AAPC CPB Exam Prep 2026/2027 | Final
Exam Study Guide | Medical Billing,
Insurance, Compliance & Reimbursement
Review
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? - correct answer-Minimum necessary
Which of the following actions is considered under the False Claim Act? - correct
answer-Upcoding or unbundling services
According to the Privacy Rule, what health information may not be de-identified?
- correct answer-Physician provider number
What is the standard time frame established for record retention? - correct
answer-There is no single standard record retention, it varies by state and federal
regulation.
A request for medical records is received for a specific date of service from the
patient's insurance company with regards to a submitted claim. No authorization
for release of information is provided. What actions should be taken? - correct
answer-Release the requested records to the insurance company.
Individuals have the right to review and obtain copies of their PHI. What is
excluded from the right of access? - correct answer-Psychotherapy notes
, What does the abbreviation of HIPAA stand for? - correct answer-Health
Insurance Portability and Accountability Act
A patient is age 65 and Medicare eligible. The patient signs up for a Medicare
Managed Care plan. When the patient presents for care, where are claims sent? -
correct answer-The Managed Care Plan
What are some of the ways that Managed care organizations (MCOs) offer
provisions that provide insurers with ways to manage the cost, use, and quality of
healthcare services received by a member?
I. Utilization Review
II. Coverage restrictions
III. Arbitration
IV. Non-emergency weekend admission restrictions - correct answer-I, IV
What is important for a CPB to know regarding Medicare beneficiaries? - correct
answer-Screening services require specific diagnosis codes to be considered for
payment.
If a provider decides not to participate with Medicare what is one of the
disadvantages? - correct answer-The patient receives the reimbursement.
A patient is scheduled in your office for Botox injections in her face for her smile
lines. She has not met her deductible and states that she is going to use money
from her Healthcare Reimbursement Account to pay for it. Is this possible? -
correct answer-No, cosmetic procedures are ineligible expenses.
Exam Study Guide | Medical Billing,
Insurance, Compliance & Reimbursement
Review
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? - correct answer-Minimum necessary
Which of the following actions is considered under the False Claim Act? - correct
answer-Upcoding or unbundling services
According to the Privacy Rule, what health information may not be de-identified?
- correct answer-Physician provider number
What is the standard time frame established for record retention? - correct
answer-There is no single standard record retention, it varies by state and federal
regulation.
A request for medical records is received for a specific date of service from the
patient's insurance company with regards to a submitted claim. No authorization
for release of information is provided. What actions should be taken? - correct
answer-Release the requested records to the insurance company.
Individuals have the right to review and obtain copies of their PHI. What is
excluded from the right of access? - correct answer-Psychotherapy notes
, What does the abbreviation of HIPAA stand for? - correct answer-Health
Insurance Portability and Accountability Act
A patient is age 65 and Medicare eligible. The patient signs up for a Medicare
Managed Care plan. When the patient presents for care, where are claims sent? -
correct answer-The Managed Care Plan
What are some of the ways that Managed care organizations (MCOs) offer
provisions that provide insurers with ways to manage the cost, use, and quality of
healthcare services received by a member?
I. Utilization Review
II. Coverage restrictions
III. Arbitration
IV. Non-emergency weekend admission restrictions - correct answer-I, IV
What is important for a CPB to know regarding Medicare beneficiaries? - correct
answer-Screening services require specific diagnosis codes to be considered for
payment.
If a provider decides not to participate with Medicare what is one of the
disadvantages? - correct answer-The patient receives the reimbursement.
A patient is scheduled in your office for Botox injections in her face for her smile
lines. She has not met her deductible and states that she is going to use money
from her Healthcare Reimbursement Account to pay for it. Is this possible? -
correct answer-No, cosmetic procedures are ineligible expenses.
