|ACTUAL
EXAM QUESTIONS WITH WELL DETAILED CORRECT
ANSWERS|GRADED A+|BRAND NEW 2026/2027 UPDATE
Medicare was passed into law under the title XVIII of what Act?
a. HIPAA
b. Stabilization Act
c. HMO
d. Social Security Act - ANSWER d. Social Security Act
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?
a. Anti-Kickback law
b. Stark Laws
c. HIPAA
d. Qui Tam - ANSWER a. Anti-Kickback law
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 covered entity
b. A business associate
c. An employee
d. A clearinghouse - ANSWER b. A business associate
1
,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. Stark case
c. Anti-Kickback
d. Qui Tam - ANSWER d. Qui Tam
What is the standard time frame established for record retention?
a. Seven years
b. The life of the patient
c .Five years
d. There is no single standard record retention, it varies by state and federal regulation -
ANSWER d. There is no single standard record retention, it varies by state and federal
regulation
What entities are exempt from HIPAA and not considered to be covered entities?
a. Workers' compensation
b. Employers with less than 100 employees
c .Church-sponsored plans
d. Sponsored group plans - ANSWER a. Workers' compensation
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
2
,b. HIPAA
c. Social Security Act
d. ADA - ANSWER b. HIPAA
When a patient is enrolled in an HMO, which options below are the responsibilities of the
primary care physician (PCP)?
I. Manage the member's treatment
II. Be the only provider for all of the patient's healthcare
III. Provide referrals to specialists
IV. Approve emergency department visits
V. Provide referrals for inpatient admissions
a. I, II, III
b. I, III, IV
c. I, III, V
d. I, II - ANSWER b. I, III, IV
What is the benefit of using NPI numbers for payers?
I. It is a single identifier for all payers
II. It contains the providers' birthdates to allow certain identification
III. Each payer can make their own number
IV. It has no personal identifying information in the number
a. I, II
b. I, II, IV
c. III, IV
d. I, IV - ANSWER d. I, IV
3
, A group contracts with a third-party administrator to manage paperwork. This group pays for
the operation of the insurance plan and the costs of administration. What type of plan does
this represent?
a. Association Group
b. Management Service Organization
c. Self-Funded ERISA
d. Fully Insured Employer Group - ANSWER c. Self-Funded ERISA
A patient presents for an immunization. When the patient pays his bill, he asks for a receipt
so that he may turn it in to meet his spenddown. What type of coverage does this patient
have?
a. Commercial insurance
b. Medicare
c. Medicaid
d. TRICARE - ANSWER c. Medicaid
What is an insurance plan that provides a gatekeeper to manage the patient's healthcare?
a. HMO
b. IPO
c. PPO
d. Medicaid - ANSWER a. HMO
Which of the following is NOT evaluated in the credentialing process?
a. Physician's residency
b. Physician's request for privileges
4
EXAM QUESTIONS WITH WELL DETAILED CORRECT
ANSWERS|GRADED A+|BRAND NEW 2026/2027 UPDATE
Medicare was passed into law under the title XVIII of what Act?
a. HIPAA
b. Stabilization Act
c. HMO
d. Social Security Act - ANSWER d. Social Security Act
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?
a. Anti-Kickback law
b. Stark Laws
c. HIPAA
d. Qui Tam - ANSWER a. Anti-Kickback law
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 covered entity
b. A business associate
c. An employee
d. A clearinghouse - ANSWER b. A business associate
1
,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. Stark case
c. Anti-Kickback
d. Qui Tam - ANSWER d. Qui Tam
What is the standard time frame established for record retention?
a. Seven years
b. The life of the patient
c .Five years
d. There is no single standard record retention, it varies by state and federal regulation -
ANSWER d. There is no single standard record retention, it varies by state and federal
regulation
What entities are exempt from HIPAA and not considered to be covered entities?
a. Workers' compensation
b. Employers with less than 100 employees
c .Church-sponsored plans
d. Sponsored group plans - ANSWER a. Workers' compensation
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
2
,b. HIPAA
c. Social Security Act
d. ADA - ANSWER b. HIPAA
When a patient is enrolled in an HMO, which options below are the responsibilities of the
primary care physician (PCP)?
I. Manage the member's treatment
II. Be the only provider for all of the patient's healthcare
III. Provide referrals to specialists
IV. Approve emergency department visits
V. Provide referrals for inpatient admissions
a. I, II, III
b. I, III, IV
c. I, III, V
d. I, II - ANSWER b. I, III, IV
What is the benefit of using NPI numbers for payers?
I. It is a single identifier for all payers
II. It contains the providers' birthdates to allow certain identification
III. Each payer can make their own number
IV. It has no personal identifying information in the number
a. I, II
b. I, II, IV
c. III, IV
d. I, IV - ANSWER d. I, IV
3
, A group contracts with a third-party administrator to manage paperwork. This group pays for
the operation of the insurance plan and the costs of administration. What type of plan does
this represent?
a. Association Group
b. Management Service Organization
c. Self-Funded ERISA
d. Fully Insured Employer Group - ANSWER c. Self-Funded ERISA
A patient presents for an immunization. When the patient pays his bill, he asks for a receipt
so that he may turn it in to meet his spenddown. What type of coverage does this patient
have?
a. Commercial insurance
b. Medicare
c. Medicaid
d. TRICARE - ANSWER c. Medicaid
What is an insurance plan that provides a gatekeeper to manage the patient's healthcare?
a. HMO
b. IPO
c. PPO
d. Medicaid - ANSWER a. HMO
Which of the following is NOT evaluated in the credentialing process?
a. Physician's residency
b. Physician's request for privileges
4
