©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
AAPC CPB Final Exam Study Guide with
Complete Solutions
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
1
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
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
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
2
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
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
3
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
AAPC CPB Final Exam Study Guide with
Complete Solutions
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
1
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
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
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
2
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
Certified Professional Biller By: American Academy of Professional Coders(AAPC)
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
3
