AAPC CPB Practice Exam Real Exam Questions And Answers (Verified Answers)
HMO plans require the enrollee to: - To have referrals to see a specialist that is generated by the patient's PCP What are PPOs (preferred provider organizations)? - Organizations in which medical professionals and facilities provide services to subscribed clients at reduced rates. What is a covered entity? - Health plans, clearinghouses, and any entity transmitting health information is considered to be as is stated by the Privacy Rule. What are the three steps to be taken when there is a breach of contract between a covered entity and a business associate? - 1. Take steps to correct or end the violation 2. Terminate the contract 3. Report the breach to HHS 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 or release of information is provided. What action should be taken? - Release the requested records to the insurance company. Can you release PHI without authorization from a patient if it is for a workers' compensation claim? - Yes, Workers compensation information is not protected under HIPAA HIPAA mandated what entity to adopt national standards for electronic transactions and code sets? - HHS What is the standard time frame established for record retention? - There is no single standard record retention time frame. It varies by state and federal regulation. CMS defines ______ as billing for a lower level of care than is supported in documentation, making false statements to obtain undeserved benefits or payment from a federal healthcare program, or billing for services that were not performed. - Fraud A claim is submitted for a patient on medicare with a higher fee schedule that a patient on Insurance ABC. What is this considered under CMS? - Abuse A person that files a claim for a Medicare beneficiary knowing that the service is not correctly reported is in violation of what statue? - FCA (False claims act) What act is "upcoding or unbundling services" considered under? - The false claims act 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? - TILA (truth in lending act) A patient is seen in your clinic. Her husband calls later in the day to ask for information about the visit. The practice pulls the patients privacy authorization to see if they can speak to the husband. What act does this action fall under? - HIPAA Medicare was passed into law under what Act? - SSA
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