AAPC CPB EXAM WITH COMPLETE
QUESTIONS & ANSWERS
HRA - -Health Reimbursement Account
-What part of Medicare pays for prescriptions - -Part D
-What type of plan allows an insurer to administer straight indemnity
insurance, an HMO, or a PPO insurance plans to its members? - -Triple
Option Plan
-HIPAA - -Health Insurance Portability and Accountability Act of 1996
-Fraud (CMS defines) - -Making false stmts or misrepresenting facts to
obtain an undeserved benefit or payment from a federal healthcare program.
Ie. misusing codes on claims, billing for services not medically necessary,
higher fees charged, etc
-Penalties for fraud - -Monetary penalties, exclusion from Federal healthcare
program, imprisonments
-Fraud Claimsexample Acct - -Billing a code that is not performed is a
violation
-HMO plans require - -A referral from PCP to see a specialist
-CMS Abuse - -Charge unnecessary cost to federal healthcare program
-What is the standard time frame established for record retention? - -There
is no standardretention requirement, it varies by state and federal
regulations. CMS 5 year time line for providers to submit cost reports. 7
years is the length of time that false claims can be investigated.
-Privacy Rule Purpose - -Is to protect individual privacy, while promoting
high quality healthcare and public health and well being
-What entities are exempt from HIPAA Andy are not considered to be
covered entities - -HIPAA allows exemption for entities providing only
worker's compensation plans, employers with less than 50 employees as well
as government funded programs such as food stamps and community health
centers
QUESTIONS & ANSWERS
HRA - -Health Reimbursement Account
-What part of Medicare pays for prescriptions - -Part D
-What type of plan allows an insurer to administer straight indemnity
insurance, an HMO, or a PPO insurance plans to its members? - -Triple
Option Plan
-HIPAA - -Health Insurance Portability and Accountability Act of 1996
-Fraud (CMS defines) - -Making false stmts or misrepresenting facts to
obtain an undeserved benefit or payment from a federal healthcare program.
Ie. misusing codes on claims, billing for services not medically necessary,
higher fees charged, etc
-Penalties for fraud - -Monetary penalties, exclusion from Federal healthcare
program, imprisonments
-Fraud Claimsexample Acct - -Billing a code that is not performed is a
violation
-HMO plans require - -A referral from PCP to see a specialist
-CMS Abuse - -Charge unnecessary cost to federal healthcare program
-What is the standard time frame established for record retention? - -There
is no standardretention requirement, it varies by state and federal
regulations. CMS 5 year time line for providers to submit cost reports. 7
years is the length of time that false claims can be investigated.
-Privacy Rule Purpose - -Is to protect individual privacy, while promoting
high quality healthcare and public health and well being
-What entities are exempt from HIPAA Andy are not considered to be
covered entities - -HIPAA allows exemption for entities providing only
worker's compensation plans, employers with less than 50 employees as well
as government funded programs such as food stamps and community health
centers
