American Academy of Professional Coders
(AAPC) questions and answers
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
Entities that have been identified as having improper billing practices is defined by CMS as a
violation of what standard? - ANSWER>>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. - 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
impermissible release or disclosure of information is discovered - ANSWER>>breach
What standard transactions is NOT included in EDI and adopted under HIPAA? -
ANSWER>>waiver of liability
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
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
Medicare overpayments should be returned within ___ days after the overpayment has been
identified - ANSWER>>60
HIPAA mandated what entity to adopt national standards for electronic transactions and code
sets? - ANSWER>>HHS
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
OIG, CMS, and Department of Justice are the government agencies enforcing ________. -
ANSWER>>fed abuse and fraud laws
A practice allows patients to pay large balances over a six month time period with a finance
charge applied. The patient receives a statement every month that only shows the unpaid
balance. What does this violate? - ANSWER>>TILA
An insurance plan that provides a gatekeeper to manage the patient's health care is known as
a/an - ANSWER>>HMO
a corporate umbrella for management of diversified healthcare delivery systems -
ANSWER>>IPO
An employee has signed up for a program through her employer. It allows her to put pre-tax
money away from her paycheck in order to pay for out-of-pocket healthcare expenses. She may
contribute up to $2650 (2018) per year. If she does not use all of the money during the current
year, she forfeits it. What is this? - ANSWER>>FSA
Which option is not considered an MCO? - ANSWER>>HSA
(AAPC) questions and answers
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
Entities that have been identified as having improper billing practices is defined by CMS as a
violation of what standard? - ANSWER>>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. - 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
impermissible release or disclosure of information is discovered - ANSWER>>breach
What standard transactions is NOT included in EDI and adopted under HIPAA? -
ANSWER>>waiver of liability
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
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
Medicare overpayments should be returned within ___ days after the overpayment has been
identified - ANSWER>>60
HIPAA mandated what entity to adopt national standards for electronic transactions and code
sets? - ANSWER>>HHS
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
OIG, CMS, and Department of Justice are the government agencies enforcing ________. -
ANSWER>>fed abuse and fraud laws
A practice allows patients to pay large balances over a six month time period with a finance
charge applied. The patient receives a statement every month that only shows the unpaid
balance. What does this violate? - ANSWER>>TILA
An insurance plan that provides a gatekeeper to manage the patient's health care is known as
a/an - ANSWER>>HMO
a corporate umbrella for management of diversified healthcare delivery systems -
ANSWER>>IPO
An employee has signed up for a program through her employer. It allows her to put pre-tax
money away from her paycheck in order to pay for out-of-pocket healthcare expenses. She may
contribute up to $2650 (2018) per year. If she does not use all of the money during the current
year, she forfeits it. What is this? - ANSWER>>FSA
Which option is not considered an MCO? - ANSWER>>HSA
