Certified Professional Biller (CPB) Final Exam
Questions and Answers Study Guide
A practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice
used x-rays of one patient to justify services on multiple other patients' claims.
The office manager brought the civil suit. What type of case is this? -
ANSWER>>Qui Tam
In which of the following circumstances may PHI not be disclosed without the
patient's authorization or permission? - ANSWER>>An office receives a call from
the patient's husband asking for information about his wife's recent office visit.
According to the Privacy Rule, what must a Business Associate and a Covered
Entity have in order to do business? - ANSWER>>A contract
HMO plans require the enrollee to: - ANSWER>>To have referrals to see a
specialist that is generated by the patient's primary care provider.
Which of the following is NOT a component of the PPO payer model? -
ANSWER>>Require the enrollee to maintain a Primary Care Provider.
Under the Privacy Rule a health plan, clearinghouses, and any entity transmitting
health information is considered? - ANSWER>>Covered entity
A request for medical records is received for a specific date of service from a
patient's insurance company with regards to a submitted claim. No authorization
for release of information is provided. What action should be taken? -
ANSWER>>Release the requested records to the insurance company.
,Which of the following situations allows the release of PHI without authorization
from the patient? - ANSWER>>Workers' Compensation
HIPAA mandated what entity to adopt national standards for electronic
transactions and code sets? - ANSWER>>HHS
What is the standard time frame established for record retention? -
ANSWER>>There is no single standard for record retention; it varies by state and
federal regulations.
CMS defines _______ as billing for a lower level of care than is supported in
documentation, making false statements to obtain undeserved benefits or
payment from a federal healthcare program, or billing for a service that was not
performed. - ANSWER>>Fraud
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? - ANSWER>>Abuse
A person that files a claim for a Medicare Beneficiary knowing that the service is
not correctly reported is in violation of what statute? - ANSWER>>False Claims Act
Which of the following actions is considered under the False Claims Act? -
ANSWER>>Up-coding or unbundling services
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? - ANSWER>>Truth in Lending Act
Medicare was passed into law under the title XVIII of what Act? - ANSWER>>Social
Security Act
Which of the following statements are true regarding healthcare regulations? -
ANSWER>>Healthcare regulations may vary by state and by payer
, A physician office (covered entity) discovers that the billing company (business
associate) is in breach of their contract. What is the first step to be taken? -
ANSWER>>Take steps to correct the problem and end the violation
OIG, CMS, and the Department of Justice are the government agencies enforcing
______? - ANSWER>>Federal fraud and abuse laws
Fraud and Abuse penalties do NOT include: - ANSWER>>Ability to re-file claims in
question
A biller at a medical practice notices that all claims contain CPT code 81002. She
questions the nurse who tells her that because they are an OB/GYN office they bill
every patient for a urinalysis. What does this violate? - ANSWER>>False Claims Act
Individuals have the right to review and obtain copies of the PHI. What is
excluded from the right of access? - ANSWER>>Psychotherapy notes
Medical Records are requested for a patient for a specific date of service. When
records are copied, multiple dates of service are copied and sent in reply to the
request. What standard does this violate? - ANSWER>>Minimum Necessary
Patient has questions and concerns regarding the Privacy Practices in the clinic
should be addressed by what party? - ANSWER>>Privacy Official
What standard transactions are NOT included in EDI and adopted under HIPAA? -
ANSWER>>Waiver of liability
The Federal False Claim Act allows for claims to be reviewed for how many years
after an incident? - ANSWER>>Seven years
Questions and Answers Study Guide
A practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice
used x-rays of one patient to justify services on multiple other patients' claims.
The office manager brought the civil suit. What type of case is this? -
ANSWER>>Qui Tam
In which of the following circumstances may PHI not be disclosed without the
patient's authorization or permission? - ANSWER>>An office receives a call from
the patient's husband asking for information about his wife's recent office visit.
According to the Privacy Rule, what must a Business Associate and a Covered
Entity have in order to do business? - ANSWER>>A contract
HMO plans require the enrollee to: - ANSWER>>To have referrals to see a
specialist that is generated by the patient's primary care provider.
Which of the following is NOT a component of the PPO payer model? -
ANSWER>>Require the enrollee to maintain a Primary Care Provider.
Under the Privacy Rule a health plan, clearinghouses, and any entity transmitting
health information is considered? - ANSWER>>Covered entity
A request for medical records is received for a specific date of service from a
patient's insurance company with regards to a submitted claim. No authorization
for release of information is provided. What action should be taken? -
ANSWER>>Release the requested records to the insurance company.
,Which of the following situations allows the release of PHI without authorization
from the patient? - ANSWER>>Workers' Compensation
HIPAA mandated what entity to adopt national standards for electronic
transactions and code sets? - ANSWER>>HHS
What is the standard time frame established for record retention? -
ANSWER>>There is no single standard for record retention; it varies by state and
federal regulations.
CMS defines _______ as billing for a lower level of care than is supported in
documentation, making false statements to obtain undeserved benefits or
payment from a federal healthcare program, or billing for a service that was not
performed. - ANSWER>>Fraud
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? - ANSWER>>Abuse
A person that files a claim for a Medicare Beneficiary knowing that the service is
not correctly reported is in violation of what statute? - ANSWER>>False Claims Act
Which of the following actions is considered under the False Claims Act? -
ANSWER>>Up-coding or unbundling services
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? - ANSWER>>Truth in Lending Act
Medicare was passed into law under the title XVIII of what Act? - ANSWER>>Social
Security Act
Which of the following statements are true regarding healthcare regulations? -
ANSWER>>Healthcare regulations may vary by state and by payer
, A physician office (covered entity) discovers that the billing company (business
associate) is in breach of their contract. What is the first step to be taken? -
ANSWER>>Take steps to correct the problem and end the violation
OIG, CMS, and the Department of Justice are the government agencies enforcing
______? - ANSWER>>Federal fraud and abuse laws
Fraud and Abuse penalties do NOT include: - ANSWER>>Ability to re-file claims in
question
A biller at a medical practice notices that all claims contain CPT code 81002. She
questions the nurse who tells her that because they are an OB/GYN office they bill
every patient for a urinalysis. What does this violate? - ANSWER>>False Claims Act
Individuals have the right to review and obtain copies of the PHI. What is
excluded from the right of access? - ANSWER>>Psychotherapy notes
Medical Records are requested for a patient for a specific date of service. When
records are copied, multiple dates of service are copied and sent in reply to the
request. What standard does this violate? - ANSWER>>Minimum Necessary
Patient has questions and concerns regarding the Privacy Practices in the clinic
should be addressed by what party? - ANSWER>>Privacy Official
What standard transactions are NOT included in EDI and adopted under HIPAA? -
ANSWER>>Waiver of liability
The Federal False Claim Act allows for claims to be reviewed for how many years
after an incident? - ANSWER>>Seven years
