AAPC CPB
AAPC CPB Final Exam Study Guide Questions
with Correct Detailed Answers UPDATED 2025
Health plan, clearinghouses, and any entity transmitting health information is considered
by the Privacy Rule to be a: -Correct Answer ✔covered entity
Which of the following is not a covered entity in the Privacy Rule -Correct Answer
✔healthcare consulting firm
A request for medical records is received for a specific date of service from patient's
insurance company with regards to a submitted claim. No authorization for release of
information is provided. What action should be taken? -Correct Answer ✔release reqt to
ins co
How many national priority purposes under the Privacy Rules for disclosure of specific
PHI without an individual's authorization or permission? -Correct 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 information?
-Correct 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? -Correct Answer ✔Truth in Lending Act
Which of the following situations allows release of PHI without authorization from the
patient? -Correct Answer ✔workers comp
misusing any information 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 higher fee
scale that non-Medicare patients. -Correct Answer ✔abuse
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? -Correct Answer ✔abuse
According to the Privacy Rule, what health information may not be de-identified? -
Correct Answer ✔phys provider number
making false statements or misrepresenting facts to obtain an undeserved benefit or
payment from a federal healthcare program -Correct Answer ✔fraud
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All the following are considered Fraud, EXCEPT: -Correct Answer ✔inadequate med
recd
A hospital records transporter is moving medical records from the hospital to an off-site
building. During the transport, a chart falls from the box on to the street. It is discovered
when the transporter arrives at the off-site building and the number of charts is not
correct. What type of violation is this? -Correct Answer ✔breach
impermissible release or disclosure of information is discovered -Correct Answer
✔breach
What standard transactions is NOT included in EDI and adopted under HIPAA? -Correct
Answer ✔waiver of liability
The Federal False Claim Act allows for claims to be reviewed for a standard of how
many years after an incident? -Correct 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? -Correct 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? -Correct Answer ✔biz associate
Medicare overpayments should be returned within ___ days after the overpayment has
been identified -Correct Answer ✔60
HIPAA mandated what entity to adopt national standards for electronic transactions and
code sets? -Correct Answer ✔HHS (Health and Human Services)
Entities that have been identified as having improper billing practices is defined by CMS
as a violation of what standard? -Correct Answer ✔abuse
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? -Correct 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? -Correct Answer ✔False Claims Act
Medicare was passed into law under the title XVIII of what Act? -Correct Answer ✔SS
Act
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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? -Correct 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? -Correct Answer ✔qui tam
OIG, CMS, and Department of Justice are the government agencies enforcing
________. -Correct 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? -Correct Answer ✔TILA
An insurance plan that provides a gatekeeper to manage the patient's health care is
known as a/an -Correct Answer ✔HMO
a corporate umbrella for management of diversified healthcare delivery systems -
Correct Answer ✔IPO
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? -Correct Answer ✔FSA
Which option is not considered an MCO? -Correct 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? -Correct 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? -Correct 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? -Correct Answer ✔non par
A new physician comes into the practice that is just out of medical school. He will need
to be able to see patients in the office and at the hospital. What process will he need to
AAPC CPB
AAPC CPB Final Exam Study Guide Questions
with Correct Detailed Answers UPDATED 2025
Health plan, clearinghouses, and any entity transmitting health information is considered
by the Privacy Rule to be a: -Correct Answer ✔covered entity
Which of the following is not a covered entity in the Privacy Rule -Correct Answer
✔healthcare consulting firm
A request for medical records is received for a specific date of service from patient's
insurance company with regards to a submitted claim. No authorization for release of
information is provided. What action should be taken? -Correct Answer ✔release reqt to
ins co
How many national priority purposes under the Privacy Rules for disclosure of specific
PHI without an individual's authorization or permission? -Correct 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 information?
-Correct 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? -Correct Answer ✔Truth in Lending Act
Which of the following situations allows release of PHI without authorization from the
patient? -Correct Answer ✔workers comp
misusing any information 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 higher fee
scale that non-Medicare patients. -Correct Answer ✔abuse
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? -Correct Answer ✔abuse
According to the Privacy Rule, what health information may not be de-identified? -
Correct Answer ✔phys provider number
making false statements or misrepresenting facts to obtain an undeserved benefit or
payment from a federal healthcare program -Correct Answer ✔fraud
AAPC CPB
,AAPC CPB
All the following are considered Fraud, EXCEPT: -Correct Answer ✔inadequate med
recd
A hospital records transporter is moving medical records from the hospital to an off-site
building. During the transport, a chart falls from the box on to the street. It is discovered
when the transporter arrives at the off-site building and the number of charts is not
correct. What type of violation is this? -Correct Answer ✔breach
impermissible release or disclosure of information is discovered -Correct Answer
✔breach
What standard transactions is NOT included in EDI and adopted under HIPAA? -Correct
Answer ✔waiver of liability
The Federal False Claim Act allows for claims to be reviewed for a standard of how
many years after an incident? -Correct 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? -Correct 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? -Correct Answer ✔biz associate
Medicare overpayments should be returned within ___ days after the overpayment has
been identified -Correct Answer ✔60
HIPAA mandated what entity to adopt national standards for electronic transactions and
code sets? -Correct Answer ✔HHS (Health and Human Services)
Entities that have been identified as having improper billing practices is defined by CMS
as a violation of what standard? -Correct Answer ✔abuse
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? -Correct 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? -Correct Answer ✔False Claims Act
Medicare was passed into law under the title XVIII of what Act? -Correct Answer ✔SS
Act
AAPC CPB
, AAPC CPB
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? -Correct 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? -Correct Answer ✔qui tam
OIG, CMS, and Department of Justice are the government agencies enforcing
________. -Correct 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? -Correct Answer ✔TILA
An insurance plan that provides a gatekeeper to manage the patient's health care is
known as a/an -Correct Answer ✔HMO
a corporate umbrella for management of diversified healthcare delivery systems -
Correct Answer ✔IPO
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? -Correct Answer ✔FSA
Which option is not considered an MCO? -Correct 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? -Correct 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? -Correct 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? -Correct Answer ✔non par
A new physician comes into the practice that is just out of medical school. He will need
to be able to see patients in the office and at the hospital. What process will he need to
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