covered entity - ANSWERSHealth plan, clearinghouses, and any entity transmitting health information is considered by the Privacy Rule to be a:
healthcare consulting firm - ANSWERSWhich of the following is not a covered entity in the Privacy Rule
release reqt to ins co - ANSWERSA request for m...
AAPC CPB Final Questions & Answers
covered entity - ANSWERSHealth plan, clearinghouses, and any entity transmitting
health information is considered by the Privacy Rule to be a:
healthcare consulting firm - ANSWERSWhich of the following is not a covered entity in
the Privacy Rule
release reqt to ins co - ANSWERSA 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?
12 - ANSWERSHow many national priority purposes under the Privacy Rules for
disclosure of specific PHI without an individual's authorization or permission?
no - ANSWERSA 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?
Truth in Lending Act - ANSWERSA 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?
workers comp - ANSWERSWhich of the following situations allows release of PHI
without authorization from the patient?
abuse - ANSWERSEntities that have been identified as having improper billing
practices is defined by CMS as a violation of what standard?
abuse - ANSWERSmisusing 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 - ANSWERSA claim is submitted for a patient on Medicare with a higher fee than
a patient on Insurance ABC. What is this considered by CMS?
phys provider number - ANSWERSAccording to the Privacy Rule, what health
information may not be de-identified?
fraud - ANSWERSmaking false statements or misrepresenting facts to obtain an
undeserved benefit or payment from a federal healthcare program
, inadequate med recd - ANSWERSAll the following are considered Fraud, EXCEPT:
breach - ANSWERSA 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 - ANSWERSimpermissible release or disclosure of information is discovered
waiver of liability - ANSWERSWhat standard transactions is NOT included in EDI and
adopted under HIPAA?
7 - ANSWERSThe Federal False Claim Act allows for claims to be reviewed for a
standard of how many years after an incident?
anti kickback laws - ANSWERSA 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?
biz associate - ANSWERSA private practice hires a consultant to come in and audit
some medical records. Under the Privacy Rule, what is this consultant considered?
60 - ANSWERSMedicare overpayments should be returned within ___ days after the
overpayment has been identified
HHS - ANSWERSHIPAA mandated what entity to adopt national standards for
electronic transactions and code sets?
abuse - ANSWERSEntities that have been identified as having improper billing
practices is defined by CMS as a violation of what standard?
unique id - ANSWERSIn 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?
False Claims Act - ANSWERSA person that files a claim for a Medicare beneficiary
knowing that the service is not correctly reported is in violation of what statute?
SS Act - ANSWERSMedicare was passed into law under the title XVIII of what Act?
fraud - ANSWERSWhile 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?
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