AAPC test - Chapter 4 - 4/4 2025
Questions and Answers
arah, Compliance Officer for Apple Hospital, explains to the physicians on staff that
_________ can occur when the same service is billed to Medicare and then billed to a
private insurance company or to the patient. - ....ANSWER ...-Selected Answer:
double billing
What is the maximum amount of days, after determining that there is credible evidence
of fraudulent conduct, should a billing company take to notify federal and state
authorities regarding the violation? - ....ANSWER ...-60
Which, of the following, is NOT a key risk area identified for third-party medical billing
companies by the OIG Compliance Program Guidance? - ....ANSWER ...-Billing
for items or services not actually documented;• Unbundling;• Upcoding, such as, for
example, DRG creep;• Inappropriate balance billing;• Inadequate resolution of
overpayments;• Lack of integrity in computer systems;• Computer software programs
that encourage billing personnel to enter data in fields indicating services were rendered
though not actually performed or documented;• Failure to maintain the confidentiality of
information/records;• Knowing misuse of provider identification numbers, which results
in improper billing;• Outpatient services rendered in connection with inpatient stays;•
Duplicate billing in an attempt to gain duplicate payment;• Billing for discharge in lieu
of transfer;• Failure to properly use modifiers;• Billing company incentives that violate
the anti-kickback statute or other similar Federal or State statute or regulation;• Joint
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 1
,ventures;• Routine waiver of copayments and billing third-party insurance only; and•
Discounts and professional courtesy.
What can result in imprisonment and penalties for providers and covered entities? -
....ANSWER ...-Medical Fraud
The OIG and the American Health Lawyers Association (AHLA) have co-sponsored
documents in an effort to assist the directors of healthcare organizations. The document
Practical Guidance for Health Care Governing Boards on Compliance Oversight to assist
the Board of Directors was collaborated on with the OIG, AHLA, HCCA, HHS, and
what other organization? - ....ANSWER ...-Association of Healthcare Internal
Auditors (AHIA)
Dr. X is contracted with Medicare. After receiving the payment from Medicare, the
difference between the total provider charges and the Medicare Part B allowable
payment is billed to the Medicare beneficiaries. Which of the coding and billing risk
areas identified in the OIG compliance guidance does this scenario implicate? -
....ANSWER ...-Inappropriate balance billing
Dr. Dallas requests a CBC on all his patients and has a standing order for his patients
that come to the lab for blood work. What should the lab do with the standing order? -
....ANSWER ...-Require a fixed term of validity for the standing order.
medical billing company should have open and frequent communication regarding the
mandatory responsibility to refund overpayments, and have this process documented,
with whom? - ....ANSWER ...-Healthcare providers
What action will show that a third party has good faith towards remediation? -
....ANSWER ...-Prompt reporting of any wrongdoing
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 2
,What third-party is in a unique position to discover fraud? - ....ANSWER ...-
Medical Billing Companies
Which of the following, is a Skilled Nursing Facility best practice guideline for the
compliance officer? - ....ANSWER ...-If audit determines claims did not meet
medical necessity, report to CMS within 60 days.
Which question below addresses a significant concern based on OIG guidance for
nursing facilities? - ....ANSWER ...-Does the organization have a written policy
regarding the quality of care for patients?
Which, of the following, is NOT a purpose of the Requisition Lab slip? -
....ANSWER ...-Contain a statement that indicates Medicare generally covers all
routine screening tests
Steve is the Compliance Officer for Orange Labs. The CEO asked Steve if laboratories
should develop standards of conduct for employees. How should Steve respond? -
....ANSWER ...-Laboratories should develop standards of conduct to clearly define
the policies.
When patients are referred to home health agencies and/or DME suppliers, what is
identified as an area of concern? - ....ANSWER ...-Anti-Kickback Statute
What should clinical laboratories charge physicians for ordered tests? -
....ANSWER ...-A price that is at fair market value.
A clinical Laboratory gets all of their Medicare patients to sign a blank ABN form in case
Medicare does not pay for a service. This is part of their written policy. Is this a
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 3
, compliance risk? - ....ANSWER ...-yes; a laboratory may never ask a patient to sign
a blank ABN
oan, at ABC Provider group, has Dr. X going on vacation. The group hired another
provider that will fill in for Dr. X starting this week. The new provider is from a different
state and will need to apply for a license to practice medicine. Dr. X says that it is alright
to let the new provider use his billing and license numbers while he is on vacation. What
is this an example of? - ....ANSWER ...-Knowing misuse of provider identification
numbers
Which office listed below is NOT addressed in the OlG Work Plan? -
....ANSWER ...-Office of Health and Human Services
The OIG Work Plan includes projects to be addressed during the fiscal year (and
beyond) by the Office of Audit Services, Office of Evaluation and Inspections, Office of
Investigations, and Office of Counsel to the Inspector General. The entire current Work
Plan or sections of the plan can be downloaded at the OIG's website at
https://oig.hhs.gov/reports-and-publications/workplan/.
The OIG is a division of which agency? - ....ANSWER ...-HHS
In a qui tam action in which the government intervenes, the relator is entitled to receive
a monetary settlement between? - ....ANSWER ...-15-25%
Penalties for mail fraud for persons who knowingly and willfully scheme to defraud a
healthcare benefit program that results in serious bodily injury include fines and
imprisonment of up to how many years? - ....ANSWER ...-20 years
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 4
Questions and Answers
arah, Compliance Officer for Apple Hospital, explains to the physicians on staff that
_________ can occur when the same service is billed to Medicare and then billed to a
private insurance company or to the patient. - ....ANSWER ...-Selected Answer:
double billing
What is the maximum amount of days, after determining that there is credible evidence
of fraudulent conduct, should a billing company take to notify federal and state
authorities regarding the violation? - ....ANSWER ...-60
Which, of the following, is NOT a key risk area identified for third-party medical billing
companies by the OIG Compliance Program Guidance? - ....ANSWER ...-Billing
for items or services not actually documented;• Unbundling;• Upcoding, such as, for
example, DRG creep;• Inappropriate balance billing;• Inadequate resolution of
overpayments;• Lack of integrity in computer systems;• Computer software programs
that encourage billing personnel to enter data in fields indicating services were rendered
though not actually performed or documented;• Failure to maintain the confidentiality of
information/records;• Knowing misuse of provider identification numbers, which results
in improper billing;• Outpatient services rendered in connection with inpatient stays;•
Duplicate billing in an attempt to gain duplicate payment;• Billing for discharge in lieu
of transfer;• Failure to properly use modifiers;• Billing company incentives that violate
the anti-kickback statute or other similar Federal or State statute or regulation;• Joint
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 1
,ventures;• Routine waiver of copayments and billing third-party insurance only; and•
Discounts and professional courtesy.
What can result in imprisonment and penalties for providers and covered entities? -
....ANSWER ...-Medical Fraud
The OIG and the American Health Lawyers Association (AHLA) have co-sponsored
documents in an effort to assist the directors of healthcare organizations. The document
Practical Guidance for Health Care Governing Boards on Compliance Oversight to assist
the Board of Directors was collaborated on with the OIG, AHLA, HCCA, HHS, and
what other organization? - ....ANSWER ...-Association of Healthcare Internal
Auditors (AHIA)
Dr. X is contracted with Medicare. After receiving the payment from Medicare, the
difference between the total provider charges and the Medicare Part B allowable
payment is billed to the Medicare beneficiaries. Which of the coding and billing risk
areas identified in the OIG compliance guidance does this scenario implicate? -
....ANSWER ...-Inappropriate balance billing
Dr. Dallas requests a CBC on all his patients and has a standing order for his patients
that come to the lab for blood work. What should the lab do with the standing order? -
....ANSWER ...-Require a fixed term of validity for the standing order.
medical billing company should have open and frequent communication regarding the
mandatory responsibility to refund overpayments, and have this process documented,
with whom? - ....ANSWER ...-Healthcare providers
What action will show that a third party has good faith towards remediation? -
....ANSWER ...-Prompt reporting of any wrongdoing
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 2
,What third-party is in a unique position to discover fraud? - ....ANSWER ...-
Medical Billing Companies
Which of the following, is a Skilled Nursing Facility best practice guideline for the
compliance officer? - ....ANSWER ...-If audit determines claims did not meet
medical necessity, report to CMS within 60 days.
Which question below addresses a significant concern based on OIG guidance for
nursing facilities? - ....ANSWER ...-Does the organization have a written policy
regarding the quality of care for patients?
Which, of the following, is NOT a purpose of the Requisition Lab slip? -
....ANSWER ...-Contain a statement that indicates Medicare generally covers all
routine screening tests
Steve is the Compliance Officer for Orange Labs. The CEO asked Steve if laboratories
should develop standards of conduct for employees. How should Steve respond? -
....ANSWER ...-Laboratories should develop standards of conduct to clearly define
the policies.
When patients are referred to home health agencies and/or DME suppliers, what is
identified as an area of concern? - ....ANSWER ...-Anti-Kickback Statute
What should clinical laboratories charge physicians for ordered tests? -
....ANSWER ...-A price that is at fair market value.
A clinical Laboratory gets all of their Medicare patients to sign a blank ABN form in case
Medicare does not pay for a service. This is part of their written policy. Is this a
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 3
, compliance risk? - ....ANSWER ...-yes; a laboratory may never ask a patient to sign
a blank ABN
oan, at ABC Provider group, has Dr. X going on vacation. The group hired another
provider that will fill in for Dr. X starting this week. The new provider is from a different
state and will need to apply for a license to practice medicine. Dr. X says that it is alright
to let the new provider use his billing and license numbers while he is on vacation. What
is this an example of? - ....ANSWER ...-Knowing misuse of provider identification
numbers
Which office listed below is NOT addressed in the OlG Work Plan? -
....ANSWER ...-Office of Health and Human Services
The OIG Work Plan includes projects to be addressed during the fiscal year (and
beyond) by the Office of Audit Services, Office of Evaluation and Inspections, Office of
Investigations, and Office of Counsel to the Inspector General. The entire current Work
Plan or sections of the plan can be downloaded at the OIG's website at
https://oig.hhs.gov/reports-and-publications/workplan/.
The OIG is a division of which agency? - ....ANSWER ...-HHS
In a qui tam action in which the government intervenes, the relator is entitled to receive
a monetary settlement between? - ....ANSWER ...-15-25%
Penalties for mail fraud for persons who knowingly and willfully scheme to defraud a
healthcare benefit program that results in serious bodily injury include fines and
imprisonment of up to how many years? - ....ANSWER ...-20 years
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 4
