AAPC CPB BUNDLE FULLY SOLVED EXAM
PAPER GRADED A+
◉ A records request is received from a health plan for three dates of
service in a chart months apart. What should the biller do?
A. Copy each date of service individually and send to the health plan
B. Copy each date of service and black out all identifying information
in the copies before sending to the health plan.
C. Copy the entire chart and send it to make sure that the health plan
has everything they need and will not request more records
D. Copy everything from the first date through the third date, even if
it is not included to cover the timeframe the health plan is looking at
for the request.
Answer: A. Copy each date of service individually and send to the
health plan
The minimum necessary standard requires covered entities to take
reasonable steps to limit the disclosure of PHI. Only the dates of
service requested should be sent. The PHI would not need to be
redacted
◉ Patient questions and concerns regarding the Privacy Practices in
the clinic should be addressed by what party?
,A. The physician
B. The billing staff
C. Any employee
D. Privacy official.
Answer: D. Privacy official
HIPAA rules indicate that all entities should designate a Privacy
official that will develop and implement privacy policies and
procedures and be a contact person for individuals with questions
◉ A request for medical records is received for a specific date of
service from the patient's insurance company with regards to a
submitted claim. No authorization for release of information is
provided. What action should be taken?
A. Request a patient's signature from the insurance company
B. Release the requested records to the insurance company
C. Request the signature for authorization from the patient
D. Release the records after receiving verbal permission from the
patient.
Answer: B. Release the requested records to the insurance company
A covered entity is permitted to release records for the purpose of
treatment, payment, or healthcare operations.
,◉ What does the acronym PHI stand for?
A. Patient History of Illness
B. Protected Health information
C. Protected Healthcare Index
D. Patient Healthcare Information.
Answer: B. Protected Health information
PHI stands for protected health information. PHI is "individually
identifiable health information" that includes many common
identifiers, such as demographic data, name, address, birth date, and
social security number.
◉ 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?
A. False claim
B. Malpractice
C. Abuse
D. Fraud.
Answer: C. Abuse
CMS considers abuse to be actions that cause unnecessary costs to a
federal healthcare program, either directly or indirectly. CMS
examples of abuse: - Misusing codes on a claim - Charging
excessively for services or supplies - Billing for services that were
, not medically necessary - Failure to maintain adequate medical or
financial records - Improper billing practices - Billing Medicare
patients a higher fee schedule than non-Medicare patients
◉ What were the eight standard transactions for electronic data
interchange adopted under?
A. HIPAA
B. The Social Security Act
C. The Truth in Lending Act
D. Anti-Kickback Statute.
Answer: A. HIPAA
Under HIPAA, provisions were included for Administrative
Simplification that mandated HHS to adopt national standards for
electronic healthcare transactions and code sets. Eight standard
transactions were adopted.
◉ When a practice sends an electronic claim to a commercial health
plan for payment, what is this considered?
A. A transaction
B. Minimum necessary
C. A data set
D. A code set.
Answer: A. A transaction
PAPER GRADED A+
◉ A records request is received from a health plan for three dates of
service in a chart months apart. What should the biller do?
A. Copy each date of service individually and send to the health plan
B. Copy each date of service and black out all identifying information
in the copies before sending to the health plan.
C. Copy the entire chart and send it to make sure that the health plan
has everything they need and will not request more records
D. Copy everything from the first date through the third date, even if
it is not included to cover the timeframe the health plan is looking at
for the request.
Answer: A. Copy each date of service individually and send to the
health plan
The minimum necessary standard requires covered entities to take
reasonable steps to limit the disclosure of PHI. Only the dates of
service requested should be sent. The PHI would not need to be
redacted
◉ Patient questions and concerns regarding the Privacy Practices in
the clinic should be addressed by what party?
,A. The physician
B. The billing staff
C. Any employee
D. Privacy official.
Answer: D. Privacy official
HIPAA rules indicate that all entities should designate a Privacy
official that will develop and implement privacy policies and
procedures and be a contact person for individuals with questions
◉ A request for medical records is received for a specific date of
service from the patient's insurance company with regards to a
submitted claim. No authorization for release of information is
provided. What action should be taken?
A. Request a patient's signature from the insurance company
B. Release the requested records to the insurance company
C. Request the signature for authorization from the patient
D. Release the records after receiving verbal permission from the
patient.
Answer: B. Release the requested records to the insurance company
A covered entity is permitted to release records for the purpose of
treatment, payment, or healthcare operations.
,◉ What does the acronym PHI stand for?
A. Patient History of Illness
B. Protected Health information
C. Protected Healthcare Index
D. Patient Healthcare Information.
Answer: B. Protected Health information
PHI stands for protected health information. PHI is "individually
identifiable health information" that includes many common
identifiers, such as demographic data, name, address, birth date, and
social security number.
◉ 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?
A. False claim
B. Malpractice
C. Abuse
D. Fraud.
Answer: C. Abuse
CMS considers abuse to be actions that cause unnecessary costs to a
federal healthcare program, either directly or indirectly. CMS
examples of abuse: - Misusing codes on a claim - Charging
excessively for services or supplies - Billing for services that were
, not medically necessary - Failure to maintain adequate medical or
financial records - Improper billing practices - Billing Medicare
patients a higher fee schedule than non-Medicare patients
◉ What were the eight standard transactions for electronic data
interchange adopted under?
A. HIPAA
B. The Social Security Act
C. The Truth in Lending Act
D. Anti-Kickback Statute.
Answer: A. HIPAA
Under HIPAA, provisions were included for Administrative
Simplification that mandated HHS to adopt national standards for
electronic healthcare transactions and code sets. Eight standard
transactions were adopted.
◉ When a practice sends an electronic claim to a commercial health
plan for payment, what is this considered?
A. A transaction
B. Minimum necessary
C. A data set
D. A code set.
Answer: A. A transaction
