Exam (elaborations)

AAPC CPB FINAL EXAM ACTUAL EXMA WITH UPDATED QUESTIONS AND VERIFIED ANSWERS (ALREADY GRADED A+)

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AAPC CPB

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AAPC CPB

AAPC CPB FINAL EXAM ACTUAL EXMA WITH UPDATED QUESTIONS AND VERIFIED ANSWERS (ALREADY GRADED A+) 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 or release of information is provi...

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Uploaded on September 14, 2024
Number of pages 129
Written in 2024/2025
Type Exam (elaborations)
Contains Questions & answers

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AAPC CPB FINAL EXAM 2024- 2025 ACTUAL EXMA

WITH UPDATED QUESTIONS AND VERIFIED

ANSWERS (ALREADY GRADED A+)

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 or release of information is provided. What action should be
taken? - ANSWER-Release the requested records to the insurance
company.

Can you release PHI without authorization from a patient if it is for a
workers' compensation claim? - ANSWER-Yes, Workers compensation
information is not protected under HIPAA

HIPAA mandated what entity to adopt national standards for electronic
transactions and code sets? - ANSWER-HHS

What is the standard time frame established for record retention? -
ANSWER-There is no single standard record retention time frame. It varies
by state and federal regulation.

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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 services that were
not performed. - ANSWER-Fraud

A claim is submitted for a patient on medicare with a higher fee schedule
that a patient on Insurance ABC. What is this considered under CMS? -
ANSWER-Abuse

A person that files a claim for a Medicare beneficiary knowing that the
service is not correctly reported is in violation of what statue? - ANSWER-
FCA (False claims act)

What act is "upcoding or unbundling services" considered under? -
ANSWER-The false claims act

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? - ANSWER-TILA (truth in
lending act)

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 patients privacy

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authorization to see if they can speak to the husband. What act does this
action fall under? - ANSWER-HIPAA

Medicare was passed into law under what Act? - ANSWER-SSA

Are healthcare regulations the same in each state? - ANSWER-No, they
will vary from state to state.

A physician's office (covered entity) discovers that the billing company
(Business associate) is in breach of their contract. What is the first steps to
be taken. - ANSWER-Take steps to correct the problem and end the
violation.

OIG, CMS, and the DOJ are the government agencies enforcing what
laws? - ANSWER-Federal fraud and abuse laws

Do fraud and abuse penalties include the ability to refile claims in question?
- ANSWER-No

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 bull every patient for a urinalysis. What does this
violate? - ANSWER-FCA

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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? - ANSWER-Minimum
necessary

Individuals have the right to review and obtain copies of the PHI. What is
excluded from rights of access? - ANSWER-- Psychotherapy notes

- Certain lab results

- Information involved in research studies

- Information related to legal proceedings

Patient questions and concerns regarding the Privacy Practices in the clinic
should be addressed by what party? - ANSWER-The Privacy official

How many standard EDI transactions were adopted under HIPAA? -
ANSWER-8

What are the standard EDI transactions adopted under HIPAA? -
ANSWER-1. Claims and encounter info

2. Payment and remittance advice

3. Claim status

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