AAPC CPB Final Exam
1. Medicare was passed into law under the title XVIII of d. Social Security Act
what Act?
a. HIPAA
b. Stabilization Act
c. HMO
d. Social Security Act
2. A new radiology company opens in town. The manag- a. Anti-Kickback law
er calls your practice and offers to pay $20 for every
Medicare patient you send to them for radiology ser-
vices. What does this offer violate?
a. Anti-Kickback law
b. Stark Laws
c. HIPAA
d. Qui Tam
3. A practice agrees to pay $250,000 to settle a lawsuit d. Qui Tam
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
4. A private practice hires a consultant to come in and b. A business associate
audit some medical records. Under the Privacy Rule,
what is this consultant considered?
a. A covered entity
, AAPC CPB Final Exam
b. A business associate
c. An employee
d. A clearinghouse
5. What is the standard time frame established for d. There is no single stan-
record retention? dard record retention, it
varies by state and federal
a. Seven years regulation
b. The life of the patient
c .Five years
d. There is no single standard record retention, it
varies by state and federal regulation
6. What entities are exempt from HIPAA and not consid- a. Workers' compensation
ered to be covered entities?
a. Workers' compensation
b. Employers with less than 100 employees
c .Church-sponsored plans
d. Sponsored group plans
7. A patient is seen in your clinic. Her husband calls later b. HIPAA
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
8. b. I, III, IV
, AAPC CPB Final Exam
When a patient is enrolled in an HMO, which op-
tions 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 health-
care
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
9. What is the benefit of using NPI numbers for payers? d. I, IV
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
10. A group contracts with a third-party administrator to c. Self-Funded ERISA
manage paperwork. This group pays for the operation
of the insurance plan and the costs of administration.
What type of plan does this represent?
, AAPC CPB Final Exam
a. Association Group
b. Management Service Organization
c. Self-Funded ERISA
d. Fully Insured Employer Group
11. A patient presents for an immunization. When the c. Medicaid
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
12. What is an insurance plan that provides a gatekeeper a. HMO
to manage the patient's healthcare?
a. HMO
b. IPO
c. PPO
d. Medicaid
13. A patient presenting for care does not have an insur- c. File a claim with Medic-
ance card and is billed CPT® code 99213 for $100. aid, a refund will be com-
The patient pays $100 to the provider. A week later, pleted when the EOB is
the patient presents verification of coverage through received showing the pa-
Medicaid for this date of service. What process should tients responsibility
be followed?
a. Nothing needs to be done
b. File a claim to Medicaid and refund the $100 to the
1. Medicare was passed into law under the title XVIII of d. Social Security Act
what Act?
a. HIPAA
b. Stabilization Act
c. HMO
d. Social Security Act
2. A new radiology company opens in town. The manag- a. Anti-Kickback law
er calls your practice and offers to pay $20 for every
Medicare patient you send to them for radiology ser-
vices. What does this offer violate?
a. Anti-Kickback law
b. Stark Laws
c. HIPAA
d. Qui Tam
3. A practice agrees to pay $250,000 to settle a lawsuit d. Qui Tam
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
4. A private practice hires a consultant to come in and b. A business associate
audit some medical records. Under the Privacy Rule,
what is this consultant considered?
a. A covered entity
, AAPC CPB Final Exam
b. A business associate
c. An employee
d. A clearinghouse
5. What is the standard time frame established for d. There is no single stan-
record retention? dard record retention, it
varies by state and federal
a. Seven years regulation
b. The life of the patient
c .Five years
d. There is no single standard record retention, it
varies by state and federal regulation
6. What entities are exempt from HIPAA and not consid- a. Workers' compensation
ered to be covered entities?
a. Workers' compensation
b. Employers with less than 100 employees
c .Church-sponsored plans
d. Sponsored group plans
7. A patient is seen in your clinic. Her husband calls later b. HIPAA
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
8. b. I, III, IV
, AAPC CPB Final Exam
When a patient is enrolled in an HMO, which op-
tions 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 health-
care
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
9. What is the benefit of using NPI numbers for payers? d. I, IV
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
10. A group contracts with a third-party administrator to c. Self-Funded ERISA
manage paperwork. This group pays for the operation
of the insurance plan and the costs of administration.
What type of plan does this represent?
, AAPC CPB Final Exam
a. Association Group
b. Management Service Organization
c. Self-Funded ERISA
d. Fully Insured Employer Group
11. A patient presents for an immunization. When the c. Medicaid
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
12. What is an insurance plan that provides a gatekeeper a. HMO
to manage the patient's healthcare?
a. HMO
b. IPO
c. PPO
d. Medicaid
13. A patient presenting for care does not have an insur- c. File a claim with Medic-
ance card and is billed CPT® code 99213 for $100. aid, a refund will be com-
The patient pays $100 to the provider. A week later, pleted when the EOB is
the patient presents verification of coverage through received showing the pa-
Medicaid for this date of service. What process should tients responsibility
be followed?
a. Nothing needs to be done
b. File a claim to Medicaid and refund the $100 to the
