AAPC CPB FINAL EXAM PREP LATEST UPDATED 2024 WITH COMPLETE
SOLUTIONS
Patient questions and concerns regarding the Privacy Practices in the
clinic should be addressed by what party?
A. The physician
B. The billing staff
C. Any employee
D. Privacy official - ANSWER-D. Privacy official
HIPAA rules indicate that all entities should designate a Privacy official
that will develop and implement privacy policies and procedures and be a
contact person for individuals with questions
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 action
should be taken?
A. Request a patient's signature from the insurance company
B. Release the requested records to the insurance company
C. Request the signature for authorization from the patient
,D. Release the records after receiving verbal permission from the patient
- ANSWER-B. Release the requested records to the insurance company
A covered entity is permitted to release records for the purpose of
treatment, payment, or healthcare operations.
What does the acronym PHI stand for?
A. Patient History of Illness
B. Protected Health information
C. Protected Healthcare Index
D. Patient Healthcare Information - ANSWER-B. Protected Health
information
PHI stands for protected health information. PHI is "individually
identifiable health information" that includes many common identifiers,
such as demographic data, name, address, birth date, and social security
number.
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. False claim
,B. Malpractice
C. Abuse
D. Fraud - ANSWER-C. Abuse
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
What were the eight standard transactions for electronic data
interchange adopted under?
A. HIPAA
B. The Social Security Act
C. The Truth in Lending Act
D. Anti-Kickback Statute - ANSWER-A. HIPAA
, Under HIPAA, provisions were included for Administrative Simplification
that mandated HHS to adopt national standards for electronic healthcare
transactions and code sets. Eight standard transactions were adopted.
A private practice hires a consultant to come in and audit some medical
records. Under the Privacy Rule, what is this consultant considered?
A. A business associate
B. An employee
C. A covered entity
D. A clearinghouse - ANSWER-A. A business associate
Business associates perform certain functions or activities, which involve
the use or disclosure of individually identifiable health information, on
behalf of another person or organization. These services include claims
processing or administration, data analysis, utilization review, billing,
benefit management, and re-pricing. Because the consultant will be
auditing medical records, PHI will need to be shared from the practice.
The practice would be the covered entity
SOLUTIONS
Patient questions and concerns regarding the Privacy Practices in the
clinic should be addressed by what party?
A. The physician
B. The billing staff
C. Any employee
D. Privacy official - ANSWER-D. Privacy official
HIPAA rules indicate that all entities should designate a Privacy official
that will develop and implement privacy policies and procedures and be a
contact person for individuals with questions
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 action
should be taken?
A. Request a patient's signature from the insurance company
B. Release the requested records to the insurance company
C. Request the signature for authorization from the patient
,D. Release the records after receiving verbal permission from the patient
- ANSWER-B. Release the requested records to the insurance company
A covered entity is permitted to release records for the purpose of
treatment, payment, or healthcare operations.
What does the acronym PHI stand for?
A. Patient History of Illness
B. Protected Health information
C. Protected Healthcare Index
D. Patient Healthcare Information - ANSWER-B. Protected Health
information
PHI stands for protected health information. PHI is "individually
identifiable health information" that includes many common identifiers,
such as demographic data, name, address, birth date, and social security
number.
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. False claim
,B. Malpractice
C. Abuse
D. Fraud - ANSWER-C. Abuse
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
What were the eight standard transactions for electronic data
interchange adopted under?
A. HIPAA
B. The Social Security Act
C. The Truth in Lending Act
D. Anti-Kickback Statute - ANSWER-A. HIPAA
, Under HIPAA, provisions were included for Administrative Simplification
that mandated HHS to adopt national standards for electronic healthcare
transactions and code sets. Eight standard transactions were adopted.
A private practice hires a consultant to come in and audit some medical
records. Under the Privacy Rule, what is this consultant considered?
A. A business associate
B. An employee
C. A covered entity
D. A clearinghouse - ANSWER-A. A business associate
Business associates perform certain functions or activities, which involve
the use or disclosure of individually identifiable health information, on
behalf of another person or organization. These services include claims
processing or administration, data analysis, utilization review, billing,
benefit management, and re-pricing. Because the consultant will be
auditing medical records, PHI will need to be shared from the practice.
The practice would be the covered entity
