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Examen

AAPC CPB Chapter 1 Review — Compliance, HIPAA & Fraud Prevention (Medical Billing & Coding, 2025/2026 Edition)

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This document provides a chapter review with practice questions and answers for AAPC CPB (Certified Professional Biller) Chapter 1. It covers essential compliance topics including HIPAA Privacy Rule, PHI, minimum necessary standard, covered entities, business associates, Stark Law, Anti-Kickback Statute, False Claims Act, Qui Tam lawsuits, Truth in Lending Act, fraud vs abuse, and electronic data interchange (EDI) standards. The Q&A format makes it a focused study tool for exam preparation and understanding healthcare compliance regulations.

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AAPC CPB - Chapter 1 Review


A hospital records transporter is moving medical records from the hospital to an off-site
building. During the transport, a chart falls from the box on to the street. It is discovered
when the transporter arrives at the off-site building and the number of charts is not
correct. What type of violation is this?

a. A breach
b. A minimum necessary violation
c. A disclosure violation
d. Fraud - ANS - a. A breach

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?

a. Stark Laws
b. HIPAA
c. Anti-Kickback law
d. Qui Tam - ANS - c. Anti-Kickback law

A patient is seen in your clinic. Her husband calls later in the day to ask for information
about the visit. The practice pulls the patient's privacy authorization to see if they can
speak to the husband. What act does this action fall under?

a. HIPAA
b. Social Security Act
c. ADA
d. Health Information Act - ANS - a. HIPAA

A practice agrees to pay $250,000 to settle a lawsuit alleging that the practice used
X-rays of one patient to justify services on multiple other patients' claims. The manager
of the office brought the civil suit. What type of case is this?

a. Qui Tam
b. Stark case

, c. Anti-Kickback
d. HIPAA - ANS - a. Qui Tam

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?

a. Truth in Lending Act
b. False Claims Act
c. HIPAA
d. Social Security Act - ANS - a. Truth in Lending Act

A private practice hires a consultant to come in and audit some medical records. Under
the Privacy Rule, what is this consultant considered?

a. An employee
b. A business associate
c. A covered entity
d. A clearinghouse - ANS - b. A business associate

A records request is received from a health plan for three dates of service in a chart
months apart. What should the biller do?

a. Copy the entire chart and send it to make sure that the health plan has everything
they need and will not request more records.
b. Copy everything from the first date through the third date, even if it is not included to
cover the timeframe the health plan is looking at for the request.
c. Copy each date of service and black out all identifying information in the copies
before sending to the health plan.
d. Copy each date of service individually and send to the health plan. - ANS - d. Copy
each date of service individually and send to the health plan

According to the Privacy Rule, what health information may not be de-identified?

a. Patient social security number
b. Medical record number
c. Patient home address
d. Physician provider number - ANS - d. Physician provider number

Información del documento

Subido en
10 de septiembre de 2025
Número de páginas
6
Escrito en
2025/2026
Tipo
Examen
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$10.49

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