AAPC CPB Final | 200 Questions and
Verified Solutions Latest Update 2024
Health plan, clearinghouses, and any entity transmitting health information is considered by the Privacy
Rule to be a: - Answer - covered entity
Which of the following is not a covered entity in the Privacy Rule - Answer - 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? - Answer - 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? - Answer - 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? - Answer - 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? - Answer - Truth in
Lending Act
Which of the following situations allows release of PHI without authorization from the patient? - Answer
- workers comp
Entities that have been identified as having improper billing practices is defined by CMS as a violation of
what standard? - Answer - abuse
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. - Answer - 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? - Answer - abuse
According to the Privacy Rule, what health information may not be de-identified? - Answer - phys
provider number
making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a
federal healthcare program - Answer - fraud
All the following are considered Fraud, EXCEPT: - Answer - 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? - Answer -
breach
impermissible release or disclosure of information is discovered - Answer - breach
What standard transactions is NOT included in EDI and adopted under HIPAA? - Answer - waiver of
liability
The Federal False Claim Act allows for claims to be reviewed for a standard of how many years after an
incident? - Answer - 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? - Answer - 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? - Answer - biz associate
Medicare overpayments should be returned within ___ days after the overpayment has been identified -
Answer - 60
HIPAA mandated what entity to adopt national standards for electronic transactions and code sets? -
Answer - HHS
Entities that have been identified as having improper billing practices is defined by CMS as a violation of
what standard? - Answer - abuse
In addition to the standardization of the codes (ICD-10, CPT, HCPCS, and NDC) used to request payment
for medical services, what must be used on all transactions for employers and providers? - Answer -
unique id
A person that files a claim for a Medicare beneficiary knowing that the service is not correctly reported is
in violation of what statute? - Answer - False Claims Act
Medicare was passed into law under the title XVIII of what Act? - Answer - SS Act
While working in a large practice, Medicare overpayments are found in several patient accounts. The
manager states that the practice will keep the money until Medicare asks for it back. What does this
action constitute? - Answer - fraud
A practice agrees to pay $250,000 to settle a lawsuit 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? - Answer - qui tam
Verified Solutions Latest Update 2024
Health plan, clearinghouses, and any entity transmitting health information is considered by the Privacy
Rule to be a: - Answer - covered entity
Which of the following is not a covered entity in the Privacy Rule - Answer - 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? - Answer - 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? - Answer - 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? - Answer - 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? - Answer - Truth in
Lending Act
Which of the following situations allows release of PHI without authorization from the patient? - Answer
- workers comp
Entities that have been identified as having improper billing practices is defined by CMS as a violation of
what standard? - Answer - abuse
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. - Answer - 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? - Answer - abuse
According to the Privacy Rule, what health information may not be de-identified? - Answer - phys
provider number
making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a
federal healthcare program - Answer - fraud
All the following are considered Fraud, EXCEPT: - Answer - 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? - Answer -
breach
impermissible release or disclosure of information is discovered - Answer - breach
What standard transactions is NOT included in EDI and adopted under HIPAA? - Answer - waiver of
liability
The Federal False Claim Act allows for claims to be reviewed for a standard of how many years after an
incident? - Answer - 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? - Answer - 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? - Answer - biz associate
Medicare overpayments should be returned within ___ days after the overpayment has been identified -
Answer - 60
HIPAA mandated what entity to adopt national standards for electronic transactions and code sets? -
Answer - HHS
Entities that have been identified as having improper billing practices is defined by CMS as a violation of
what standard? - Answer - abuse
In addition to the standardization of the codes (ICD-10, CPT, HCPCS, and NDC) used to request payment
for medical services, what must be used on all transactions for employers and providers? - Answer -
unique id
A person that files a claim for a Medicare beneficiary knowing that the service is not correctly reported is
in violation of what statute? - Answer - False Claims Act
Medicare was passed into law under the title XVIII of what Act? - Answer - SS Act
While working in a large practice, Medicare overpayments are found in several patient accounts. The
manager states that the practice will keep the money until Medicare asks for it back. What does this
action constitute? - Answer - fraud
A practice agrees to pay $250,000 to settle a lawsuit 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? - Answer - qui tam
