pg. 1 AAPC CPB Final Exam Latest 2024 -2025/ Complete 200 Real Exam Questions with Correct Verified Answers/ Graded A+
What is the standard time frame established for record retention?
- Seven years
- The life of the patient
- There is no single standard record retention, it varies by state and federal regulation
c .Five years
Correct Answer - d. There is no single standard record retention, it varies by state and federal regulation
What entities are exempt from HIPAA and not considered to be covered entities?
- Workers' compensation
- Employers with less than 100 employees
- Sponsored group plans
c .Church-sponsored plans
Correct Answer - a. Workers' compensation
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 patient's privacy authorization to see if they can speak to the husband. What act does this action fall under?
- Health Information Act
- HIPAA
- Social Security Act
- ADA
Correct Answer - b. HIPAA 1 / 4
pg. 2 When a patient is enrolled in an HMO, which options below are the responsibilities of the primary care physician (PCP)?
- Manage the member's treatment
- Provide referrals for inpatient admissions
II. Be the only provider for all of the patient's healthcare III. Provide referrals to specialists IV. Approve emergency department visits
- I, II, III
- I, III, IV
- I, III, V
- I, II
Correct Answer - b. I, III, IV
What is the benefit of using NPI numbers for payers?
- It is a single identifier for all payers
II. It contains the providers' birthdates to allow certain identification III. Each payer can make their own number IV. It has no personal identifying information in the number
- I, II
- I, II, IV
- III, IV
- I, IV
Correct Answer - d. I, IV
A group contracts with a third-party administrator to manage paperwork. This group pays for the operation of the insurance plan and the costs of administration. What type of plan does this represent? 2 / 4
pg. 3
- Association Group
- Management Service Organization
- Self-Funded ERISA
- Fully Insured Employer Group
Correct Answer - c. Self-Funded ERISA
A patient presents for an immunization. When the patient pays his bill, he asks for a receipt so that he may turn it in to meet his spenddown. What type of coverage does this patient have?
- Commercial insurance
- Medicare
- Medicaid
- TRICARE
Correct Answer - c. Medicaid
What is an insurance plan that provides a gatekeeper to manage the patient's healthcare?
- HMO
- IPO
- PPO
- Medicaid
Correct Answer - a. HMO
A patient presenting for care does not have an insurance card and is billed CPT® code 99213 for $100. The patient pays $100 to the provider. A week later, the patient presents verification of coverage through Medicaid for this date of service. What process should be followed?
- Nothing needs to be done 3 / 4
pg. 4
- File a claim to Medicaid and refund the $100 to the patient
- File a claim with Medicaid, a refund will be completed when the EOB is received
- None of the above
showing the patients responsibility
Correct Answer - c. File a claim with Medicaid, a refund will be completed when the EOB is received showing the patients responsibility
Which of the following is NOT evaluated in the credentialing process?
- Physician's residency
- Physician's request for privileges
- Physician's license(s)
- Physician's education
Correct Answer - b. Physician's request for privileges
Review the insurance card and patient registration form below:
What information could cause a potential problem?
- Employer is not listed
- Date of birth is incorrect
- The patient's name is not consistent
- Relationship to the patient is incorrect
Correct Answer - c. The patient's name is not consistent
When using the Practitioner PTP Edits table, an NCCI tool, the modifier indicator of 0 (zero) tells the user what?
- The codes are not bundled and a modifier is not required.
- A modifier is allowed.
- The edit is not applicable to this code set.
- A modifier is not allowed.
- / 4
Correct Answer - d. A modifier is not allowed.