CPB EXAM QUESTIONS

1. The biller at a medical practice has identified $575 in Medicare overpayments. After verification, they are presented to the office manager, who tells the biller not to write the refund check. 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 - Answer-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. 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 - Answer-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. 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 - Answer-3. Answer: C. Minimum necessary standard Rationale: The minimum necessary standard in HIPAA requires covered entities to take 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.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®