AAPC CPB FINAL EXAM 2025
QUESTIONS AND ANSWERS
,Medicare was passed into law under the title XVIII of what Act?
a. HIPAA
b. Stabilization Act
c. HMO
d. Social Security Act
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
a. Anti-Kickback law
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
d. Qui Tam
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
b. A business associate
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
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
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
b. HIPAA
c. Social Security Act
d. ADA
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
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
d. I, IV
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
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
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
a. HMO
A patient presenting for care does not have an insurance card and is billed
CPT® code 99213 for $100. The patient pays $100 to the provider. A week later,
the patient presents verification of coverage through Medicaid for this date of
service. What process should be followed?
a. Nothing needs to be done
b. File a claim to Medicaid and refund the $100 to the patient
c. File a claim with Medicaid, a refund will be completed when the EOB is
received showing the patients responsibility
d. None of the above
c. File a claim with Medicaid, a refund will be completed when the EOB
is received showing the patients responsibility
Which of the following is NOT evaluated in the credentialing process?
a. Physician's residency
b. Physician's request for privileges
c. Physician's license(s)
d. Physician's education
b. Physician's request for privileges
Review the insurance card and patient registration form below:
What information could cause a potential problem?
a. Employer is not listed
b. Date of birth is incorrect
QUESTIONS AND ANSWERS
,Medicare was passed into law under the title XVIII of what Act?
a. HIPAA
b. Stabilization Act
c. HMO
d. Social Security Act
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
a. Anti-Kickback law
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
d. Qui Tam
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
b. A business associate
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
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
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
b. HIPAA
c. Social Security Act
d. ADA
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
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
d. I, IV
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
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
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
a. HMO
A patient presenting for care does not have an insurance card and is billed
CPT® code 99213 for $100. The patient pays $100 to the provider. A week later,
the patient presents verification of coverage through Medicaid for this date of
service. What process should be followed?
a. Nothing needs to be done
b. File a claim to Medicaid and refund the $100 to the patient
c. File a claim with Medicaid, a refund will be completed when the EOB is
received showing the patients responsibility
d. None of the above
c. File a claim with Medicaid, a refund will be completed when the EOB
is received showing the patients responsibility
Which of the following is NOT evaluated in the credentialing process?
a. Physician's residency
b. Physician's request for privileges
c. Physician's license(s)
d. Physician's education
b. Physician's request for privileges
Review the insurance card and patient registration form below:
What information could cause a potential problem?
a. Employer is not listed
b. Date of birth is incorrect
