AAPC CPB ACTUAL FINAL EXAM | COMPLETE QUESTIONS WITH
EXPERT SOLUTIONS | 2026 LATEST UPDATED | GET A+
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
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
EXPERT SOLUTIONS | 2026 LATEST UPDATED | GET A+
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
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
