AAPC CPB - CHAPTER 1: QUESTIONS
A biller at a medical practice notices that all claims contain CPT code 81002. She
questions the nurse who tells her that because they are an OB/Gyn office, they bill
every patient for a urinalysis. What does this violate?
a. False Claim Act
b. Anti-kickback
c. Stark Law
d. Qui Tam Action - ANS - a. False Claim Act
A claim is received by a payer that subsequently requests the medical records for the
date of service on the claim. What procedure should be followed by the practice?
a. Only the date of service on the claim should be sent to the payer
b. The records for the claim can be sent after authorization is received from the patient
c. The entire patient record should be sent as part of HIPAA based on treatment,
payment and operations
d. The payer is required to provide authorization signed from the patient prior to
requesting the medical records - ANS - a. Only the date of service on the claim should
be sent to the payer.
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?
a. Fraud
b. Abuse
c. False claim
d. Malpractice - ANS - b. abuse
(CMS considers abuse to be actions that cause unnecessary costs to a federal
healthcare program, either directly or indirectly. CMS examples of abuse: - Misusing
codes on a claim - Charging excessively for services or supplies - Billing for services
that were not medically necessary - Failure to maintain adequate medical or financial
records - Improper billing practices - Billing Medicare patients a higher fee schedule
than non-Medicare patients)
, A health plan sends a request for medical records to adjudicate a claim. Does the office
have to notify the patient or have them sign a release to send the information?
a. No, since the information is used for payment activities it is not necessary to notify or
obtain authorization from the patient
b. Yes, since PHI is being sent the patient must be notified and approve of the release
c. No, because the office owns the medical record
d. Yes, since it involves payment of a claim - ANS - a. No, since the information is
used for payment activities it is not necessary to notify or obtain authorization from the
patient
A person that files a claim for a Medicare beneficiary knowing that the service is not
correctly reported is in violation of what statute?
a. HIPAA
b. Stark
c. False Claims Act
d. Anti-kickback - ANS - c. False Claims Act
A physician billed claims to Medicare and Medicaid for procedures that were not
performed on 800 patients resulting in a loss of $2.6 million. Is this fraud or abuse?
a. Fraud; subject to the Anti-kickback Statute
b. Fraud; subject to the False Claims Act
c. Abuse; subject only to education of the provider
d. Abuse; subject to the Stark Law - ANS - b. Fraud; subject to the False Claims Act
A physician office (covered entity) discovers that the billing company (Business
Associate) is in breach of their contract. What is the first steps to be taken?
a. Contact HHS and report the billing company
b. Terminate the contract
c. Take steps to correct the problem and end the violation
d. Contact your attorney - ANS - c. Take steps to correct the problem and end the
violation
A physician received office space at a reduced rate for referring patients to the
hospital's outpatient physical therapy center. What law does this violate?
a. Anti-kickback Statute
A biller at a medical practice notices that all claims contain CPT code 81002. She
questions the nurse who tells her that because they are an OB/Gyn office, they bill
every patient for a urinalysis. What does this violate?
a. False Claim Act
b. Anti-kickback
c. Stark Law
d. Qui Tam Action - ANS - a. False Claim Act
A claim is received by a payer that subsequently requests the medical records for the
date of service on the claim. What procedure should be followed by the practice?
a. Only the date of service on the claim should be sent to the payer
b. The records for the claim can be sent after authorization is received from the patient
c. The entire patient record should be sent as part of HIPAA based on treatment,
payment and operations
d. The payer is required to provide authorization signed from the patient prior to
requesting the medical records - ANS - a. Only the date of service on the claim should
be sent to the payer.
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?
a. Fraud
b. Abuse
c. False claim
d. Malpractice - ANS - b. abuse
(CMS considers abuse to be actions that cause unnecessary costs to a federal
healthcare program, either directly or indirectly. CMS examples of abuse: - Misusing
codes on a claim - Charging excessively for services or supplies - Billing for services
that were not medically necessary - Failure to maintain adequate medical or financial
records - Improper billing practices - Billing Medicare patients a higher fee schedule
than non-Medicare patients)
, A health plan sends a request for medical records to adjudicate a claim. Does the office
have to notify the patient or have them sign a release to send the information?
a. No, since the information is used for payment activities it is not necessary to notify or
obtain authorization from the patient
b. Yes, since PHI is being sent the patient must be notified and approve of the release
c. No, because the office owns the medical record
d. Yes, since it involves payment of a claim - ANS - a. No, since the information is
used for payment activities it is not necessary to notify or obtain authorization from the
patient
A person that files a claim for a Medicare beneficiary knowing that the service is not
correctly reported is in violation of what statute?
a. HIPAA
b. Stark
c. False Claims Act
d. Anti-kickback - ANS - c. False Claims Act
A physician billed claims to Medicare and Medicaid for procedures that were not
performed on 800 patients resulting in a loss of $2.6 million. Is this fraud or abuse?
a. Fraud; subject to the Anti-kickback Statute
b. Fraud; subject to the False Claims Act
c. Abuse; subject only to education of the provider
d. Abuse; subject to the Stark Law - ANS - b. Fraud; subject to the False Claims Act
A physician office (covered entity) discovers that the billing company (Business
Associate) is in breach of their contract. What is the first steps to be taken?
a. Contact HHS and report the billing company
b. Terminate the contract
c. Take steps to correct the problem and end the violation
d. Contact your attorney - ANS - c. Take steps to correct the problem and end the
violation
A physician received office space at a reduced rate for referring patients to the
hospital's outpatient physical therapy center. What law does this violate?
a. Anti-kickback Statute
