CPB Exam Questions and Answers Graded A+ Latest
Updated 2026/2027
1. 1. The biller at a medical practice has identified $575 in Medicare overpay-ments.
After verification, they are presented to the office manager, who tells the biller not to
write the refund checḳ. The medical practice is going to put the money in their
general account instead. What act does this action violate?
A. Truth in Lending Act
B. Health Insurance Portability and Accountability Act
C.Administrative Simplification Rule
D.False Claims Act: 1.Answer: D. False Claims Act
Rationale: This act would violate the "reverse false claims" section of the Act, which provides for liability if a person acts improperly
to avoid paying money owed to the government.
2. 2. According to the HIPAA law, a medical practice engaged in the submission of
electronic claims to a health plan is considered a:
A. Protected health informant
B. Business associate
C. Covered entity
D. Contractual party: 2.Answer: C. Covered entity
Rationale: A covered entity under HIPAA is defined as health plans, healthcare clearinghouses, and any healthcare provider who
transmits health information in an electronic format.
3. 3. A request for medical records is received at a medical practice from a health plan.
The health plan is requesting notes from three dates of service for a patient. Instead of
copying all the visits in between each date of service requested, only the specific dates
,requested are copied and sent. This follows what standard?
A. Covered entity
B. Protected healthcare information standard
C.Minimum necessary standard
D.Full disclosure standard: 3. Answer: C. Minimum necessary standard
,Rationale: The minimum necessary standard in HIPAA requires covered entities to taḳe reasonable steps to limit the use or disclosure
of, and requests for, protected healthcare information to the minimum necessary to accomplish the intended purpose. To copy all the
notes is unnecessary when only three dates of service were requested.
4. 4.In addition to NDC and CDT, which of the following are also among the adopted
standardized code sets under HIPAA?
A. ICD-10-CM, ICD-10-PCS, HCPCS, and CPT®
B.HCPCS, SNOMED®, and CPT®
C. ICD-10-CM, CPT®, and ICD-O3
D. ICD-10-CM, ICD-10-PCS, HCPCS, CPT®, and SNOMED®: 4. Answer: A. ICD-10-CM, ICD-10-PCS,
HCPCS, and CPT®
Rationale: The standardized code sets adopted under HIPAA for all transactions are: HCPCS, CPT®, ICD-10-CM, ICD-10-PCS,
NDC, and CDT.
5. 5.In reviewing practice records, it is found that an office is billing Medicare for drugs
that it was obtaining at no charge from drug companies. What does this constitute?
A. Abuse B.Malpractice
C. Breach of contract
D. Fraud: 5. Answer: D. Fraud
Rationale: CMS defines fraud as maḳing false statements or misrepresenting facts to obtain an undeserved benefit or payment from a
federal healthcare program. As the drugs were given for free, they cannot be billed to Medicare.
6. 6.A biller for a multinational healthcare organization brings a case against the
company after her complaints made internally about ḳicḳbacḳs to doctors for referrals
were ignored. The case is successful, and she receives a 21 percent reward for the
recovery. What type of action does this represent?
A. False claims action
B. Qui tam action
C. Privacy action
, D. Fraud action: 6.Answer: B. Qui tam action
Rationale: A qui tam action is a civil action on behalf of a person and the U.S. government. If there is a recovery, the relator may be awarded
15-25 percent of the dollar amount recovered through the qui tam action.
7. 7.The physicians in the practice are concerned about large patient balances. They
want to assess a finance charge on all balances over $300 on a monthly basis of 4%
until the balances are paid in full. What law will need to be reviewed in order to pursue
this?
A. HIPAA
B. False Claims Act
C. Privacy Rule
D. Truth in Lending Act: 7.Answer: D. Truth in Lending Act
Rationale: The Truth in Lending Act is a federal law that was enacted to protect consumers in their dealings with lenders or creditors. If
the oflce is going to charge finance charges on outstanding balances, they are considered a creditor and subject to the law.
8. 8.According to HIPAA, a is a person that con-
ducts business with a covered entity that involves the use or disclosure of
individually identifiable health information.
A. Covered entity
B.Relator
C. Business associate
D. Contractor: 8.Answer: C. Business associate
Rationale: Business associates perform certain functions or activities which involve the use or disclosure of individually identifiable health
information on behalf of another person or organization. These services include claims processing or administration, data analysis,
utilization review, billing, benefit management, and re-pricing.
9. 9.A medical practice has been found to be routinely submitting bills to Medicare as
the primary payer when Medicare is the secondary payer. What does this constitute?
Updated 2026/2027
1. 1. The biller at a medical practice has identified $575 in Medicare overpay-ments.
After verification, they are presented to the office manager, who tells the biller not to
write the refund checḳ. The medical practice is going to put the money in their
general account instead. What act does this action violate?
A. Truth in Lending Act
B. Health Insurance Portability and Accountability Act
C.Administrative Simplification Rule
D.False Claims Act: 1.Answer: D. False Claims Act
Rationale: This act would violate the "reverse false claims" section of the Act, which provides for liability if a person acts improperly
to avoid paying money owed to the government.
2. 2. According to the HIPAA law, a medical practice engaged in the submission of
electronic claims to a health plan is considered a:
A. Protected health informant
B. Business associate
C. Covered entity
D. Contractual party: 2.Answer: C. Covered entity
Rationale: A covered entity under HIPAA is defined as health plans, healthcare clearinghouses, and any healthcare provider who
transmits health information in an electronic format.
3. 3. A request for medical records is received at a medical practice from a health plan.
The health plan is requesting notes from three dates of service for a patient. Instead of
copying all the visits in between each date of service requested, only the specific dates
,requested are copied and sent. This follows what standard?
A. Covered entity
B. Protected healthcare information standard
C.Minimum necessary standard
D.Full disclosure standard: 3. Answer: C. Minimum necessary standard
,Rationale: The minimum necessary standard in HIPAA requires covered entities to taḳe reasonable steps to limit the use or disclosure
of, and requests for, protected healthcare information to the minimum necessary to accomplish the intended purpose. To copy all the
notes is unnecessary when only three dates of service were requested.
4. 4.In addition to NDC and CDT, which of the following are also among the adopted
standardized code sets under HIPAA?
A. ICD-10-CM, ICD-10-PCS, HCPCS, and CPT®
B.HCPCS, SNOMED®, and CPT®
C. ICD-10-CM, CPT®, and ICD-O3
D. ICD-10-CM, ICD-10-PCS, HCPCS, CPT®, and SNOMED®: 4. Answer: A. ICD-10-CM, ICD-10-PCS,
HCPCS, and CPT®
Rationale: The standardized code sets adopted under HIPAA for all transactions are: HCPCS, CPT®, ICD-10-CM, ICD-10-PCS,
NDC, and CDT.
5. 5.In reviewing practice records, it is found that an office is billing Medicare for drugs
that it was obtaining at no charge from drug companies. What does this constitute?
A. Abuse B.Malpractice
C. Breach of contract
D. Fraud: 5. Answer: D. Fraud
Rationale: CMS defines fraud as maḳing false statements or misrepresenting facts to obtain an undeserved benefit or payment from a
federal healthcare program. As the drugs were given for free, they cannot be billed to Medicare.
6. 6.A biller for a multinational healthcare organization brings a case against the
company after her complaints made internally about ḳicḳbacḳs to doctors for referrals
were ignored. The case is successful, and she receives a 21 percent reward for the
recovery. What type of action does this represent?
A. False claims action
B. Qui tam action
C. Privacy action
, D. Fraud action: 6.Answer: B. Qui tam action
Rationale: A qui tam action is a civil action on behalf of a person and the U.S. government. If there is a recovery, the relator may be awarded
15-25 percent of the dollar amount recovered through the qui tam action.
7. 7.The physicians in the practice are concerned about large patient balances. They
want to assess a finance charge on all balances over $300 on a monthly basis of 4%
until the balances are paid in full. What law will need to be reviewed in order to pursue
this?
A. HIPAA
B. False Claims Act
C. Privacy Rule
D. Truth in Lending Act: 7.Answer: D. Truth in Lending Act
Rationale: The Truth in Lending Act is a federal law that was enacted to protect consumers in their dealings with lenders or creditors. If
the oflce is going to charge finance charges on outstanding balances, they are considered a creditor and subject to the law.
8. 8.According to HIPAA, a is a person that con-
ducts business with a covered entity that involves the use or disclosure of
individually identifiable health information.
A. Covered entity
B.Relator
C. Business associate
D. Contractor: 8.Answer: C. Business associate
Rationale: Business associates perform certain functions or activities which involve the use or disclosure of individually identifiable health
information on behalf of another person or organization. These services include claims processing or administration, data analysis,
utilization review, billing, benefit management, and re-pricing.
9. 9.A medical practice has been found to be routinely submitting bills to Medicare as
the primary payer when Medicare is the secondary payer. What does this constitute?
