AAPC CPB Final questions with complete solution

AAPC CPB Final questions with complete solution Health plan, clearinghouses, and any entity transmitting health information is considered by the Privacy Rule to be a: - Correct Answers-covered entity Which of the following is not a covered entity in the Privacy Rule - Correct Answers-healthcare consulting firm 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? - Correct Answers-release reqt to ins co How many national priority purposes under the Privacy Rules for disclosure of specific PHI without an individual's authorization or permission? - Correct Answers-12 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? - Correct Answers-no 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? - Correct Answers-Truth in Lending Act Which of the following situations allows release of PHI without authorization from the patient? - Correct Answers-workers comp 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. - Correct Answers-abuse 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? - Correct Answers-abuse According to the Privacy Rule, what health information may not be de-identified? - Correct Answers-phys provider number making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program - Correct Answers-fraud All the following are considered Fraud, EXCEPT: - Correct Answers-inadequate med recd 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? - Correct Answers-breach impermissible release or disclosure of information is discovered - Correct Answers-breach What standard transactions is NOT included in EDI and adopted under HIPAA? - Correct Answers-waiver of liability The Federal False Claim Act allows for claims to be reviewed for a standard of how many years after an incident? - Correct Answers-7 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? - Correct Answers-anti kickback laws A private practice hires a consultant to come in and audit some medical records. Under the Privacy Rule, what is this consultant considered? - Correct Answers-biz associate Medicare overpayments should be returned within ___ days after the overpayment has been identified - Correct Answers-60 HIPAA mandated what entity to adopt national standards for electronic transactions and code sets? - Correct Answers-HHS Entities that have been identified as having improper billing practices is defined by CMS as a violation of what standard? - Correct Answers-abuse In addition to the standardization of the codes (ICD-10, CPT, HCPCS, and NDC) used to request payment for medical services, what must be used on all transactions for employers and providers? - Correct Answers-unique id A person that files a claim for a Medicare beneficiary knowing that the service is not correctly reported is in violation of what statute? - Correct Answers-False Claims Act Medicare w