AAPC CPB BUNDLE PRACTICE QUESTIONS
AND DETAILED SOLUTIONS
◉ Is a healthcare consulting firm considered a covered entity?
Answer: No
◉ A request for medical records is received 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 the request to insurance company
◉ How many national priority purposes under the Privacy Rule for
disclosure of specific Private Health Information without an
individual's auth/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 info?
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
◉ Does Worker's Comp need authorization to release PHI?
Answer: No
◉ Misusing and info 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 high fee scale than non-
Medicare patients
Answer: Abuse
◉ A claim is submitted for a patient with 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: Physician Provider Number
,◉ Making false statements or misrepresenting facts to obtain an
undeserved benefit or payment from a federal healthcare program:
Answer: Fraud
◉ Inadequate Medical Record
Answer: Abuse (NOT FRAUD)
◉ Is Waiver of Liability included as a standard transaction in EDI
and adopted under HIPAA?
Answer: No
◉ 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: Business Associate
, ◉ Medicare overpayments should be returned within _____ days after
the overpayment ahs be 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 code sets 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 know 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?
AND DETAILED SOLUTIONS
◉ Is a healthcare consulting firm considered a covered entity?
Answer: No
◉ A request for medical records is received 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 the request to insurance company
◉ How many national priority purposes under the Privacy Rule for
disclosure of specific Private Health Information without an
individual's auth/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 info?
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
◉ Does Worker's Comp need authorization to release PHI?
Answer: No
◉ Misusing and info 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 high fee scale than non-
Medicare patients
Answer: Abuse
◉ A claim is submitted for a patient with 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: Physician Provider Number
,◉ Making false statements or misrepresenting facts to obtain an
undeserved benefit or payment from a federal healthcare program:
Answer: Fraud
◉ Inadequate Medical Record
Answer: Abuse (NOT FRAUD)
◉ Is Waiver of Liability included as a standard transaction in EDI
and adopted under HIPAA?
Answer: No
◉ 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: Business Associate
, ◉ Medicare overpayments should be returned within _____ days after
the overpayment ahs be 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 code sets 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 know 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?
