Page 1 of 164
AAPC CPB FINAL Exam STUDY GUIDE QUESTIONS
AND CORRECT VERIFIED ANSWERS LATEST UPDATE
JUST RELEASED THIS YEAR
Medicare overpayments should be returned within what time frame after the overpayment
has been identified?
A. 60 days
B. 1 year
C. 120 days
D. 30 days
A. 60 days
A provider must report and return an overpayment to the Secretary of HHS, the state, an
intermediary, a carrier, or a contractor, as appropriate, by the later of 60 days from the date
when the overpayment was "identified" or the date "any corresponding cost report is due."
What do the government agencies OIG, CMS, and Department of Justice enforce?
A. Qui tam violations
B. Medical malpractice
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C. HIPAA violations
D. Federal fraud and abuse laws
D. Federal fraud and abuse laws
The Department of Justice (DOJ), the Department of Health & Human Services Office of
Inspector General (OIG), and the Centers for Medicare and Medicaid are the government
agencies that enforce the federal fraud and abuse laws.
What standard transactions is NOT included in EDI and adopted under HIPAA?
A. Healthcare claim status
B. Waiver of liability
C. Referrals and Authorizations
D. Eligibility in the health plan
B. Waiver of liability
There are 8 standard transactions for EDI - waiver of liability is not included. The eight standard
transactions for Electronic Data Interchange (EDI) adopted under HIPAA are: - Claims and
encounter information; - Healthcare payment and remittance advice; - Healthcare claims status;
- Eligibility for a health plan; - Enrollment and disenrollment in a health plan; - Referrals and
authorizations; - Coordination of benefits; and - Health plan premium payments
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If a provider is excluded from federal health plans, what does that mean?
I. They may not participate in Medicare, but may participate in Medicaid to help the needy.
II. They may not participate in Medicare, Medicaid, VA programs or TRICARE.
III. They cannot bill for services, provide services, order services, or prescribe medication to
any beneficiary of a federal plan.
IV. They cannot bill for services or provide services, but may give Medicare patients referrals
to receive services somewhere else
A. II, III
B. I, III
C. II, IV
D. I, III, IV
A. II, III
One of the most severe penalties associated with the Social Security Act is the ability of the
Office of Inspector General (OIG) to exclude an entity or an individual from participation in any
and all federal healthcare programs. This includes Medicare, Medicaid, VA programs, and
TRICARE. An excluded individual cannot bill for services, provide referrals, prescribe medications
or order services for any beneficiary of a federally administered health plan.
What types of entities do conditions of participation (CoP) apply to for health plans?
I. Hospitals
II. Clinics
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III. Transplant centers
IV. Psychiatric hospitals
A. I, II, III
B. I, II, III, IV
C. II, III, IV
D. I, III, IV
B. I, II, III, IV
CMS and other health plans have conditions that healthcare organizations must meet to
participate with the plan or program. CoPs are designed to protect patient health and safety,
and to ensure quality of care. These apply to entities such as: ambulatory surgical centers,
hospitals, hospices, clinics, psychiatric hospitals, long term care facilities, and transplant centers.
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?
A. A breach
B. Fraud
C. A minimum necessary violation
D. A disclosure violation
4
SUCCESS!
AAPC CPB FINAL Exam STUDY GUIDE QUESTIONS
AND CORRECT VERIFIED ANSWERS LATEST UPDATE
JUST RELEASED THIS YEAR
Medicare overpayments should be returned within what time frame after the overpayment
has been identified?
A. 60 days
B. 1 year
C. 120 days
D. 30 days
A. 60 days
A provider must report and return an overpayment to the Secretary of HHS, the state, an
intermediary, a carrier, or a contractor, as appropriate, by the later of 60 days from the date
when the overpayment was "identified" or the date "any corresponding cost report is due."
What do the government agencies OIG, CMS, and Department of Justice enforce?
A. Qui tam violations
B. Medical malpractice
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,Page 2 of 164
C. HIPAA violations
D. Federal fraud and abuse laws
D. Federal fraud and abuse laws
The Department of Justice (DOJ), the Department of Health & Human Services Office of
Inspector General (OIG), and the Centers for Medicare and Medicaid are the government
agencies that enforce the federal fraud and abuse laws.
What standard transactions is NOT included in EDI and adopted under HIPAA?
A. Healthcare claim status
B. Waiver of liability
C. Referrals and Authorizations
D. Eligibility in the health plan
B. Waiver of liability
There are 8 standard transactions for EDI - waiver of liability is not included. The eight standard
transactions for Electronic Data Interchange (EDI) adopted under HIPAA are: - Claims and
encounter information; - Healthcare payment and remittance advice; - Healthcare claims status;
- Eligibility for a health plan; - Enrollment and disenrollment in a health plan; - Referrals and
authorizations; - Coordination of benefits; and - Health plan premium payments
2
SUCCESS!
,Page 3 of 164
If a provider is excluded from federal health plans, what does that mean?
I. They may not participate in Medicare, but may participate in Medicaid to help the needy.
II. They may not participate in Medicare, Medicaid, VA programs or TRICARE.
III. They cannot bill for services, provide services, order services, or prescribe medication to
any beneficiary of a federal plan.
IV. They cannot bill for services or provide services, but may give Medicare patients referrals
to receive services somewhere else
A. II, III
B. I, III
C. II, IV
D. I, III, IV
A. II, III
One of the most severe penalties associated with the Social Security Act is the ability of the
Office of Inspector General (OIG) to exclude an entity or an individual from participation in any
and all federal healthcare programs. This includes Medicare, Medicaid, VA programs, and
TRICARE. An excluded individual cannot bill for services, provide referrals, prescribe medications
or order services for any beneficiary of a federally administered health plan.
What types of entities do conditions of participation (CoP) apply to for health plans?
I. Hospitals
II. Clinics
3
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, Page 4 of 164
III. Transplant centers
IV. Psychiatric hospitals
A. I, II, III
B. I, II, III, IV
C. II, III, IV
D. I, III, IV
B. I, II, III, IV
CMS and other health plans have conditions that healthcare organizations must meet to
participate with the plan or program. CoPs are designed to protect patient health and safety,
and to ensure quality of care. These apply to entities such as: ambulatory surgical centers,
hospitals, hospices, clinics, psychiatric hospitals, long term care facilities, and transplant centers.
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?
A. A breach
B. Fraud
C. A minimum necessary violation
D. A disclosure violation
4
SUCCESS!
