AAPC CPB FINAL EXAM 2025. COMPLETE QUESTIONS AND CORRECT ANSWERS. ALREADY GRADED A+.

AAPC CPB FINAL EXAM 2025. COMPLETE QUESTIONS AND CORRECT ANSWERS. ALREADY GRADED A+. Health plan, clearinghouses, and any entity transmitting health information is considered by the Privacy Rule to be a: - CORRECT ANScovered entity Which of the following is not a covered entity in the Privacy Rule - CORRECT ANShealthcare 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 ANSrelease 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 ANS12 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 ANSno 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 ANSTruth in Lending Act Which of the following situations allows release of PHI without authorization from the patient? - CORRECT ANSworker’s 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 ANSabuse 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 ANSabuse According to the Privacy Rule, what health information may not be de-identified? - CORRECT ANSPhys provider number making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program - CORRECT ANSfraud All the following are considered Fraud, EXCEPT: - CORRECT ANSinadequate 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 ANSbreach impermissible release or disclosure of information is discovered - CORRECT ANSbreach What standard transactions is NOT included in EDI and adopted under HIPAA? - CORRECT ANSwaiver of liability The Federal False Claim Act allows for claims to be reviewed for a standard of how many years after an incident? - CORRECT ANS7 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 ANSanti-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 ANSbiz associate Medicare overpayments should be returned within days after the overpayment has been identified - CORRECT ANS60 HIPAA mandated what entity to adopt national standards for electronic transactions and code sets? - CORRECT ANSHHS Entities that have been identified as having improper billing practices is defined by CMS as a violation of what standard? - CORRECT ANSabuse 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 ANSunique 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 ANSFalse Claims Act Medicare was passed into law under the title XVIII of what Act? - CORRECT ANSSS 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? - CORRECT ANSfraud 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 ANSqui tam OIG, CMS, and Department of Justice are the government agencies enforcing . - CORRECT ANSfed 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 ANSTILA An insurance plan that provides a gatekeeper to manage the patient's health care is known as a/an - CORRECT ANSHMO a corporate umbrella for management of diversified healthcare delivery systems - CORRECT ANSIPO 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 ANSFSA Which option is not considered an MCO? - CORRECT ANSHSA