AAPC CPB FINAL EXAM PREP
Study online at https://quizlet.com/_ddnnwh
1. A private practice hires a con- A. A business associate
sultant to come in and audit
some medical Business associates perform certain functions or activities,
records. Under the Privacy which involve the use or disclosure of individually identifiable
Rule, what is this consultant health information, on behalf of another person or organiza-
considered? tion. These services include claims processing or administra-
A. A business associate tion, data analysis, utilization review, billing, benefit manage-
B. An employee ment, and re-pricing. Because the consultant will be auditing
C. A covered entity medical records, PHI will need to be shared from the practice.
D. A clearinghouse The practice would be the covered entity
2. A practice agrees to pay B. Qui Tam
$250,000 to settle a lawsuit al-
leging that the practice used A Qui Tam case is also known as a whistleblower case. If an
X-rays of one patient to justi- individual knows of a violation of the FCA, he or she may bring
fy services on multiple other a civil action on behalf of him or herself and on behalf of the
patients' claims. The manager U.S. government (such an individual is called a relator)
of the office brought the civil
suit. What type of case is this?
A. HIPAA
B. Qui Tam
C. Anti-Kickback
D. Stark case
3. A patient is seen in your clin- C. HIPAA
ic. Her husband calls later in
the day to ask for information The Privacy Act is under HIPAA and protects the health infor-
about the visit. The practice mation of the patient. According to HIPAA, for the practice to
pulls the patient's privacy au- release information to the husband, the patient would have to
thorization to see if they can have signed an authorization.
speak to the husband. What
act does this action fall un-
, AAPC CPB FINAL EXAM PREP
Study online at https://quizlet.com/_ddnnwh
der?
A. Health Information Act
B. Social Security Act
C. HIPAA
D. ADA
4. Which of the following situa- D. Workers' compensation
tions allows the release of PHI
without authorization from Workers' compensation is listed as one of the exceptions per-
the patient? mitted by the Privacy rule for use and disclosure of information.
A. Request for life insurance
B. Request from family mem-
ber
C. Physician's office to release
to a family member
D. Workers' compensation
5. Billing for a lower level of D. fraud
care than is supported in
documentation, making false All of these actions are considered Fraud by CMS. CMS de-
statements to obtain unde- fines fraud as making false statements or misrepresenting facts
served benefits or payment to obtain an undeserved benefit or payment from a feder-
from a federal healthcare pro- al healthcare program. CMS defines abuse as an action that
gram, or billing for services results in unnecessary costs to a federal healthcare program,
that were not performed is either directly or indirectly
defined as what by CMS?
A. an Anti-kickback
B. abuse
C. a Stark violation
D. fraud
6. A. 60 days
, AAPC CPB FINAL EXAM PREP
Study online at https://quizlet.com/_ddnnwh
Medicare overpayments A provider must report and return an overpayment to the
should be returned within Secretary of HHS, the state, an intermediary, a carrier, or a
what time frame after the contractor, as appropriate, by the later of 60 days from the
overpayment has been identi- date when the overpayment was "identified" or the date "any
fied? corresponding cost report is due."
A. 60 days
B. 1 year
C. 120 days
D. 30 days
7. What do the government D. Federal fraud and abuse laws
agencies OIG, CMS, and De-
partment of Justice enforce? The Department of Justice (DOJ), the Department of Health &
A. Qui tam violations Human Services Oflce of Inspector General (OIG), and the
B. Medical malpractice Centers for Medicare and Medicaid are the government agen-
C. HIPAA violations cies that enforce the federal fraud and abuse laws.
D. Federal fraud and abuse
laws
8. What standard transactions B. Waiver of liability
is NOT included in EDI and
adopted under HIPAA? There are 8 standard transactions for EDI - waiver of liability
A. Healthcare claim status is not included. The eight standard transactions for Electronic
B. Waiver of liability Data Interchange (EDI) adopted under HIPAA are: - Claims and
C. Referrals and Authoriza- encounter information; - Healthcare payment and remittance
tions advice; - Healthcare claims status; - Eligibility for a health plan;
D. Eligibility in the health plan - Enrollment and disenrollment in a health plan; - Referrals and
authorizations; - Coordination of benefits; and - Health plan
premium payments
9. If a provider is excluded from A. II, III
federal health plans, what
does that mean? One of the most severe penalties associated with the Social Se-
, AAPC CPB FINAL EXAM PREP
Study online at https://quizlet.com/_ddnnwh
I. They may not participate curity Act is the ability of the Oflce of Inspector General (OIG)
in Medicare, but may partici- to exclude an entity or an individual from participation in any
pate in Medicaid to help the and all federal healthcare programs. This includes Medicare,
needy. Medicaid, VA programs, and TRICARE. An excluded individual
II. They may not participate in cannot bill for services, provide referrals, prescribe medications
Medicare, Medicaid, VA pro- or order services for any beneficiary of a federally administered
grams or TRICARE. health plan.
III. They cannot bill for ser-
vices, provide services, order
services, or prescribe medica-
tion to any beneficiary of a
federal plan.
IV. They cannot bill for ser-
vices 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
10. What types of entities do con- B. I, II, III, IV
ditions of participation (CoP)
apply to for health plans? CMS and other health plans have conditions that healthcare
I. Hospitals organizations must meet to participate with the plan or pro-
II. Clinics gram. CoPs are designed to protect patient health and safety,
III. Transplant centers and to ensure quality of care. These apply to entities such
IV. Psychiatric hospitals as: ambulatory surgical centers, hospitals, hospices, clinics,
A. I, II, III psychiatric hospitals, long term care facilities, and transplant
B. I, II, III, IV centers.
Study online at https://quizlet.com/_ddnnwh
1. A private practice hires a con- A. A business associate
sultant to come in and audit
some medical Business associates perform certain functions or activities,
records. Under the Privacy which involve the use or disclosure of individually identifiable
Rule, what is this consultant health information, on behalf of another person or organiza-
considered? tion. These services include claims processing or administra-
A. A business associate tion, data analysis, utilization review, billing, benefit manage-
B. An employee ment, and re-pricing. Because the consultant will be auditing
C. A covered entity medical records, PHI will need to be shared from the practice.
D. A clearinghouse The practice would be the covered entity
2. A practice agrees to pay B. Qui Tam
$250,000 to settle a lawsuit al-
leging that the practice used A Qui Tam case is also known as a whistleblower case. If an
X-rays of one patient to justi- individual knows of a violation of the FCA, he or she may bring
fy services on multiple other a civil action on behalf of him or herself and on behalf of the
patients' claims. The manager U.S. government (such an individual is called a relator)
of the office brought the civil
suit. What type of case is this?
A. HIPAA
B. Qui Tam
C. Anti-Kickback
D. Stark case
3. A patient is seen in your clin- C. HIPAA
ic. Her husband calls later in
the day to ask for information The Privacy Act is under HIPAA and protects the health infor-
about the visit. The practice mation of the patient. According to HIPAA, for the practice to
pulls the patient's privacy au- release information to the husband, the patient would have to
thorization to see if they can have signed an authorization.
speak to the husband. What
act does this action fall un-
, AAPC CPB FINAL EXAM PREP
Study online at https://quizlet.com/_ddnnwh
der?
A. Health Information Act
B. Social Security Act
C. HIPAA
D. ADA
4. Which of the following situa- D. Workers' compensation
tions allows the release of PHI
without authorization from Workers' compensation is listed as one of the exceptions per-
the patient? mitted by the Privacy rule for use and disclosure of information.
A. Request for life insurance
B. Request from family mem-
ber
C. Physician's office to release
to a family member
D. Workers' compensation
5. Billing for a lower level of D. fraud
care than is supported in
documentation, making false All of these actions are considered Fraud by CMS. CMS de-
statements to obtain unde- fines fraud as making false statements or misrepresenting facts
served benefits or payment to obtain an undeserved benefit or payment from a feder-
from a federal healthcare pro- al healthcare program. CMS defines abuse as an action that
gram, or billing for services results in unnecessary costs to a federal healthcare program,
that were not performed is either directly or indirectly
defined as what by CMS?
A. an Anti-kickback
B. abuse
C. a Stark violation
D. fraud
6. A. 60 days
, AAPC CPB FINAL EXAM PREP
Study online at https://quizlet.com/_ddnnwh
Medicare overpayments A provider must report and return an overpayment to the
should be returned within Secretary of HHS, the state, an intermediary, a carrier, or a
what time frame after the contractor, as appropriate, by the later of 60 days from the
overpayment has been identi- date when the overpayment was "identified" or the date "any
fied? corresponding cost report is due."
A. 60 days
B. 1 year
C. 120 days
D. 30 days
7. What do the government D. Federal fraud and abuse laws
agencies OIG, CMS, and De-
partment of Justice enforce? The Department of Justice (DOJ), the Department of Health &
A. Qui tam violations Human Services Oflce of Inspector General (OIG), and the
B. Medical malpractice Centers for Medicare and Medicaid are the government agen-
C. HIPAA violations cies that enforce the federal fraud and abuse laws.
D. Federal fraud and abuse
laws
8. What standard transactions B. Waiver of liability
is NOT included in EDI and
adopted under HIPAA? There are 8 standard transactions for EDI - waiver of liability
A. Healthcare claim status is not included. The eight standard transactions for Electronic
B. Waiver of liability Data Interchange (EDI) adopted under HIPAA are: - Claims and
C. Referrals and Authoriza- encounter information; - Healthcare payment and remittance
tions advice; - Healthcare claims status; - Eligibility for a health plan;
D. Eligibility in the health plan - Enrollment and disenrollment in a health plan; - Referrals and
authorizations; - Coordination of benefits; and - Health plan
premium payments
9. If a provider is excluded from A. II, III
federal health plans, what
does that mean? One of the most severe penalties associated with the Social Se-
, AAPC CPB FINAL EXAM PREP
Study online at https://quizlet.com/_ddnnwh
I. They may not participate curity Act is the ability of the Oflce of Inspector General (OIG)
in Medicare, but may partici- to exclude an entity or an individual from participation in any
pate in Medicaid to help the and all federal healthcare programs. This includes Medicare,
needy. Medicaid, VA programs, and TRICARE. An excluded individual
II. They may not participate in cannot bill for services, provide referrals, prescribe medications
Medicare, Medicaid, VA pro- or order services for any beneficiary of a federally administered
grams or TRICARE. health plan.
III. They cannot bill for ser-
vices, provide services, order
services, or prescribe medica-
tion to any beneficiary of a
federal plan.
IV. They cannot bill for ser-
vices 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
10. What types of entities do con- B. I, II, III, IV
ditions of participation (CoP)
apply to for health plans? CMS and other health plans have conditions that healthcare
I. Hospitals organizations must meet to participate with the plan or pro-
II. Clinics gram. CoPs are designed to protect patient health and safety,
III. Transplant centers and to ensure quality of care. These apply to entities such
IV. Psychiatric hospitals as: ambulatory surgical centers, hospitals, hospices, clinics,
A. I, II, III psychiatric hospitals, long term care facilities, and transplant
B. I, II, III, IV centers.
