AAPC – CPB – CHAPTER 1 REVIEW EXAM – FULL QUESTIONS AND ANSWERS –
QUESTIONS 1 TO 25
QUESTION 1
When a practice sends an electronic claim to a commercial health plan for
payment, what is this considered?
A. A code set
B. Correct: A transaction
C. A data set
D. Minimum necessary
Feedback: Rationale: A transaction is the electronic transfer of information
between two parties for specific purposes.
QUESTION# 2
According to the Privacy Rule, what must a Business Associate and covered
entity have to do business?
A. A mutually exclusive agreement describing the services that will be
rendered by the business associate
B. A notice of privacy
C. A background check of both parties to ensure full disclosure
D. Correct: A contract with specific safeguards on the individually
identifiable health information used or disclosed by the business
associate
Feedback: Rationale: According to the Privacy Rule, a contract is required
between business associates to impose specified written safeguards on the
individually identifiable health information used or disclosed by the business
associate.
QUESTION# 3
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?
A. Fraud
B. Correct: Abuse
, C. False claim
D. Malpractice
Feedback: Rationale: CMS considers abuse to be actions that cause
unnecessary costs to a federal healthcare program, either directly or
indirectly. CMS examples of abuse:
- Misusing codes on a claim
- Charging excessively for services or supplies
- Billing for services that were not medically necessary
- Failure to maintain adequate medical or financial records
- Improper billing practices
- Billing Medicare patients a higher fee schedule than non-Medicare patients
QUESTION# 4
What are health plans, clearinghouses, and any entity transmitting health
information considered to be by the Privacy Rule?
A. Health entity
B. Business entity
C. Correct: Covered entity
D. Protected entity
Feedback: Rationale: The Privacy Rule defines these as covered entities.
QUESTION# 5
Which of the following is not a covered entity in the Privacy Rule?
A. Commercial insurance company
B. Correct: A healthcare consulting firm
C. A Pediatric practice
D. A billing service
Feedback: Rationale: Covered entities are defined as health plans,
healthcare clearinghouses, and any healthcare provider who transmits health
information in an electronic format.
QUESTION# 6
QUESTIONS 1 TO 25
QUESTION 1
When a practice sends an electronic claim to a commercial health plan for
payment, what is this considered?
A. A code set
B. Correct: A transaction
C. A data set
D. Minimum necessary
Feedback: Rationale: A transaction is the electronic transfer of information
between two parties for specific purposes.
QUESTION# 2
According to the Privacy Rule, what must a Business Associate and covered
entity have to do business?
A. A mutually exclusive agreement describing the services that will be
rendered by the business associate
B. A notice of privacy
C. A background check of both parties to ensure full disclosure
D. Correct: A contract with specific safeguards on the individually
identifiable health information used or disclosed by the business
associate
Feedback: Rationale: According to the Privacy Rule, a contract is required
between business associates to impose specified written safeguards on the
individually identifiable health information used or disclosed by the business
associate.
QUESTION# 3
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?
A. Fraud
B. Correct: Abuse
, C. False claim
D. Malpractice
Feedback: Rationale: CMS considers abuse to be actions that cause
unnecessary costs to a federal healthcare program, either directly or
indirectly. CMS examples of abuse:
- Misusing codes on a claim
- Charging excessively for services or supplies
- Billing for services that were not medically necessary
- Failure to maintain adequate medical or financial records
- Improper billing practices
- Billing Medicare patients a higher fee schedule than non-Medicare patients
QUESTION# 4
What are health plans, clearinghouses, and any entity transmitting health
information considered to be by the Privacy Rule?
A. Health entity
B. Business entity
C. Correct: Covered entity
D. Protected entity
Feedback: Rationale: The Privacy Rule defines these as covered entities.
QUESTION# 5
Which of the following is not a covered entity in the Privacy Rule?
A. Commercial insurance company
B. Correct: A healthcare consulting firm
C. A Pediatric practice
D. A billing service
Feedback: Rationale: Covered entities are defined as health plans,
healthcare clearinghouses, and any healthcare provider who transmits health
information in an electronic format.
QUESTION# 6
