AAPC CPB CERTIFIED PROFESSIONAL BILLER
EXAM 2026 COMPLETE QUESTIONS WITH
ANSWERS
◉ healthcare consulting firm. Answer: Which of the following is not
a covered entity in the Privacy Rule
◉ release reqt to ins co. Answer: A request for medical records is
received for a specific date of service from patient's insurance
company with regards to a submitted claim. No authorization for
release of information is provided. What action should be taken?
◉ 12. Answer: How many national priority purposes under the
Privacy Rules for disclosure of specific PHI without an individual's
authorization or permission?
◉ no. Answer: A health plan sends a request for medical records in
order to adjudicate a claim. Does the office have to notify the patient
or have them sign a release to send the information?
◉ Truth in Lending Act. Answer: 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?
,◉ workers comp. Answer: Which of the following situations allows
release of PHI without authorization from the patient?
◉ abuse. Answer: Entities that have been identified as having
improper billing practices is defined by CMS as a violation of what
standard?
◉ abuse. Answer: misusing any information on the claim, charging
excessively for services or supplies, billing for services not medically
necessary, failure to maintain adequate medical or financial records,
improper billing practices, or billing Medicare patients at a higher
fee scale that non-Medicare patients.
◉ abuse. Answer: 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?
◉ phys provider number. Answer: According to the Privacy Rule,
what health information may not be de-identified?
◉ fraud. Answer: making false statements or misrepresenting facts
to obtain an undeserved benefit or payment from a federal
healthcare program
, ◉ inadequate med recd. Answer: All the following are considered
Fraud, EXCEPT:
◉ breach. Answer: 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?
◉ breach. Answer: impermissible release or disclosure of
information is discovered
◉ waiver of liability. Answer: What standard transactions is NOT
included in EDI and adopted under HIPAA?
◉ 7. Answer: The Federal False Claim Act allows for claims to be
reviewed for a standard of how many years after an incident?
◉ anti kickback laws. Answer: 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?
EXAM 2026 COMPLETE QUESTIONS WITH
ANSWERS
◉ healthcare consulting firm. Answer: Which of the following is not
a covered entity in the Privacy Rule
◉ release reqt to ins co. Answer: A request for medical records is
received for a specific date of service from patient's insurance
company with regards to a submitted claim. No authorization for
release of information is provided. What action should be taken?
◉ 12. Answer: How many national priority purposes under the
Privacy Rules for disclosure of specific PHI without an individual's
authorization or permission?
◉ no. Answer: A health plan sends a request for medical records in
order to adjudicate a claim. Does the office have to notify the patient
or have them sign a release to send the information?
◉ Truth in Lending Act. Answer: 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?
,◉ workers comp. Answer: Which of the following situations allows
release of PHI without authorization from the patient?
◉ abuse. Answer: Entities that have been identified as having
improper billing practices is defined by CMS as a violation of what
standard?
◉ abuse. Answer: misusing any information on the claim, charging
excessively for services or supplies, billing for services not medically
necessary, failure to maintain adequate medical or financial records,
improper billing practices, or billing Medicare patients at a higher
fee scale that non-Medicare patients.
◉ abuse. Answer: 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?
◉ phys provider number. Answer: According to the Privacy Rule,
what health information may not be de-identified?
◉ fraud. Answer: making false statements or misrepresenting facts
to obtain an undeserved benefit or payment from a federal
healthcare program
, ◉ inadequate med recd. Answer: All the following are considered
Fraud, EXCEPT:
◉ breach. Answer: 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?
◉ breach. Answer: impermissible release or disclosure of
information is discovered
◉ waiver of liability. Answer: What standard transactions is NOT
included in EDI and adopted under HIPAA?
◉ 7. Answer: The Federal False Claim Act allows for claims to be
reviewed for a standard of how many years after an incident?
◉ anti kickback laws. Answer: 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?
