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2023 AAPC CPB Final Exam Questions and
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Answers (2022/2023) (Verified Answers)
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AGRADE ne
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Health plan, clearinghouses, and any entity transmitting health information is
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considered by the Privacy Rule to be a: Correct Answer: covered entity
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Which of the following is not a covered entity in the Privacy Rule Correct Answer:
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healthcare consulting firm
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A request for medical records is received for a specific date of service from
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patient's insurance company with regards to a submitted claim. No authorization
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for release of information is provided. What action should be taken? Correct
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Answer: release reqt to ins co
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How many national priority purposes under the Privacy Rules for disclosure of
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specific PHI without an individual's authorization or permission? Correct Answer:
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12 sh
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A health plan sends a request for medical records in order to adjudicate a claim.
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Does the office have to notify the patient or have them sign a release to send the
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information? Correct Answer: no
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A practice sets up a payment plan with a patient. If more than four installments are
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extended to the patient, what regulation is the practice subject to that makes the
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practice a creditor? Correct Answer: Truth in Lending Act
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Which of the following situations allows release of PHI without authorization from
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the patient? Correct Answer: workers comp
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misusing any information on the claim, charging excessively for services or
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supplies, billing for services not medically necessary, failure to maintain adequate
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medical or financial records, improper billing practices, or billing Medicare
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patients at a higher fee scale that non-Medicare patients. Correct Answer: abuse
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A claim is submitted for a patient on Medicare with a higher fee than a patient on
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Insurance ABC. What is this considered by CMS? Correct Answer: abuse
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According to the Privacy Rule, what health information may not be de-identified?
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Correct Answer: phys provider number
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making false statements or misrepresenting facts to obtain an undeserved benefit or
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payment from a federal healthcare program Correct Answer: fraud
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All the following are considered Fraud, EXCEPT: Correct Answer: inadequate
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A hospital records transporter is moving medical records from the hospital to an
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off-site building. During the transport, a chart falls from the box on to the street. It
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is discovered when the transporter arrives at the off-site building and the number of
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charts is not correct. What type of violation is this? Correct Answer: breach
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impermissible release or disclosure of information is discovered Correct Answer:
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breach
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What standard transactions is NOT included in EDI and adopted under HIPAA?
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Correct Answer: waiver of liability
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The Federal False Claim Act allows for claims to be reviewed for a standard of
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how many years after an incident? Correct Answer: 7
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A new radiology company opens in town. The manager calls your practice and
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offers to pay $20 for every Medicare patient you send to them for radiology
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services. What does this offer violate? Correct Answer: anti kickback laws
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A private practice hires a consultant to come in and audit some medical records.
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Under the Privacy Rule, what is this consultant considered? Correct Answer: biz
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associate
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Medicare overpayments should be returned within ___ days after the overpayment
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has been identified Correct Answer: 60
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HIPAA mandated what entity to adopt national standards for electronic
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transactions and code sets? Correct Answer: HHS
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Entities that have been identified as having improper billing practices is defined by
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CMS as a violation of what standard? Correct Answer: abuse
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In addition to the standardization of the codes (ICD-10, CPT, HCPCS, and NDC)
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used to request payment for medical services, what must be used on all
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transactions for employers and providers? Correct Answer: unique id
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A person that files a claim for a Medicare beneficiary knowing that the service is
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not correctly reported is in violation of what statute? Correct Answer: False
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Claims Act
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Medicare was passed into law under the title XVIII of what Act? Correct Answer:
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SS Act
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While working in a large practice, Medicare overpayments are found in several
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patient accounts. The manager states that the practice will keep the money until
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Medicare asks for it back. What does this action constitute? Correct Answer: fraud
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A practice agrees to pay $250,000 to settle a lawsuit alleging that the practice used
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X-rays of one patient to justify services on multiple other patients' claims. The
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manager of the office brought the civil suit. What type of case is this? Correct
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Answer: qui tam
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OIG, CMS, and Department of Justice are the government agencies enforcing
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________. Correct Answer: fed abuse and fraud laws
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A practice allows patients to pay large balances over a six month time period with
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a finance charge applied. The patient receives a statement every month that only
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shows the unpaid balance. What does this violate? Correct Answer: TILA
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An insurance plan that provides a gatekeeper to manage the patient's health care is
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known as a/an Correct Answer: HMO
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a corporate umbrella for management of diversified healthcare delivery systems
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Correct Answer: IPO
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An employee has signed up for a program through her employer. It allows her to
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put pre-tax money away from her paycheck in order to pay for out-of-pocket
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healthcare expenses. She may contribute up to $2650 (2018) per year. If she does
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2023 AAPC CPB Final Exam Questions and
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tz
Answers (2022/2023) (Verified Answers)
sh
Sp
AGRADE ne
la
tz
sh
Sp
ne
la
tz
sh
Sp
Health plan, clearinghouses, and any entity transmitting health information is
ne
considered by the Privacy Rule to be a: Correct Answer: covered entity
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tz
sh
Which of the following is not a covered entity in the Privacy Rule Correct Answer:
Sp
healthcare consulting firm
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tz
A request for medical records is received for a specific date of service from
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Sp
patient's insurance company with regards to a submitted claim. No authorization
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for release of information is provided. What action should be taken? Correct
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Answer: release reqt to ins co
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sh
Sp
How many national priority purposes under the Privacy Rules for disclosure of
ne
specific PHI without an individual's authorization or permission? Correct Answer:
la
tz
12 sh
Sp
ne
A health plan sends a request for medical records in order to adjudicate a claim.
la
Does the office have to notify the patient or have them sign a release to send the
tz
sh
information? Correct Answer: no
Sp
ne
A practice sets up a payment plan with a patient. If more than four installments are
la
tz
extended to the patient, what regulation is the practice subject to that makes the
sh
Sp
practice a creditor? Correct Answer: Truth in Lending Act
ne
la
Which of the following situations allows release of PHI without authorization from
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the patient? Correct Answer: workers comp
sh
Sp
ne
misusing any information on the claim, charging excessively for services or
la
tz
supplies, billing for services not medically necessary, failure to maintain adequate
sh
Sp
medical or financial records, improper billing practices, or billing Medicare
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patients at a higher fee scale that non-Medicare patients. Correct Answer: abuse
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sh
Sp
la
Sp
, ne
tz
sh
ne
la
A claim is submitted for a patient on Medicare with a higher fee than a patient on
tz
sh
Insurance ABC. What is this considered by CMS? Correct Answer: abuse
Sp
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According to the Privacy Rule, what health information may not be de-identified?
la
tz
Correct Answer: phys provider number
sh
Sp
ne
making false statements or misrepresenting facts to obtain an undeserved benefit or
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payment from a federal healthcare program Correct Answer: fraud
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sh
Sp
All the following are considered Fraud, EXCEPT: Correct Answer: inadequate
ne
med recd
la
tz
sh
Sp
A hospital records transporter is moving medical records from the hospital to an
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off-site building. During the transport, a chart falls from the box on to the street. It
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is discovered when the transporter arrives at the off-site building and the number of
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sh
charts is not correct. What type of violation is this? Correct Answer: breach
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impermissible release or disclosure of information is discovered Correct Answer:
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tz
breach
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Sp
ne
What standard transactions is NOT included in EDI and adopted under HIPAA?
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Correct Answer: waiver of liability
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sh
Sp
The Federal False Claim Act allows for claims to be reviewed for a standard of
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how many years after an incident? Correct Answer: 7
la
tz
sh
Sp
A new radiology company opens in town. The manager calls your practice and
ne
offers to pay $20 for every Medicare patient you send to them for radiology
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services. What does this offer violate? Correct Answer: anti kickback laws
tz
sh
Sp
A private practice hires a consultant to come in and audit some medical records.
ne
Under the Privacy Rule, what is this consultant considered? Correct Answer: biz
la
tz
associate
sh
Sp
ne
Medicare overpayments should be returned within ___ days after the overpayment
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has been identified Correct Answer: 60
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sh
Sp
HIPAA mandated what entity to adopt national standards for electronic
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transactions and code sets? Correct Answer: HHS
la
sh
Sp
la
Sp
, ne
tz
sh
ne
la
Entities that have been identified as having improper billing practices is defined by
tz
sh
CMS as a violation of what standard? Correct Answer: abuse
Sp
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In addition to the standardization of the codes (ICD-10, CPT, HCPCS, and NDC)
la
tz
used to request payment for medical services, what must be used on all
sh
Sp
transactions for employers and providers? Correct Answer: unique id
ne
la
A person that files a claim for a Medicare beneficiary knowing that the service is
tz
sh
not correctly reported is in violation of what statute? Correct Answer: False
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Claims Act
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la
tz
Medicare was passed into law under the title XVIII of what Act? Correct Answer:
sh
Sp
SS Act
ne
la
While working in a large practice, Medicare overpayments are found in several
tz
sh
patient accounts. The manager states that the practice will keep the money until
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Medicare asks for it back. What does this action constitute? Correct Answer: fraud
ne
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tz
A practice agrees to pay $250,000 to settle a lawsuit alleging that the practice used
sh
Sp
X-rays of one patient to justify services on multiple other patients' claims. The
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manager of the office brought the civil suit. What type of case is this? Correct
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Answer: qui tam
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sh
Sp
OIG, CMS, and Department of Justice are the government agencies enforcing
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________. Correct Answer: fed abuse and fraud laws
la
tz
sh
Sp
A practice allows patients to pay large balances over a six month time period with
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a finance charge applied. The patient receives a statement every month that only
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shows the unpaid balance. What does this violate? Correct Answer: TILA
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sh
Sp
An insurance plan that provides a gatekeeper to manage the patient's health care is
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known as a/an Correct Answer: HMO
la
tz
sh
Sp
a corporate umbrella for management of diversified healthcare delivery systems
ne
Correct Answer: IPO
la
tz
An employee has signed up for a program through her employer. It allows her to
sh
Sp
put pre-tax money away from her paycheck in order to pay for out-of-pocket
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healthcare expenses. She may contribute up to $2650 (2018) per year. If she does
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Sp
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