AAPC CPB Final Exam Study Guide

AAPC CPB Final Exam Study Guide Health plan, clearinghouses, and any entity transmitting health information is considered by the Privacy Rule to be a: - covered entity Which of the following is not a covered entity in the Privacy Rule - healthcare consulting firm A request for medical records is received for a specific date of service from patient's insurance company with regards to a submitted claim. No authorization for release of information is provided. What action should be taken? - release reqt to ins co How many national priority purposes under the Privacy Rules for disclosure of specific PHI without an individual's authorization or permission? - 12 A health plan sends a request for medical records in order to adjudicate a claim. Does the office have to notify the patient or have them sign a release to send the information? - no A practice sets up a payment plan with a patient. If more than four installments are extended to the patient, what regulation is the practice subject to that makes the practice a creditor? - Truth in Lending Act Which of the following situations allows release of PHI without authorization from the patient? - workers comp misusing any information on the claim, charging excessively for services or supplies, billing for services not medically necessary, failure to maintain adequate medical or financial records, improper billing practices, or billing Medicare patients at a higher fee scale that non-Medicare patients. - abuse 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? - abuse According to the Privacy Rule, what health information may not be de-identified? - phys provider number making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program - fraud All the following are considered Fraud, EXCEPT: - inadequate med recd 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? - breach impermissible release or disclosure of information is discovered - breach What standard transactions is NOT included in EDI and adopted under HIPAA? - waiver of liability The Federal False Claim Act allows for claims to be reviewed for a standard of how many years after an incident? - 7 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? - anti kickback laws A private practice hires a consultant to come in and audit some medical records. Under the Privacy Rule, what is this consultant considered? - biz associate Medicare overpayments should be returned within ___