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AAPC CPB Final Exam|197 Questions with Verified Solutions
AAPC CPB Final Exam|197 Questions with Verified Solutions
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AAPC CPB Final Exam|197 Questionswith Verified Solutions
Health plan, clearinghouses, and any entity transmitting health information
is considered by the Privacy Rule to be a: - -covered entity
-Which of the following is not a covered entity in the Privacy Rule - -
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? - -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? - -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? - -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? - -Truth in Lending Act
-Which of the following situations allows release of PHI without authorization
from the patient? - -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. - -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? - -abuse
-According to the Privacy Rule, what health information may not be de-
identified? - -phys provider number
-making false statements or misrepresenting facts to obtain an undeserved
benefit or payment from a federal healthcare program - -fraud
-All the following are considered Fraud, EXCEPT: - -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? - -breach
-impermissible release or disclosure of information is discovered - -breach
-What standard transactions is NOT included in EDI and adopted under
HIPAA? - -waiver of liability
-The Federal False Claim Act allows for claims to be reviewed for a standard
of how many years after an incident? - -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? - -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? - -biz
associate
-Medicare overpayments should be returned within ___ days after the
overpayment has been identified - -60
-HIPAA mandated what entity to adopt national standards for electronic
transactions and code sets? - -HHS
-Entities that have been identified as having improper billing practices is
defined by CMS as a violation of what standard? - -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? - -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? - -False
Claims Act
-Medicare was passed into law under the title XVIII of what Act? - -SS Act
-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 does this action constitute? - -
fraud
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