CPB Final Exam UPDATED ACTUAL Exam Questions and CORRECT Answers
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Course
CPB
Institution
CPB
CPB Final Exam UPDATED ACTUAL
Exam Questions and CORRECT Answers
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...
CPB Final Exam UPDATED ACTUAL
Exam Questions and CORRECT Answers
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? - CORRECT ANSWER✔✔- Qui Tam
In which of the following circumstances may PHI not be disclosed without the patient's
authorization or permission? - CORRECT ANSWER✔✔- 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? - CORRECT ANSWER✔✔- A contract
HMO plans require the enrollee to: - CORRECT ANSWER✔✔- 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? - CORRECT
ANSWER✔✔- 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? - CORRECT ANSWER✔✔- 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? - CORRECT ANSWER✔✔- Release
the requested records to the insurance company.
Which of the following situations allows the release of PHI without authorization from the
patient? - CORRECT ANSWER✔✔- Workers' Compensation
HIPAA mandated what entity to adopt national standards for electronic transactions and code
sets? - CORRECT ANSWER✔✔- HHS
,What is the standard time frame established for record retention? - CORRECT
ANSWER✔✔- 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. - CORRECT ANSWER✔✔- 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? - CORRECT 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 statute? - CORRECT ANSWER✔✔- False Claims
Act
Which of the following actions is considered under the False Claims Act? - CORRECT
ANSWER✔✔- 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? -
CORRECT ANSWER✔✔- Truth in Lending Act
Medicare was passed into law under the title XVIII of what Act? - CORRECT
ANSWER✔✔- Social Security Act
Which of the following statements are true regarding healthcare regulations? - CORRECT
ANSWER✔✔- 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? - CORRECT ANSWER✔✔-
Take steps to correct the problem and end the violation
OIG, CMS, and the Department of Justice are the government agencies enforcing ______? -
CORRECT ANSWER✔✔- Federal fraud and abuse laws
, Fraud and Abuse penalties do NOT include: - CORRECT ANSWER✔✔- 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? - CORRECT ANSWER✔✔- False Claims Act
Individuals have the right to review and obtain copies of the PHI. What is excluded from the
right of access? - CORRECT ANSWER✔✔- 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? - CORRECT ANSWER✔✔- Minimum Necessary
Patient has questions and concerns regarding the Privacy Practices in the clinic should be
addressed by what party? - CORRECT ANSWER✔✔- Privacy Official
What standard transactions are NOT included in EDI and adopted under HIPAA? -
CORRECT ANSWER✔✔- Waiver of liability
The Federal False Claim Act allows for claims to be reviewed for how many years after an
incident? - CORRECT ANSWER✔✔- 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? - CORRECT ANSWER✔✔- Fraud
What penalties can be imposed for Fraud and/or Abuse related to the United States Code? -
CORRECT ANSWER✔✔- 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
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