CPB Final Exam (2026-2027 Latest
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A practice agrees to pay $250,000.00 to settle a lawsuit alleging that
the practice used x-rays of one patient to justify services on
multiple other patients' claims. The office manager brought the civil
suit. What type of case is this?
Qui Tam
In which of the following circumstances may PHI not be disclosed
without the patient's authorization or permission?
An office receives a call from the patient's husband asking for
information about his wife's recent office visit.
According to the Privacy Rule, what must a Business Associate
and a Covered Entity have in order to do business?
A contract
HMO plans require the enrollee to:
To have referrals to see a specialist that is generated by the
patient's primary care provider.
Which of the following is NOT a component of the PPO payer
model?
Require the enrollee to maintain a Primary Care Provider.
Under the Privacy Rule a health plan, clearinghouses, and any
entity transmitting health information is considered?
Covered entity
A request for medical records is received for a specific date of
service from a patient's insurance company with regards to a
,submitted claim. No authorization for release of information is
provided. What action should be taken?
Release the requested records to the insurance company.
Which of the following situations allows the release of PHI without
authorization from the patient?
Workers' Compensation
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 for record retention; it varies by state
and federal regulations.
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 a service that was not performed.
Fraud
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
A person that files a claim for a Medicare Beneficiary knowing that
the service is not correctly reported is in violation of what statute?
False Claims Act
Which of the following actions is considered under the False
Claims Act?
Up-coding or unbundling services
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
Medicare was passed into law under the title XVIII of what Act?
Social Security Act
Which of the following statements are true regarding healthcare
regulations?
, Healthcare regulations may vary by state and by payer
A physician office (covered entity) discovers that the billing
company (business associate) is in breach of their contract. What
is the first step to be taken?
Take steps to correct the problem and end the violation
OIG, CMS, and the Department of Justice are the government
agencies enforcing ______?
Federal fraud and abuse laws
Fraud and Abuse penalties do NOT include:
Ability to re-file claims in question
A biller at a medical practice notices that all claims contain CPT
code 81002. She questions the nurse who tells her that because
they are an OB/GYN office they bill every patient for a urinalysis.
What does this violate?
False Claims Act
Individuals have the right to review and obtain copies of the PHI.
What is excluded from the right of access?
Psychotherapy notes
Medical Records are requested for a patient for a specific date of
service. When records are copied, multiple dates of service are
copied and sent in reply to the request. What standard does this
violate?
Minimum Necessary
Patient has questions and concerns regarding the Privacy
Practices in the clinic should be addressed by what party?
Privacy Official
What standard transactions are NOT included in EDI and adopted
under HIPAA?
Waiver of liability
The Federal False Claim Act allows for claims to be reviewed for
how many years after an incident?
Seven years
While working in a large practice, Medicare overpayments are
found in several patient accounts. The manager states that the
Version) with Most Tested Questions and
Correct Answers Guaranteed for Pass /
Fully Solved / Already Rated A+
A practice agrees to pay $250,000.00 to settle a lawsuit alleging that
the practice used x-rays of one patient to justify services on
multiple other patients' claims. The office manager brought the civil
suit. What type of case is this?
Qui Tam
In which of the following circumstances may PHI not be disclosed
without the patient's authorization or permission?
An office receives a call from the patient's husband asking for
information about his wife's recent office visit.
According to the Privacy Rule, what must a Business Associate
and a Covered Entity have in order to do business?
A contract
HMO plans require the enrollee to:
To have referrals to see a specialist that is generated by the
patient's primary care provider.
Which of the following is NOT a component of the PPO payer
model?
Require the enrollee to maintain a Primary Care Provider.
Under the Privacy Rule a health plan, clearinghouses, and any
entity transmitting health information is considered?
Covered entity
A request for medical records is received for a specific date of
service from a patient's insurance company with regards to a
,submitted claim. No authorization for release of information is
provided. What action should be taken?
Release the requested records to the insurance company.
Which of the following situations allows the release of PHI without
authorization from the patient?
Workers' Compensation
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 for record retention; it varies by state
and federal regulations.
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 a service that was not performed.
Fraud
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
A person that files a claim for a Medicare Beneficiary knowing that
the service is not correctly reported is in violation of what statute?
False Claims Act
Which of the following actions is considered under the False
Claims Act?
Up-coding or unbundling services
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
Medicare was passed into law under the title XVIII of what Act?
Social Security Act
Which of the following statements are true regarding healthcare
regulations?
, Healthcare regulations may vary by state and by payer
A physician office (covered entity) discovers that the billing
company (business associate) is in breach of their contract. What
is the first step to be taken?
Take steps to correct the problem and end the violation
OIG, CMS, and the Department of Justice are the government
agencies enforcing ______?
Federal fraud and abuse laws
Fraud and Abuse penalties do NOT include:
Ability to re-file claims in question
A biller at a medical practice notices that all claims contain CPT
code 81002. She questions the nurse who tells her that because
they are an OB/GYN office they bill every patient for a urinalysis.
What does this violate?
False Claims Act
Individuals have the right to review and obtain copies of the PHI.
What is excluded from the right of access?
Psychotherapy notes
Medical Records are requested for a patient for a specific date of
service. When records are copied, multiple dates of service are
copied and sent in reply to the request. What standard does this
violate?
Minimum Necessary
Patient has questions and concerns regarding the Privacy
Practices in the clinic should be addressed by what party?
Privacy Official
What standard transactions are NOT included in EDI and adopted
under HIPAA?
Waiver of liability
The Federal False Claim Act allows for claims to be reviewed for
how many years after an incident?
Seven years
While working in a large practice, Medicare overpayments are
found in several patient accounts. The manager states that the
