. What were the eight standard EDI transactions adopted under? - Correct Answer: HIPAA
15. A practice agrees to pay $250k to settle a lawsuit alleging that the practice used x-rays of
one patient to justify services on multiple other patient's claims. That manager of the office
brought the civil suit. What type of case is this? - Correct Answer: Qui Tam
16. A health plan sends a request for medical records in order to adjudicate a claim. Does the
office have to notify the patient or have them sign a release to send the information? -
Correct Answer: No, since the information is used for payment activities it is not necessary to
notify or obtain authorization (reference: TPO)
17. Fraud or Abuse: A clinic fails to maintain adequate medical records - Correct Answer:
Abuse
18. Fraud or Abuse: A clinic bills every new patient at the highest level E/M visit no matter what
- Correct Answer: Fraud
19. Fraud or Abuse: A clinic is found to be falsifying documentation to support a service that
was billed to receive payment - Correct Answer: Fraud
20. Fraud or Abuse: Reporting a diagnosis code that the patient does not have, but is payable
by medicare. - Correct Answer: Fraud
21. According to the privacy rule, what must a business associate and covered entity have in
order to do business? - Correct Answer: A contract
, 22. If a provider is excluded from federal health plans, what does that mean? - Correct
Answer: They many not participate in Medicare, Medicaid, VA programs, or Tricare and They
cannot bill for services or provide services, order services, or prescribe medication to any
beneficiary of a federal plan.
23. What is the purpose of the privacy rule? - Correct Answer: To protect patient privacy
24. A records request is received from a health plan for three dates of service in a chart months
apart. What should the biller do? - Correct Answer: Copy each date of service individually
and send to the health plan.
25. Is a healthcare consulting firm considered a covered entity? - Correct Answer: No
A new radiology company opens in town. The manager calls your practice and offers to pay $20
for every medicare patient you send them for radiology services. What does this offer violate? -
Correct Answer: The Anti-kickback law
How many national priority purposes are under the Privacy rule to disclose PHI without an
individuals authorization? - Correct Answer: 12
What are the 12 national priority purposes under the privacy rule? - Correct Answer: 1.
Required by law
2. Public health activities
3. Victims of abuse / neglect/ domestic violence
4. Health oversight activities
5. Judicial and administrative proceedings
6. Law enforcement purposes
Resource To Help You Ace 2026-2027 Includes
Frequently Tested Questions With ELABORATED
100% Correct COMPLETE SOLUTIONS
Guaranteed Pass First Attempt!!
Current Update!!
1. How many standard EDI transactions were adopted under HIPAA? - Correct Answer: 8
2. What are the standard EDI transactions adopted under HIPAA? - Correct Answer: 1.
Claims and encounter info
2. Payment and remittance advice
3. Claim status
4. Eligibility for a health plan
5. Enroll / Dis-enrollment in a health plan
6. Referrals and authorizations
7. COB
8. Premium payments
3. In addition to the standardization of the codes what other identifier is used on all claims? -
Correct Answer: A unique identifier for employers and providers
4. The federal false claims act allows for claims to be reviewed for how many years after an
incident? - Correct Answer: Seven years
,5. Entities that have been identified as having improper billing practices are defined by CMS as
a violation of what standard? - Correct Answer: Abuse
6. What penalties can be imposed for Fraud and / or abuse related to the US code? -
Correct Answer: Monetary penalties ranging from $10k to $50k (before inflation) for each
item or service, imprisonment, and exclusion from federal healthcare programs.
7. How long after being identified should a practice return medicare over payments? (days) -
Correct Answer: 60 days
8. A private practice hires a consultant to come in and audit some medical records. Under the
Privacy Rule, what is this consultant considered? - Correct Answer: A covered entity
9. According to the privacy rule, what health information *may not* be de-identified? -
Correct Answer: The physician provider number
10. A hospital records transporter is moving medical records from the hospital to an off-site
building. During the transport, a chart falls from the box on the street. It is discovered when
the transporter arrives at the off-site building and the number of charts is not correct. What
type of violation is this? - Correct Answer: A breach
11. A practice allows patients to pay large balances over a six month time period with a finance
charge applied. The patient receives a statement every month that only shows the unpaid
balance. What does this violate? - Correct Answer: TILA
12. When a practice sends an electronic claim to a commercial health plan for payment, what is
this considered? - Correct Answer: A transaction
,13. While working in a large practice, medicare over-payments are found in several patient
accounts. The manager states that the practice will keep the money until medicare asks for it
back. What does this action constitute? - Correct Answer: Fraud
14. What were the eight standard EDI transactions adopted under? - Correct Answer: HIPAA
15. A practice agrees to pay $250k to settle a lawsuit alleging that the practice used x-rays of
one patient to justify services on multiple other patient's claims. That manager of the office
brought the civil suit. What type of case is this? - Correct Answer: Qui Tam
16. A health plan sends a request for medical records in order to adjudicate a claim. Does the
office have to notify the patient or have them sign a release to send the information? -
Correct Answer: No, since the information is used for payment activities it is not necessary to
notify or obtain authorization (reference: TPO)
17. Fraud or Abuse: A clinic fails to maintain adequate medical records - Correct Answer:
Abuse
18. Fraud or Abuse: A clinic bills every new patient at the highest level E/M visit no matter what
- Correct Answer: Fraud
19. Fraud or Abuse: A clinic is found to be falsifying documentation to support a service that
was billed to receive payment - Correct Answer: Fraud
20. Fraud or Abuse: Reporting a diagnosis code that the patient does not have, but is payable
by medicare. - Correct Answer: Fraud
21. According to the privacy rule, what must a business associate and covered entity have in
order to do business? - Correct Answer: A contract
, 22. If a provider is excluded from federal health plans, what does that mean? - Correct
Answer: They many not participate in Medicare, Medicaid, VA programs, or Tricare and They
cannot bill for services or provide services, order services, or prescribe medication to any
beneficiary of a federal plan.
23. What is the purpose of the privacy rule? - Correct Answer: To protect patient privacy
24. A records request is received from a health plan for three dates of service in a chart months
apart. What should the biller do? - Correct Answer: Copy each date of service individually
and send to the health plan.
25. Is a healthcare consulting firm considered a covered entity? - Correct Answer: No
A new radiology company opens in town. The manager calls your practice and offers to pay $20
for every medicare patient you send them for radiology services. What does this offer violate? -
Correct Answer: The Anti-kickback law
How many national priority purposes are under the Privacy rule to disclose PHI without an
individuals authorization? - Correct Answer: 12
What are the 12 national priority purposes under the privacy rule? - Correct Answer: 1.
Required by law
2. Public health activities
3. Victims of abuse / neglect/ domestic violence
4. Health oversight activities
5. Judicial and administrative proceedings
6. Law enforcement purposes
