CPB Final Exam Complete Solution 2023
A practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice used x-rays of one
patient to justify services on multiple other patients' claims. The office manager brought the civil suit.
What type of case is this? Ans- Qui Tam
In wh...
CPB Final Exam Complete Solution 2023
A practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice used x-rays of one
patient to justify services on multiple other patients' claims. The office manager brought the civil suit.
What type of case is this? Ans- Qui Tam
In which of the following circumstances may PHI not be disclosed without the patient's authorization or
permission? Ans- An office receives a call from the patient's husband asking for information about his
wife's recent office visit.
According to the Privacy Rule, what must a Business Associate and a Covered Entity have in order to do
business? Ans- A contract
HMO plans require the enrollee to: Ans- To have referrals to see a specialist that is generated by the
patient's primary care provider.
Which of the following is NOT a component of the PPO payer model? Ans- Require the enrollee to
maintain a Primary Care Provider.
Under the Privacy Rule a health plan, clearinghouses, and any entity transmitting health information is
considered? Ans- Covered entity
A request for medical records is received for a specific date of service from a patient's insurance
company with regards to a submitted claim. No authorization for release of information is provided.
What action should be taken? Ans- Release the requested records to the insurance company.
Which of the following situations allows the release of PHI without authorization from the patient? Ans-
Workers' Compensation
HIPAA mandated what entity to adopt national standards for electronic transactions and code sets? Ans-
HHS
,What is the standard time frame established for record retention? Ans- There is no single standard for
record retention; it varies by state and federal regulations.
CMS defines _______ as billing for a lower level of care than is supported in documentation, making
false statements to obtain undeserved benefits or payment from a federal healthcare program, or billing
for a service that was not performed. Ans- Fraud
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? Ans- Abuse
A person that files a claim for a Medicare Beneficiary knowing that the service is not correctly reported
is in violation of what statute? Ans- False Claims Act
Which of the following actions is considered under the False Claims Act? Ans- Up-coding or unbundling
services
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? Ans- Truth in
Lending Act
Medicare was passed into law under the title XVIII of what Act? Ans- Social Security Act
Which of the following statements are true regarding healthcare regulations? Ans- Healthcare
regulations may vary by state and by payer
A physician office (covered entity) discovers that the billing company (business associate) is in breach of
their contract. What is the first step to be taken? Ans- Take steps to correct the problem and end the
violation
OIG, CMS, and the Department of Justice are the government agencies enforcing ______? Ans- Federal
fraud and abuse laws
Fraud and Abuse penalties do NOT include: Ans- Ability to re-file claims in question
, A biller at a medical practice notices that all claims contain CPT code 81002. She questions the nurse
who tells her that because they are an OB/GYN office they bill every patient for a urinalysis. What does
this violate? Ans- False Claims Act
Individuals have the right to review and obtain copies of the PHI. What is excluded from the right of
access? Ans- Psychotherapy notes
Medical Records are requested for a patient for a specific date of service. When records are copied,
multiple dates of service are copied and sent in reply to the request. What standard does this violate?
Ans- Minimum Necessary
Patient has questions and concerns regarding the Privacy Practices in the clinic should be addressed by
what party? Ans- Privacy Official
What standard transactions are NOT included in EDI and adopted under HIPAA? Ans- Waiver of liability
The Federal False Claim Act allows for claims to be reviewed for how many years after an incident? Ans-
Seven years
While working in a large practice, Medicare overpayments are found in several patient accounts. The
manager states that the practice will keep the money until Medicare asks for it back. What is that action
considered? Ans- Fraud
What penalties can be imposed for Fraud and/or Abuse related to the United States Code? Ans- a.
Monetary penalties ranging from $10,000 to $50,000 for each item or service
b. Imprisonment
c. Exclusion from Federal Healthcare Programs
(d.) All of the above
Medicare overpayments should be returned within ____ days after the overpayment has been
identified? Ans- 60 days
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