AAPC CPB FINAL EXAM C NEWEST EXAM 2026
| ALL QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) | LATEST EXAM | GRADED
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Terms in this set (205)
A private practice hires a consultant A. A business associate
to come in and audit some medical
records. Under the Privacy Rule, Business associates perform certain functions or
what is this consultant considered? activities, which involve the use or disclosure of
A. A business associate individually identifiable health information, on
B. An employee behalf of another person or organization. These
C. A covered entity services include claims processing or
D. A clearinghouse administration, data analysis, utilization review,
billing, benefit management, and re-pricing.
Because the consultant will be auditing medical
records, PHI will need to be shared from the
practice. The practice would be the covered
entity
,A practice agrees to pay $250,000 B. Qui Tam
to settle a lawsuit alleging that the
practice used X-rays of one patient A Qui Tam case is also known as a whistleblower
to justify services on multiple other case. If an individual knows of a violation of the
patients' claims. The manager of the FCA, he or she may bring a civil action on behalf
office brought the civil suit. What of him or herself and on behalf of the U.S.
type of case is this? government (such an individual is called a relator)
A. HIPAA
B. Qui Tam
C. Anti-Kickback
D. Stark case
A patient is seen in your clinic. Her C. HIPAA
husband calls later in the day to ask
for information about the visit. The The Privacy Act is under HIPAA and protects the
practice pulls the patient's privacy health information of the patient. According to
authorization to see if they can HIPAA, for the practice to release information to
speak to the husband. What act the husband, the patient would have to have
does this action fall under? signed an authorization.
A. Health Information Act
B. Social Security Act
C. HIPAA
D. ADA
,Which of the following situations D. Workers' compensation
allows the release of PHI without
authorization from the patient? Workers' compensation is listed as one of the
A. Request for life insurance exceptions permitted by the Privacy rule for use
B. Request from family member and disclosure of information.
C. Physician's office to release to a
family member
D. Workers' compensation
Billing for a lower level of care than D. fraud
is supported in documentation,
making false statements to obtain All of these actions are considered Fraud by
undeserved benefits or payment CMS. CMS defines fraud as making false
from a federal healthcare program, statements or misrepresenting facts to obtain an
or billing for services that were not undeserved benefit or payment from a federal
performed is defined as what by healthcare program. CMS defines abuse as an
CMS? action that results in unnecessary costs to a
A. an Anti-kickback federal healthcare program, either directly or
B. abuse indirectly
C. a Stark violation
D. fraud
Medicare overpayments should be A. 60 days
returned within what time frame
after the overpayment has been A provider must report and return an
identified? overpayment to the Secretary of HHS, the state,
A. 60 days an intermediary, a carrier, or a contractor, as
B. 1 year appropriate, by the later of 60 days from the date
C. 120 days when the overpayment was "identified" or the
D. 30 days date "any corresponding cost report is due."
What do the government agencies D. Federal fraud and abuse laws
OIG, CMS, and Department of
Justice enforce? The Department of Justice (DOJ), the Department
A. Qui tam violations of Health & Human Services Office of Inspector
B. Medical malpractice General (OIG), and the Centers for Medicare and
C. HIPAA violations Medicaid are the government agencies that
D. Federal fraud and abuse laws enforce the federal fraud and abuse laws.
, What standard transactions is NOT B. Waiver of liability
included in EDI and adopted under
HIPAA? There are 8 standard transactions for EDI - waiver
A. Healthcare claim status of liability is not included. The eight standard
B. Waiver of liability transactions for Electronic Data Interchange (EDI)
C. Referrals and Authorizations adopted under HIPAA are: - Claims and
D. Eligibility in the health plan 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
If a provider is excluded from A. II, III
federal health plans, what does that
mean? One of the most severe penalties associated with
I. They may not participate in the Social Security Act is the ability of the Office
Medicare, but may participate in of Inspector General (OIG) to exclude an entity
Medicaid to help the needy. or an individual from participation in any and all
II. They may not participate in federal healthcare programs. This includes
Medicare, Medicaid, VA programs Medicare, Medicaid, VA programs, and TRICARE.
or TRICARE. An excluded individual cannot bill for services,
III. They cannot bill for services, provide referrals, prescribe medications or order
provide services, order services, or services for any beneficiary of a federally
prescribe medication to any administered health plan.
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
| ALL QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) | LATEST EXAM | GRADED
A+
Save
Terms in this set (205)
A private practice hires a consultant A. A business associate
to come in and audit some medical
records. Under the Privacy Rule, Business associates perform certain functions or
what is this consultant considered? activities, which involve the use or disclosure of
A. A business associate individually identifiable health information, on
B. An employee behalf of another person or organization. These
C. A covered entity services include claims processing or
D. A clearinghouse administration, data analysis, utilization review,
billing, benefit management, and re-pricing.
Because the consultant will be auditing medical
records, PHI will need to be shared from the
practice. The practice would be the covered
entity
,A practice agrees to pay $250,000 B. Qui Tam
to settle a lawsuit alleging that the
practice used X-rays of one patient A Qui Tam case is also known as a whistleblower
to justify services on multiple other case. If an individual knows of a violation of the
patients' claims. The manager of the FCA, he or she may bring a civil action on behalf
office brought the civil suit. What of him or herself and on behalf of the U.S.
type of case is this? government (such an individual is called a relator)
A. HIPAA
B. Qui Tam
C. Anti-Kickback
D. Stark case
A patient is seen in your clinic. Her C. HIPAA
husband calls later in the day to ask
for information about the visit. The The Privacy Act is under HIPAA and protects the
practice pulls the patient's privacy health information of the patient. According to
authorization to see if they can HIPAA, for the practice to release information to
speak to the husband. What act the husband, the patient would have to have
does this action fall under? signed an authorization.
A. Health Information Act
B. Social Security Act
C. HIPAA
D. ADA
,Which of the following situations D. Workers' compensation
allows the release of PHI without
authorization from the patient? Workers' compensation is listed as one of the
A. Request for life insurance exceptions permitted by the Privacy rule for use
B. Request from family member and disclosure of information.
C. Physician's office to release to a
family member
D. Workers' compensation
Billing for a lower level of care than D. fraud
is supported in documentation,
making false statements to obtain All of these actions are considered Fraud by
undeserved benefits or payment CMS. CMS defines fraud as making false
from a federal healthcare program, statements or misrepresenting facts to obtain an
or billing for services that were not undeserved benefit or payment from a federal
performed is defined as what by healthcare program. CMS defines abuse as an
CMS? action that results in unnecessary costs to a
A. an Anti-kickback federal healthcare program, either directly or
B. abuse indirectly
C. a Stark violation
D. fraud
Medicare overpayments should be A. 60 days
returned within what time frame
after the overpayment has been A provider must report and return an
identified? overpayment to the Secretary of HHS, the state,
A. 60 days an intermediary, a carrier, or a contractor, as
B. 1 year appropriate, by the later of 60 days from the date
C. 120 days when the overpayment was "identified" or the
D. 30 days date "any corresponding cost report is due."
What do the government agencies D. Federal fraud and abuse laws
OIG, CMS, and Department of
Justice enforce? The Department of Justice (DOJ), the Department
A. Qui tam violations of Health & Human Services Office of Inspector
B. Medical malpractice General (OIG), and the Centers for Medicare and
C. HIPAA violations Medicaid are the government agencies that
D. Federal fraud and abuse laws enforce the federal fraud and abuse laws.
, What standard transactions is NOT B. Waiver of liability
included in EDI and adopted under
HIPAA? There are 8 standard transactions for EDI - waiver
A. Healthcare claim status of liability is not included. The eight standard
B. Waiver of liability transactions for Electronic Data Interchange (EDI)
C. Referrals and Authorizations adopted under HIPAA are: - Claims and
D. Eligibility in the health plan 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
If a provider is excluded from A. II, III
federal health plans, what does that
mean? One of the most severe penalties associated with
I. They may not participate in the Social Security Act is the ability of the Office
Medicare, but may participate in of Inspector General (OIG) to exclude an entity
Medicaid to help the needy. or an individual from participation in any and all
II. They may not participate in federal healthcare programs. This includes
Medicare, Medicaid, VA programs Medicare, Medicaid, VA programs, and TRICARE.
or TRICARE. An excluded individual cannot bill for services,
III. They cannot bill for services, provide referrals, prescribe medications or order
provide services, order services, or services for any beneficiary of a federally
prescribe medication to any administered health plan.
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
