AAPC CPB CHAPTER 1 REVIEW 2026
COMPREHENSIVE PRACTICE
QUESTIONS AND VERIFIED CORRECT
ANSWERS CERTIFIED PROFESSIONAL
BILLER CPB CERTIFICATION EXAM
STUDY GUIDE
Under the HIPAA Privacy Rule, fully insured group health plans have only
2 obligations. What are they?? - CORRECT ANSWER -(1) Banned from
retaliatory acts and waiver of individual rights
(2) To provide documentation for the disclosure of PHI through
documentation
The ______ ______ contains ?? and was established by the ?? to
establish nation standards to protect and secure patient data that is stored
electronically. - CORRECT ANSWER --HIPAA Security Rule
-Information on transactions and code sets FCA - CORRECT ANSWER -False
Claims Act (FCA): {"knowing" and "knowingly"}-Federal statue setting civil
and criminal penalties to protect the government from being overcharged
or sold substandard goods or services:
-falsely billing the government
-over-representing the amount of a delivered product
....or....
-under-stating an obligation to the government
,Minimum Necessary Standard. What should be sent if records are being
requested?? - CORRECT ANSWER -The ? requires covered entities to take
reasonable steps to limit the disclosure of PHI. Only the dates of service
requested should be sent. The PHI would not need to be redacted.
What does PHI stand for?? What does it include?? - CORRECT ANSWER -
Protected Health Information-"individually identifiable health
information" that includes many common identifiers, such as demographic
data, name, address, birth date, and social security number.
If a provider is excluded from federal health plans, what does that mean?? -
CORRECT ANSWER -One of the most severe penalties associated with the
Social Security Act is the ability of the Office of Inspector General (OIG) to
exclude an entity or an individual from participation in any and all federal
healthcare programs. This includes Medicare, Medicaid, VA programs, and
TRICARE. An excluded individual cannot bill for services, provide referrals,
prescribe medications or order services for any beneficiary of a federally
administered health plan.
HMO plans require the enrollee to?? - CORRECT ANSWER -To have referrals
to see a specialist that is generated by patient's PCP.
HMO plans are managed and overseen by?? - CORRECT ANSWER -The
patient's PCP. The PCP is responsible to manage the referrals for panel of
patients assigned to them.
The Federal False Claim Act allows for claims to be reviewed for a standard
of how many years after an incident?? - CORRECT ANSWER -The federal
, False Claims Act (31 USC § 3729) allows for claims to be brought up to
seven years after the incident, but has been extended to 10 years in some
cases, but this is not the standard.
What entities are exempt from HIPAA and not considered to be covered
entities?? (3) - CORRECT ANSWER -HIPAA allows exemption for entities
providing only worker's compensation plans, employers with less than 50
employees as well as government funded programs such as food stamps
and community health centers.
What is the purpose of the Privacy Rule? - CORRECT ANSWER -The purpose
of the Privacy Rule is to protect individual privacy, while promoting high
quality healthcare and public health and well-being.
______, _____, and _____ of Justice are the government agencies
enforcing ________?? - CORRECT ANSWER -The Department of Justice
(DOJ), the Department of Health & Human Services Office of Inspector
General (OIG), and the Centers for Medicare and Medicaid (CMS) are the
government agencies that enforce the Federal fraud and abuse laws.
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 ANSWER -The
Anti-Kickback law-a federal law that makes it a criminal offense to
knowingly or willingly offer, pay, solicit, or receive any remuneration to
induce or reward referrals of items or services reimbursable by a federal
healthcare program.
What are conditions of participation (CoP)??
COMPREHENSIVE PRACTICE
QUESTIONS AND VERIFIED CORRECT
ANSWERS CERTIFIED PROFESSIONAL
BILLER CPB CERTIFICATION EXAM
STUDY GUIDE
Under the HIPAA Privacy Rule, fully insured group health plans have only
2 obligations. What are they?? - CORRECT ANSWER -(1) Banned from
retaliatory acts and waiver of individual rights
(2) To provide documentation for the disclosure of PHI through
documentation
The ______ ______ contains ?? and was established by the ?? to
establish nation standards to protect and secure patient data that is stored
electronically. - CORRECT ANSWER --HIPAA Security Rule
-Information on transactions and code sets FCA - CORRECT ANSWER -False
Claims Act (FCA): {"knowing" and "knowingly"}-Federal statue setting civil
and criminal penalties to protect the government from being overcharged
or sold substandard goods or services:
-falsely billing the government
-over-representing the amount of a delivered product
....or....
-under-stating an obligation to the government
,Minimum Necessary Standard. What should be sent if records are being
requested?? - CORRECT ANSWER -The ? requires covered entities to take
reasonable steps to limit the disclosure of PHI. Only the dates of service
requested should be sent. The PHI would not need to be redacted.
What does PHI stand for?? What does it include?? - CORRECT ANSWER -
Protected Health Information-"individually identifiable health
information" that includes many common identifiers, such as demographic
data, name, address, birth date, and social security number.
If a provider is excluded from federal health plans, what does that mean?? -
CORRECT ANSWER -One of the most severe penalties associated with the
Social Security Act is the ability of the Office of Inspector General (OIG) to
exclude an entity or an individual from participation in any and all federal
healthcare programs. This includes Medicare, Medicaid, VA programs, and
TRICARE. An excluded individual cannot bill for services, provide referrals,
prescribe medications or order services for any beneficiary of a federally
administered health plan.
HMO plans require the enrollee to?? - CORRECT ANSWER -To have referrals
to see a specialist that is generated by patient's PCP.
HMO plans are managed and overseen by?? - CORRECT ANSWER -The
patient's PCP. The PCP is responsible to manage the referrals for panel of
patients assigned to them.
The Federal False Claim Act allows for claims to be reviewed for a standard
of how many years after an incident?? - CORRECT ANSWER -The federal
, False Claims Act (31 USC § 3729) allows for claims to be brought up to
seven years after the incident, but has been extended to 10 years in some
cases, but this is not the standard.
What entities are exempt from HIPAA and not considered to be covered
entities?? (3) - CORRECT ANSWER -HIPAA allows exemption for entities
providing only worker's compensation plans, employers with less than 50
employees as well as government funded programs such as food stamps
and community health centers.
What is the purpose of the Privacy Rule? - CORRECT ANSWER -The purpose
of the Privacy Rule is to protect individual privacy, while promoting high
quality healthcare and public health and well-being.
______, _____, and _____ of Justice are the government agencies
enforcing ________?? - CORRECT ANSWER -The Department of Justice
(DOJ), the Department of Health & Human Services Office of Inspector
General (OIG), and the Centers for Medicare and Medicaid (CMS) are the
government agencies that enforce the Federal fraud and abuse laws.
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 ANSWER -The
Anti-Kickback law-a federal law that makes it a criminal offense to
knowingly or willingly offer, pay, solicit, or receive any remuneration to
induce or reward referrals of items or services reimbursable by a federal
healthcare program.
What are conditions of participation (CoP)??
