AAPC CPB Final Exam Updated Questions and
Answers (2025/2026)
Health plan, clearinghouses, and any entity transmitting health information is considered
by the Privacy Rule to be a: - ANS-covered entity
Which of the following is not a covered entity in the Privacy Rule - ANS-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? - ANS-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? - ANS-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?
- ANS-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? - ANS-Truth in Lending Act
Which of the following situations allows release of PHI without authorization from the
patient? - ANS-workers comp
Entities that have been identified as having improper billing practices is defined by CMS
as a violation of what standard? - ANS-abuse
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. - ANS-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? - ANS-abuse
According to the Privacy Rule, what health information may not be de-identified? - ANS-
phys provider number
making false statements or misrepresenting facts to obtain an undeserved benefit or
payment from a federal healthcare program - ANS-fraud
All the following are considered Fraud, EXCEPT: - ANS-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? - ANS-breach
impermissible release or disclosure of information is discovered - ANS-breach
What standard transactions is NOT included in EDI and adopted under HIPAA? - ANS-
waiver of liability
The Federal False Claim Act allows for claims to be reviewed for a standard of how
many years after an incident? - ANS-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? - ANS-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? - ANS-biz associate
Medicare overpayments should be returned within ___ days after the overpayment has
been identified - ANS-60
HIPAA mandated what entity to adopt national standards for electronic transactions and
code sets? - ANS-HHS
Entities that have been identified as having improper billing practices is defined by CMS
as a violation of what standard? - ANS-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? - ANS-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? - ANS-False Claims Act
Medicare was passed into law under the title XVIII of what Act? - ANS-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? - ANS-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? - ANS-qui tam
Answers (2025/2026)
Health plan, clearinghouses, and any entity transmitting health information is considered
by the Privacy Rule to be a: - ANS-covered entity
Which of the following is not a covered entity in the Privacy Rule - ANS-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? - ANS-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? - ANS-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?
- ANS-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? - ANS-Truth in Lending Act
Which of the following situations allows release of PHI without authorization from the
patient? - ANS-workers comp
Entities that have been identified as having improper billing practices is defined by CMS
as a violation of what standard? - ANS-abuse
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. - ANS-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? - ANS-abuse
According to the Privacy Rule, what health information may not be de-identified? - ANS-
phys provider number
making false statements or misrepresenting facts to obtain an undeserved benefit or
payment from a federal healthcare program - ANS-fraud
All the following are considered Fraud, EXCEPT: - ANS-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? - ANS-breach
impermissible release or disclosure of information is discovered - ANS-breach
What standard transactions is NOT included in EDI and adopted under HIPAA? - ANS-
waiver of liability
The Federal False Claim Act allows for claims to be reviewed for a standard of how
many years after an incident? - ANS-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? - ANS-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? - ANS-biz associate
Medicare overpayments should be returned within ___ days after the overpayment has
been identified - ANS-60
HIPAA mandated what entity to adopt national standards for electronic transactions and
code sets? - ANS-HHS
Entities that have been identified as having improper billing practices is defined by CMS
as a violation of what standard? - ANS-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? - ANS-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? - ANS-False Claims Act
Medicare was passed into law under the title XVIII of what Act? - ANS-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? - ANS-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? - ANS-qui tam
