|ACTUAL EXAM
QUESTIONS WITH WELL DETAILED CORRECT ANSWERS|GRADED
A+|BRAND NEW 2026/2027 UPDATE
Health plan, clearinghouses, and any entity transmitting health information is considered by
the Privacy Rule to be a: - ANSWER covered entity
Which of the following is not a covered entity in the Privacy Rule - ANSWER healthcare
consulting firm
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? - ANSWER release reqt to ins co
How many national priority purposes under the Privacy Rules for disclosure of specific PHI
without an individual's authorization or permission? - ANSWER 12
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? -
ANSWER no
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? - ANSWER Truth in Lending Act
Which of the following situations allows release of PHI without authorization from the
patient? - ANSWER workers comp
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
1
,records, improper billing practices, or billing Medicare patients at a higher fee scale that
non-Medicare patients. - ANSWER 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? - ANSWER abuse
According to the Privacy Rule, what health information may not be de-identified? -
ANSWER phys provider number
making false statements or misrepresenting facts to obtain an undeserved benefit or
payment from a federal healthcare program - ANSWER fraud
All the following are considered Fraud, EXCEPT: - ANSWER inadequate med recd
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? - ANSWER breach
What standard transactions is NOT included in EDI and adopted under HIPAA? - ANSWER
waiver of liability
impermissible release or disclosure of information is discovered - ANSWER breach
The Federal False Claim Act allows for claims to be reviewed for a standard of how many
years after an incident? - ANSWER 7
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? - ANSWER anti kickback laws
2
, A private practice hires a consultant to come in and audit some medical records. Under the
Privacy Rule, what is this consultant considered? - ANSWER biz associate
HIPAA mandated what entity to adopt national standards for electronic transactions and
code sets? - ANSWER HHS
Medicare overpayments should be returned within ___ days after the overpayment has
been identified - ANSWER 60
Entities that have been identified as having improper billing practices is defined by CMS as a
violation of what standard? - ANSWER abuse
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? - ANSWER unique id
A person that files a claim for a Medicare beneficiary knowing that the service is not
correctly reported is in violation of what statute? - ANSWER False Claims Act
Medicare was passed into law under the title XVIII of what Act? - ANSWER SS Act
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? - ANSWER fraud
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? - ANSWER qui tam
3
QUESTIONS WITH WELL DETAILED CORRECT ANSWERS|GRADED
A+|BRAND NEW 2026/2027 UPDATE
Health plan, clearinghouses, and any entity transmitting health information is considered by
the Privacy Rule to be a: - ANSWER covered entity
Which of the following is not a covered entity in the Privacy Rule - ANSWER healthcare
consulting firm
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? - ANSWER release reqt to ins co
How many national priority purposes under the Privacy Rules for disclosure of specific PHI
without an individual's authorization or permission? - ANSWER 12
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? -
ANSWER no
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? - ANSWER Truth in Lending Act
Which of the following situations allows release of PHI without authorization from the
patient? - ANSWER workers comp
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
1
,records, improper billing practices, or billing Medicare patients at a higher fee scale that
non-Medicare patients. - ANSWER 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? - ANSWER abuse
According to the Privacy Rule, what health information may not be de-identified? -
ANSWER phys provider number
making false statements or misrepresenting facts to obtain an undeserved benefit or
payment from a federal healthcare program - ANSWER fraud
All the following are considered Fraud, EXCEPT: - ANSWER inadequate med recd
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? - ANSWER breach
What standard transactions is NOT included in EDI and adopted under HIPAA? - ANSWER
waiver of liability
impermissible release or disclosure of information is discovered - ANSWER breach
The Federal False Claim Act allows for claims to be reviewed for a standard of how many
years after an incident? - ANSWER 7
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? - ANSWER anti kickback laws
2
, A private practice hires a consultant to come in and audit some medical records. Under the
Privacy Rule, what is this consultant considered? - ANSWER biz associate
HIPAA mandated what entity to adopt national standards for electronic transactions and
code sets? - ANSWER HHS
Medicare overpayments should be returned within ___ days after the overpayment has
been identified - ANSWER 60
Entities that have been identified as having improper billing practices is defined by CMS as a
violation of what standard? - ANSWER abuse
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? - ANSWER unique id
A person that files a claim for a Medicare beneficiary knowing that the service is not
correctly reported is in violation of what statute? - ANSWER False Claims Act
Medicare was passed into law under the title XVIII of what Act? - ANSWER SS Act
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? - ANSWER fraud
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? - ANSWER qui tam
3
