|ACTUAL
EXAM QUESTIONS WITH WELL DETAILED CORRECT
ANSWERS|GRADED A+|BRAND NEW 2026/2027 UPDATE
HIPPA OF 1996 includes a security rule that is established to provide what national stands for
protecting and transmitting patient data. Which of the following is NOT true?
A) The security rule applies to healthcare providers, health plans, and any covered entity
involved in the care of a patient.
B) The security role applies only to the Institute that initiates the release of protected health
information
C) Standards for storing transmitting patient data and electronic form include portable
electronic devices
D) The security rule states that safeguards must be in place to prevent unsecured release of
information - ANSWER B
Eight standard transactions were adopted for electronic data, interchange under HIPAA
which of the following is not included as a standard transaction
A) payment and remittance advice
B) eligibility in a health plan
C) coordination of benefits
D) physician unique identify number - ANSWER D
A claim is received by a payer that subsequently request the medical records for the date of
service on the claim what procedure should be followed by the practice? - ANSWER Only
the date of service on the claim should be sent to the payer. The records can be sent as part
of HIPAA based on treatment payment and operations.
HIPAA requires that privacy practice notices be provided in several circumstances, which of
the following is not required
A) must be available on any website that practice maintains
B) must be provided upon request
1
,C) must be presented to all patients
D) must be placed into the patient's file - ANSWER D
When is subpoena is received by the practice for medical records, and what circumstances
may the records be released according to the HIPAA privacy rule
A) the subpoena allows for the release of the medical records
B) this subpoena is accompanied by a court order, or the patient is notified, and given a
chance to object
C) the individual must sign an authorization for release at the information
D) records cannot be released under any circumstances based on the subpoena -
ANSWER B
A physician received office space at a reduced rate for referring patients to the hospitals,
outpatient physical therapy center. What law does this violate? - ANSWER Anti-Kickback
Statute
One of the most severe penalties that can be associated with violations at the Social Security
act is exclusion from federal healthcare plans, which of the following statements is true of
excluded individuals?
A) physicians that have been excluded can build the patient for services, but cannot bill
federal health plans
B) physicians that have been excluded can refer further patients to other facilities for
treatment
C) physicians that have been excluded or prohibited from billing for any service to a federally
administered health plan
D) physicians that have been excluded are exempt from billing for services, but are allowed
to write prescriptions and order tests - ANSWER C
Federal healthcare plans include what payers? - ANSWER Medicare, Medicaid, Tricare
2
, A physician built claims to Medicare and Medicaid for procedures that were not performed
on 800 patients resulting in loss of $2.6 million. Is this fraud or abuse? - ANSWER Fraud;
subject to the false claims act
The regulation of finance charges or interest, applied to outstanding balances, and medical
practice is under what law? - ANSWER Truth in Lending Act
What type of insurance is paid for by employers for employees and takes advantage of
purchasing power of having large member numbers? - ANSWER Group Health Plan
An internist sees a 20-year-old patient for an office visit. The patient needs to see an
endocrinologist for a consultation regarding her diabetes. The internist is a participating
provider in her plan. She can choose any provider she wishes for her consultation, but she
will save money if she sees a specialist that is in her network. She does not require a referral
for her consultation. What type of insurance does the patient have? - ANSWER PPO
What are the options for a provider with regards to participation with Medicare? -
ANSWER Providers may participate, may choose not to participate, or may opt-out of
Medicare
A family practitioner sees a Medicare patient and bills a 99213. This provider has opted out
of Medicare. His fee for the service is $125. Medicare's approved amount is $73.08 and the
patient has met $0 of his deductible. What can the provider bill a patient? - ANSWER
$125.00
Under the patient protection in affordable care act what is banned? - ANSWER Lifetime
limits
A Medicaid patient presents for services on the first day of the month. He has a $50
spenddown he's had no services this month. The visit for today was $100. If the patient
wants to be covered as long as possible from today's visit, what can he do? - ANSWER
Turn the receipt into his caseworker and be eligible for two months of coverage
3
EXAM QUESTIONS WITH WELL DETAILED CORRECT
ANSWERS|GRADED A+|BRAND NEW 2026/2027 UPDATE
HIPPA OF 1996 includes a security rule that is established to provide what national stands for
protecting and transmitting patient data. Which of the following is NOT true?
A) The security rule applies to healthcare providers, health plans, and any covered entity
involved in the care of a patient.
B) The security role applies only to the Institute that initiates the release of protected health
information
C) Standards for storing transmitting patient data and electronic form include portable
electronic devices
D) The security rule states that safeguards must be in place to prevent unsecured release of
information - ANSWER B
Eight standard transactions were adopted for electronic data, interchange under HIPAA
which of the following is not included as a standard transaction
A) payment and remittance advice
B) eligibility in a health plan
C) coordination of benefits
D) physician unique identify number - ANSWER D
A claim is received by a payer that subsequently request the medical records for the date of
service on the claim what procedure should be followed by the practice? - ANSWER Only
the date of service on the claim should be sent to the payer. The records can be sent as part
of HIPAA based on treatment payment and operations.
HIPAA requires that privacy practice notices be provided in several circumstances, which of
the following is not required
A) must be available on any website that practice maintains
B) must be provided upon request
1
,C) must be presented to all patients
D) must be placed into the patient's file - ANSWER D
When is subpoena is received by the practice for medical records, and what circumstances
may the records be released according to the HIPAA privacy rule
A) the subpoena allows for the release of the medical records
B) this subpoena is accompanied by a court order, or the patient is notified, and given a
chance to object
C) the individual must sign an authorization for release at the information
D) records cannot be released under any circumstances based on the subpoena -
ANSWER B
A physician received office space at a reduced rate for referring patients to the hospitals,
outpatient physical therapy center. What law does this violate? - ANSWER Anti-Kickback
Statute
One of the most severe penalties that can be associated with violations at the Social Security
act is exclusion from federal healthcare plans, which of the following statements is true of
excluded individuals?
A) physicians that have been excluded can build the patient for services, but cannot bill
federal health plans
B) physicians that have been excluded can refer further patients to other facilities for
treatment
C) physicians that have been excluded or prohibited from billing for any service to a federally
administered health plan
D) physicians that have been excluded are exempt from billing for services, but are allowed
to write prescriptions and order tests - ANSWER C
Federal healthcare plans include what payers? - ANSWER Medicare, Medicaid, Tricare
2
, A physician built claims to Medicare and Medicaid for procedures that were not performed
on 800 patients resulting in loss of $2.6 million. Is this fraud or abuse? - ANSWER Fraud;
subject to the false claims act
The regulation of finance charges or interest, applied to outstanding balances, and medical
practice is under what law? - ANSWER Truth in Lending Act
What type of insurance is paid for by employers for employees and takes advantage of
purchasing power of having large member numbers? - ANSWER Group Health Plan
An internist sees a 20-year-old patient for an office visit. The patient needs to see an
endocrinologist for a consultation regarding her diabetes. The internist is a participating
provider in her plan. She can choose any provider she wishes for her consultation, but she
will save money if she sees a specialist that is in her network. She does not require a referral
for her consultation. What type of insurance does the patient have? - ANSWER PPO
What are the options for a provider with regards to participation with Medicare? -
ANSWER Providers may participate, may choose not to participate, or may opt-out of
Medicare
A family practitioner sees a Medicare patient and bills a 99213. This provider has opted out
of Medicare. His fee for the service is $125. Medicare's approved amount is $73.08 and the
patient has met $0 of his deductible. What can the provider bill a patient? - ANSWER
$125.00
Under the patient protection in affordable care act what is banned? - ANSWER Lifetime
limits
A Medicaid patient presents for services on the first day of the month. He has a $50
spenddown he's had no services this month. The visit for today was $100. If the patient
wants to be covered as long as possible from today's visit, what can he do? - ANSWER
Turn the receipt into his caseworker and be eligible for two months of coverage
3
