AAPC CPB Final Exam | UPDATED Questions with 100% Correct Answers
covered entity - Health plan, clearinghouses, and any entity transmitting health
information is considered by the Privacy Rule to be a:
healthcare consulting firm - Which of the following is not a covered entity in the Privacy
Rule
release reqt to ins co - A request for medical records is received for a specific date of
service from patient's insurance company with regards to a submitted claim. No authorization
for release of information is provided. What action should be taken?
12 - How many national priority purposes under the Privacy Rules for disclosure of
specific PHI without an individual's authorization or permission?
no - 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?
Truth in Lending Act - A practice sets up a payment plan with a patient. If more than four
installments are extended to the patient, what regulation is the practice subject to that makes
the practice a creditor?
workers comp - Which of the following situations allows release of PHI without
authorization from the patient?
abuse - Entities that have been identified as having improper billing practices is defined
by CMS as a violation of what standard?
abuse - misusing any information on the claim, charging excessively for services or
supplies, billing for services not medically necessary, failure to maintain adequate medical or
,financial records, improper billing practices, or billing Medicare patients at a higher fee scale
that non-Medicare patients.
abuse - A claim is submitted for a patient on Medicare with a higher fee than a patient on
Insurance ABC. What is this considered by CMS?
phys provider number - According to the Privacy Rule, what health information may not
be de-identified?
fraud - making false statements or misrepresenting facts to obtain an undeserved benefit
or payment from a federal healthcare program
inadequate med recd - All the following are considered Fraud, EXCEPT:
breach - 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 to 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?
breach - impermissible release or disclosure of information is discovered
waiver of liability - What standard transactions is NOT included in EDI and adopted under
HIPAA?
7- The Federal False Claim Act allows for claims to be reviewed for a standard of how
many years after an incident?
, anti kickback laws - A new radiology company opens in town. The manager calls your
practice and offers to pay $20 for every Medicare patient you send to them for radiology
services. What does this offer violate?
biz associate - A private practice hires a consultant to come in and audit some medical
records. Under the Privacy Rule, what is this consultant considered?
60 - Medicare overpayments should be returned within ___ days after the overpayment
has been identified
HHS - HIPAA mandated what entity to adopt national standards for electronic
transactions and code sets?
abuse - Entities that have been identified as having improper billing practices is defined
by CMS as a violation of what standard?
unique id - In addition to the standardization of the codes (ICD-10, CPT, HCPCS, and NDC)
used to request payment for medical services, what must be used on all transactions for
employers and providers?
False Claims Act - A person that files a claim for a Medicare beneficiary knowing that the
service is not correctly reported is in violation of what statute?
SS Act - Medicare was passed into law under the title XVIII of what Act?
fraud - While working in a large practice, Medicare overpayments 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?
covered entity - Health plan, clearinghouses, and any entity transmitting health
information is considered by the Privacy Rule to be a:
healthcare consulting firm - Which of the following is not a covered entity in the Privacy
Rule
release reqt to ins co - A request for medical records is received for a specific date of
service from patient's insurance company with regards to a submitted claim. No authorization
for release of information is provided. What action should be taken?
12 - How many national priority purposes under the Privacy Rules for disclosure of
specific PHI without an individual's authorization or permission?
no - 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?
Truth in Lending Act - A practice sets up a payment plan with a patient. If more than four
installments are extended to the patient, what regulation is the practice subject to that makes
the practice a creditor?
workers comp - Which of the following situations allows release of PHI without
authorization from the patient?
abuse - Entities that have been identified as having improper billing practices is defined
by CMS as a violation of what standard?
abuse - misusing any information on the claim, charging excessively for services or
supplies, billing for services not medically necessary, failure to maintain adequate medical or
,financial records, improper billing practices, or billing Medicare patients at a higher fee scale
that non-Medicare patients.
abuse - A claim is submitted for a patient on Medicare with a higher fee than a patient on
Insurance ABC. What is this considered by CMS?
phys provider number - According to the Privacy Rule, what health information may not
be de-identified?
fraud - making false statements or misrepresenting facts to obtain an undeserved benefit
or payment from a federal healthcare program
inadequate med recd - All the following are considered Fraud, EXCEPT:
breach - 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 to 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?
breach - impermissible release or disclosure of information is discovered
waiver of liability - What standard transactions is NOT included in EDI and adopted under
HIPAA?
7- The Federal False Claim Act allows for claims to be reviewed for a standard of how
many years after an incident?
, anti kickback laws - A new radiology company opens in town. The manager calls your
practice and offers to pay $20 for every Medicare patient you send to them for radiology
services. What does this offer violate?
biz associate - A private practice hires a consultant to come in and audit some medical
records. Under the Privacy Rule, what is this consultant considered?
60 - Medicare overpayments should be returned within ___ days after the overpayment
has been identified
HHS - HIPAA mandated what entity to adopt national standards for electronic
transactions and code sets?
abuse - Entities that have been identified as having improper billing practices is defined
by CMS as a violation of what standard?
unique id - In addition to the standardization of the codes (ICD-10, CPT, HCPCS, and NDC)
used to request payment for medical services, what must be used on all transactions for
employers and providers?
False Claims Act - A person that files a claim for a Medicare beneficiary knowing that the
service is not correctly reported is in violation of what statute?
SS Act - Medicare was passed into law under the title XVIII of what Act?
fraud - While working in a large practice, Medicare overpayments 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?
