AAPC CPB FINAL EXAM PREP WITH 200 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES NEW UPDATE!!!!!!!!!!!!!!!!!
The patient encounter begins with what step?
A. Patient information
B. Charge entry
C. Scheduling an appointment
D. Submitting a claim - ANS... -C. Scheduling an appointment
Rationale: All the above processes are necessary for an encounter — the
scheduling of the appointment is the initial step of the patient encounter
Listed below are examples of patient reminders for appointments. Which one is
HIPAA compliant?
A. "This is the obstetrical office calling to remind you of your appointment
Tuesday, April 12 at 9 am for your annual exam."
B. "This is Dr. Smith's office calling to remind you of your appointment Tuesday,
April 12 at 9 am for your annual exam."
C. "This is to confirm your appointment for your first prenatal visit with Dr. Jones.
Please notify us if you are not able to keep this appointment."
D. "This is the doctor's office calling to remind you of your appointment Tuesday,
April 12 at 9 am." - ANS... -D. "This is the doctor's office calling to remind you of
your appointment Tuesday, April 12 at 9 am."
HIPAA allows calls to verify appointments but the information should be the
minimum necessary to accomplish the task. Giving the reason for the
appointments, is not necessary.
A child is brought in by the mother to be seen. The mother (DOB 02/08/93) is the
custodial parent and is remarried. She has an individual policy. The father (DOB
10/10/92) is covered by a policy from work. The step-father is also covered at
work. Which of the following is correct?
A. The mother's insurance is primary
B. The step-parent is primary
C. The father is always primary
D. Either the mother or the father can be primary - ANS... -A. The mother's
insurance is primary
In divorce cases where the custodial parent has remarried—The custodial parent
coverage is primary, with the step-parent being secondary. The non-custodial
parent is the payer of last resort.
,HIPAA Section 164.508 states that covered entities may not use or disclose
protected information without a valid authorization. In what circumstances can a
practice NOT release protected information with a signed authorization?
A. Records sent to a physician asked to consult with the patient
B. Payment of claims
C. Records requested by the health department for communicable diseases
D. Records requested for life insurance - ANS... -D. Records requested for life
insurance
HIPAA allows for release of records for treatment of the patient, payment of
claims, and clinical operations. It does not allow for release of records for life
insurance. This would need to be authorized by the patient
Patient is seen and billed for a 99213 for $75.00. She has a policy that pays 80% of
the allowable amount which is $68.00. What is the patient responsibility and
amount to collect for the visit?
A.$10.00
B. $61.40
C.$13.60
D. $15.00 - ANS... -C.$13.60
Rationale: Policy pays 80% of $68 (contracted amount) with 20% of $68 being
patient responsibility, $13.60.
Which statement regarding patient demographic information is correct?
A. Patients can provide information by completing a paper form or by completing
online registration.
B. The patient will always be the responsible party.
C. The patient does not need to provide all information on the registration form. D.
There is no need for a copy of the insurance card if the patient demographic sheet
is completed in its entirety. - ANS... -A. Patients can provide information by
completing a paper form or by completing online registration.
Rationale: Registration forms must be completed in their entirety. If the patient is a
child, the parent(s) or guardian(s) is the responsible party. Maintaining a copy of
the insurance card helps the event of data entry errors. Registration forms may be
completed on paper or via an online registration form.
Information about deductibles, copays, eligibility dates, and benefit plans is
completed during what step?
A. Patient check-in
,B. Patient registration
C. Consent for payment
D. Verification of Benefits - ANS... -D. Verification of Benefits
Rationale: Verification of benefits provides information concerning the patient's
coverage. This should be performed during the appointment scheduling process
and before the patient arrives at the office. This step verifies eligibility effective
dates, patient coinsurance, copay and deductible amounts; and plan benefits as they
pertain to specialty and place of service. Benefit information allows staff to be
informed and ready to collect the appropriate copay, deductible, coinsurance or full
balance due at the patient's visit.
Which software system is used to store appointments, scheduling, registration, and
billing and receivables?
A. Electronic Medical Record (EMR)
B. Practice Management System (PMS) C. Electronic Health Record (EHR)
D. Health Information Management System - ANS... -B. Practice Management
System (PMS)
Rationale: Practice management system (PMS) is software used by physicians for
scheduling, registration, billing, and receivables management
What process would NOT be performed at the check-out process?
A. Patient registration process
B. Follow-up appointments
C. Review of charge ticket or encounter form
D. Collection of copays or deductibles - ANS... -A. Patient registration process
Rationale: Patient registration should be completed at the start of the visit, or at
check-in. Copays and deductibles can be collected at check-in or check-out.
A private practice hires a consultant to come in and audit some medical
records. Under the Privacy Rule, what is this consultant considered?
A. A business associate
B. An employee
C. A covered entity
D. A clearinghouse - ANS... -A. A business associate
Business associates perform certain functions or activities, which involve the use
or disclosure of individually identifiable health information, on behalf of another
person or organization. These services include claims processing or administration,
data analysis, utilization review, billing, benefit management, and re-pricing.
, Because the consultant will be auditing medical records, PHI will need to be
shared from the practice. The practice would be the covered entity
A practice agrees to pay $250,000 to settle a lawsuit alleging that the practice used
X-rays of one patient to justify services on multiple other patients' claims. The
manager of the office brought the civil suit. What type of case is this?
A. HIPAA
B. Qui Tam
C. Anti-Kickback
D. Stark case - ANS... -B. Qui Tam
A Qui Tam case is also known as a whistleblower case. If an individual knows of a
violation of the FCA, he or she may bring a civil action on behalf of him or herself
and on behalf of the U.S. government (such an individual is called a relator)
A patient is seen in your clinic. Her husband calls later in the day to ask for
information about the visit. The practice pulls the patient's privacy authorization to
see if they can speak to the husband. What act does this action fall under?
A. Health Information Act
B. Social Security Act
C. HIPAA
D. ADA - ANS... -C. HIPAA
The Privacy Act is under HIPAA and protects the health information of the patient.
According to HIPAA, for the practice to release information to the husband, the
patient would have to have signed an authorization.
Which of the following situations allows the release of PHI without authorization
from the patient?
A. Request for life insurance
B. Request from family member
C. Physician's office to release to a family member
D. Workers' compensation - ANS... -D. Workers' compensation
Workers' compensation is listed as one of the exceptions permitted by the Privacy
rule for use and disclosure of information.
Billing for a lower level of care than is supported in documentation, making false
statements to obtain undeserved benefits or payment from a federal healthcare
CORRECT ANSWERS WITH RATIONALES NEW UPDATE!!!!!!!!!!!!!!!!!
The patient encounter begins with what step?
A. Patient information
B. Charge entry
C. Scheduling an appointment
D. Submitting a claim - ANS... -C. Scheduling an appointment
Rationale: All the above processes are necessary for an encounter — the
scheduling of the appointment is the initial step of the patient encounter
Listed below are examples of patient reminders for appointments. Which one is
HIPAA compliant?
A. "This is the obstetrical office calling to remind you of your appointment
Tuesday, April 12 at 9 am for your annual exam."
B. "This is Dr. Smith's office calling to remind you of your appointment Tuesday,
April 12 at 9 am for your annual exam."
C. "This is to confirm your appointment for your first prenatal visit with Dr. Jones.
Please notify us if you are not able to keep this appointment."
D. "This is the doctor's office calling to remind you of your appointment Tuesday,
April 12 at 9 am." - ANS... -D. "This is the doctor's office calling to remind you of
your appointment Tuesday, April 12 at 9 am."
HIPAA allows calls to verify appointments but the information should be the
minimum necessary to accomplish the task. Giving the reason for the
appointments, is not necessary.
A child is brought in by the mother to be seen. The mother (DOB 02/08/93) is the
custodial parent and is remarried. She has an individual policy. The father (DOB
10/10/92) is covered by a policy from work. The step-father is also covered at
work. Which of the following is correct?
A. The mother's insurance is primary
B. The step-parent is primary
C. The father is always primary
D. Either the mother or the father can be primary - ANS... -A. The mother's
insurance is primary
In divorce cases where the custodial parent has remarried—The custodial parent
coverage is primary, with the step-parent being secondary. The non-custodial
parent is the payer of last resort.
,HIPAA Section 164.508 states that covered entities may not use or disclose
protected information without a valid authorization. In what circumstances can a
practice NOT release protected information with a signed authorization?
A. Records sent to a physician asked to consult with the patient
B. Payment of claims
C. Records requested by the health department for communicable diseases
D. Records requested for life insurance - ANS... -D. Records requested for life
insurance
HIPAA allows for release of records for treatment of the patient, payment of
claims, and clinical operations. It does not allow for release of records for life
insurance. This would need to be authorized by the patient
Patient is seen and billed for a 99213 for $75.00. She has a policy that pays 80% of
the allowable amount which is $68.00. What is the patient responsibility and
amount to collect for the visit?
A.$10.00
B. $61.40
C.$13.60
D. $15.00 - ANS... -C.$13.60
Rationale: Policy pays 80% of $68 (contracted amount) with 20% of $68 being
patient responsibility, $13.60.
Which statement regarding patient demographic information is correct?
A. Patients can provide information by completing a paper form or by completing
online registration.
B. The patient will always be the responsible party.
C. The patient does not need to provide all information on the registration form. D.
There is no need for a copy of the insurance card if the patient demographic sheet
is completed in its entirety. - ANS... -A. Patients can provide information by
completing a paper form or by completing online registration.
Rationale: Registration forms must be completed in their entirety. If the patient is a
child, the parent(s) or guardian(s) is the responsible party. Maintaining a copy of
the insurance card helps the event of data entry errors. Registration forms may be
completed on paper or via an online registration form.
Information about deductibles, copays, eligibility dates, and benefit plans is
completed during what step?
A. Patient check-in
,B. Patient registration
C. Consent for payment
D. Verification of Benefits - ANS... -D. Verification of Benefits
Rationale: Verification of benefits provides information concerning the patient's
coverage. This should be performed during the appointment scheduling process
and before the patient arrives at the office. This step verifies eligibility effective
dates, patient coinsurance, copay and deductible amounts; and plan benefits as they
pertain to specialty and place of service. Benefit information allows staff to be
informed and ready to collect the appropriate copay, deductible, coinsurance or full
balance due at the patient's visit.
Which software system is used to store appointments, scheduling, registration, and
billing and receivables?
A. Electronic Medical Record (EMR)
B. Practice Management System (PMS) C. Electronic Health Record (EHR)
D. Health Information Management System - ANS... -B. Practice Management
System (PMS)
Rationale: Practice management system (PMS) is software used by physicians for
scheduling, registration, billing, and receivables management
What process would NOT be performed at the check-out process?
A. Patient registration process
B. Follow-up appointments
C. Review of charge ticket or encounter form
D. Collection of copays or deductibles - ANS... -A. Patient registration process
Rationale: Patient registration should be completed at the start of the visit, or at
check-in. Copays and deductibles can be collected at check-in or check-out.
A private practice hires a consultant to come in and audit some medical
records. Under the Privacy Rule, what is this consultant considered?
A. A business associate
B. An employee
C. A covered entity
D. A clearinghouse - ANS... -A. A business associate
Business associates perform certain functions or activities, which involve the use
or disclosure of individually identifiable health information, on behalf of another
person or organization. These services include claims processing or administration,
data analysis, utilization review, billing, benefit management, and re-pricing.
, Because the consultant will be auditing medical records, PHI will need to be
shared from the practice. The practice would be the covered entity
A practice agrees to pay $250,000 to settle a lawsuit alleging that the practice used
X-rays of one patient to justify services on multiple other patients' claims. The
manager of the office brought the civil suit. What type of case is this?
A. HIPAA
B. Qui Tam
C. Anti-Kickback
D. Stark case - ANS... -B. Qui Tam
A Qui Tam case is also known as a whistleblower case. If an individual knows of a
violation of the FCA, he or she may bring a civil action on behalf of him or herself
and on behalf of the U.S. government (such an individual is called a relator)
A patient is seen in your clinic. Her husband calls later in the day to ask for
information about the visit. The practice pulls the patient's privacy authorization to
see if they can speak to the husband. What act does this action fall under?
A. Health Information Act
B. Social Security Act
C. HIPAA
D. ADA - ANS... -C. HIPAA
The Privacy Act is under HIPAA and protects the health information of the patient.
According to HIPAA, for the practice to release information to the husband, the
patient would have to have signed an authorization.
Which of the following situations allows the release of PHI without authorization
from the patient?
A. Request for life insurance
B. Request from family member
C. Physician's office to release to a family member
D. Workers' compensation - ANS... -D. Workers' compensation
Workers' compensation is listed as one of the exceptions permitted by the Privacy
rule for use and disclosure of information.
Billing for a lower level of care than is supported in documentation, making false
statements to obtain undeserved benefits or payment from a federal healthcare
