AAPC CPB Final Exam/ Questions with
Certified Answers.
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
Page 1 of 22
,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
While working in a large practice, Medicare overpayments are found in several patient accounts.
The manager states that the practice will keep the money until Medicare asks for it back. What
does this action constitute? - Answer: fraud
A practice agrees to pay $250,000 to settle a lawsuit alleging that the practice used X-rays of one
patient to justify services on multiple other patients' claims. The manager of the office brought
the civil suit. What type of case is this? - Answer: qui tam
OIG, CMS, and Department of Justice are the government agencies enforcing ________. -
Answer: fed abuse and fraud laws
A practice allows patients to pay large balances over a six month time period with a finance
charge applied. The patient receives a statement every month that only shows the unpaid
balance. What does this violate? - Answer: TILA
An insurance plan that provides a gatekeeper to manage the patient's health care is known as
a/an - Answer: HMO
a corporate umbrella for management of diversified healthcare delivery systems - Answer: IPO
Page 2 of 22
, An employee has signed up for a program through her employer. It allows her to put pre-tax
money away from her paycheck in order to pay for out-of-pocket healthcare expenses. She may
contribute up to $2650 (2018) per year. If she does not use all of the money during the current
year, she forfeits it. What is this? - Answer: FSA
Which option is not considered an MCO? - Answer: HSA
A Medicare patient presents after slipping and falling in a neighbor's walkway. The cement had a
large crack, which caused the pavement to raise and be unsteady. The neighbor has contacted
his homeowner's insurance and they are accepting liability and have initiated a claim. How
should the visit be billed? - Answer: Homeowners, then Medicare
Insurance coverage provided by an organization that is not an employer (such as a membership
organization or credit card company that offer benefits to its members) is what kind of group
insurance? - Answer: association group
office bills Medicare, but the patient receives the payment and the office must collect their fee
from the patient. The office, by state law, can charge the patient a limiting charge that is 10
percent above the Medicare fee schedule amount. What type of Medicare provider is this
physician? - Answer: non par
A patient presenting for care does not have an insurance card and is billed CPT 99213 for $100.
The patient pays $100 to the provider. A week later, the patient presents verification of coverage
through Medicaid for this date of service. What process should be followed? - Answer: file a
claim to Medicaid w EOB
Medicare part without a monthly charge if worked for 10+ years - Answer: A
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Certified Answers.
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
Page 1 of 22
,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
While working in a large practice, Medicare overpayments are found in several patient accounts.
The manager states that the practice will keep the money until Medicare asks for it back. What
does this action constitute? - Answer: fraud
A practice agrees to pay $250,000 to settle a lawsuit alleging that the practice used X-rays of one
patient to justify services on multiple other patients' claims. The manager of the office brought
the civil suit. What type of case is this? - Answer: qui tam
OIG, CMS, and Department of Justice are the government agencies enforcing ________. -
Answer: fed abuse and fraud laws
A practice allows patients to pay large balances over a six month time period with a finance
charge applied. The patient receives a statement every month that only shows the unpaid
balance. What does this violate? - Answer: TILA
An insurance plan that provides a gatekeeper to manage the patient's health care is known as
a/an - Answer: HMO
a corporate umbrella for management of diversified healthcare delivery systems - Answer: IPO
Page 2 of 22
, An employee has signed up for a program through her employer. It allows her to put pre-tax
money away from her paycheck in order to pay for out-of-pocket healthcare expenses. She may
contribute up to $2650 (2018) per year. If she does not use all of the money during the current
year, she forfeits it. What is this? - Answer: FSA
Which option is not considered an MCO? - Answer: HSA
A Medicare patient presents after slipping and falling in a neighbor's walkway. The cement had a
large crack, which caused the pavement to raise and be unsteady. The neighbor has contacted
his homeowner's insurance and they are accepting liability and have initiated a claim. How
should the visit be billed? - Answer: Homeowners, then Medicare
Insurance coverage provided by an organization that is not an employer (such as a membership
organization or credit card company that offer benefits to its members) is what kind of group
insurance? - Answer: association group
office bills Medicare, but the patient receives the payment and the office must collect their fee
from the patient. The office, by state law, can charge the patient a limiting charge that is 10
percent above the Medicare fee schedule amount. What type of Medicare provider is this
physician? - Answer: non par
A patient presenting for care does not have an insurance card and is billed CPT 99213 for $100.
The patient pays $100 to the provider. A week later, the patient presents verification of coverage
through Medicaid for this date of service. What process should be followed? - Answer: file a
claim to Medicaid w EOB
Medicare part without a monthly charge if worked for 10+ years - Answer: A
Page 3 of 22
