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AAPC CPB FINAL EXAM 2024 NEWEST/ REAL EXAM
QUESTIONS WITH CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) GRADED A+
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?
- A breach
- Fraud
- A minimum necessary violation
- A disclosure violation - Correct Answer - A. A breach
A breach occurs when an impermissible release or disclosure of information is discovered.
A practice allows patients to pay large balances over a six-month time period with a finance charge applied. The patient receives a statement every month that only shows the unpaid balance. What does this violate?
- The Truth in Lending Act
B. HIPAA
- Federal Fraud Statute
- The Fair Debt Collection Act - Correct Answer - A. The Truth in Lending Act
If the practice assesses finance charges on statements, the amount of the finance charge must be disclosed as an annual percentage rate. If the practice sets up payment plans with patients that extend past four installments, the following information must be disclosed to the patient (as applicable): · The "cash price" of the service · The amount of any down payment · The resulting unpaid balance · The total amount financed · The amount of the finance charge · The annual percentage rate of the finance charge · The total price to be paid under the credit plan · The schedule of payments, including number, amount, and due dates of payments · The sum of such scheduled payments, or total of payments, and · The amount or method of computing the amount of any late payment charges 1 / 4
pg. 2 A records request is received from a health plan for three dates of service in a chart months apart. What should the biller do?
- Copy each date of service individually and send to the health plan
- Copy each date of service and black out all identifying information in the copies
- Copy the entire chart and send it to make sure that the health plan has everything
- Copy everything from the first date through the third date, even if it is not included to
before sending to the health plan.
they need and will not request more records
cover the timeframe the health plan is looking at for the request - Correct Answer - A.Copy each date of service individually and send to the health plan The minimum necessary standard requires covered entities to take reasonable steps to limit the disclosure of PHI. Only the dates of service requested should be sent. The PHI would not need to be redacted
Patient questions and concerns regarding the Privacy Practices in the clinic should be addressed by what party?
- The physician
- The billing staff
- Any employee
- Privacy official - Correct Answer - D. Privacy official
HIPAA rules indicate that all entities should designate a Privacy official that will develop and implement privacy policies and procedures and be a contact person for individuals with questions
A request for medical records is received for a specific date of service from the patient's insurance company with regards to a submitted claim. No authorization for release of information is provided. What action should be taken?
- Request a patient's signature from the insurance company
- Release the requested records to the insurance company
- Request the signature for authorization from the patient
- Release the records after receiving verbal permission from the patient - Correct
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Answer - B. Release the requested records to the insurance company
pg. 3 A covered entity is permitted to release records for the purpose of treatment, payment, or healthcare operations.
What does the acronym PHI stand for?
- Patient History of Illness
- Protected Health information
- Protected Healthcare Index
- Patient Healthcare Information - Correct Answer - B. Protected Health information
PHI stands for protected health information. PHI is "individually identifiable health information" that includes many common identifiers, such as demographic data, name, address, birth date, and social security number.
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?
- False claim
- Malpractice
- Abuse
- Fraud - Correct Answer - C. Abuse
CMS considers abuse to be actions that cause unnecessary costs to a federal healthcare program, either directly or indirectly. CMS examples of abuse: - Misusing codes on a claim - Charging excessively for services or supplies - Billing for services that were not medically necessary - Failure to maintain adequate medical or financial records - Improper billing practices - Billing Medicare patients a higher fee schedule than non-Medicare patients
Managed Care Organizations (MCOs) place the physician at financial risk for the care of the patient. How are they reimbursed?
- Patient payments
- Capitation
- Fee-for-service
- Reimbursement account - Correct Answer - B. Capitation 3 / 4
pg. 4 Rationale: The physician is paid on per-patient per month method rather than a fee-for- service method
A patient is scheduled in your office for Botox injections in her face for her smile lines.She has not met her deductible and states that she is going to use money from her Healthcare Reimbursement Account to pay for it. Is this possible?
- Yes, as long as she has enough money in the account, she may use it for any
- No, cosmetic procedures are ineligible expenses.
- Yes, but only a portion since it is a cosmetic procedure.
- No, because a Healthcare Reimbursement Account cannot be used to meet a
medical expense she chooses.
deductible. - Correct Answer - B. No, cosmetic procedures are ineligible expenses.Rationale: Eligible medical expenses under an HRA are defined by the IRS as those items and services that are meant to diagnose, cure, mitigate, treat, or prevent illness or disease, including transportation that is primarily for medical care. Cosmetic procedures are ineligible.
The Protecting Patients and Affordable Care Act (PPACA) is a federal mandate which establishes that coverage can no longer be denied for what reason?
- Pre-existing conditions
- Being unemployed
- Having high medical costs
- Having other coverage - Correct Answer - A. Pre-existing conditions
Rationale: PPACA stipulates that coverage cannot be denied for pre-existing
conditions, maternity care, newborn care, mental health services, and preventive care
What is the largest health program in the United States?
- Medicare
- Medicaid
C. TRICARE
- Blue Cross Blue Shield - Correct Answer - A. Medicare
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