AAPC CPB - Chapter 1 Review

What does the acronym PHI stand for?

a. Patient Healthcare Information

b. Patient History of Illness

c. Protected Health Information

d. Protected Healthcare Index

c. Protected Health Information

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?

a. Stark Laws

b. HIPAA

c. Anti-Kickback law

d. Qui Tam

c. Anti-Kickback law

Which of the following is NOT a component of the Preferred Provider Organizations (PPO) payer model?

a. Offer a discounted fee schedule

b. Operate within networks

c. Require the enrollee to maintain a PCP

d. Utilization of preferred providers

c. Require the enrollee to maintain a PCP

In which of the following circumstances may PHI not be disclosed without the patient's authorization or permission?

a. An office receives a court order.

b. An office receives requests for medical records for a Medicare audit.

c. An office receives a call from a patient's husband asking for information about his wife's recent office visit.

d. An office releases patient information to the Coroner's office upon the death of a patient.

c. An office receives a call from a patient's husband asking for information about his wife's recent office visit.

Which of the following is not a covered entity in the Privacy Rule?

a. Commercial insurance company

b. A healthcare consulting firm

c. A Pediatric practice

d. A billing service

b. A healthcare consulting firm

What types of entities do conditions of participation (CoP) apply to for health plans?

I. Hospitals

II. Clinics

III. Transplant centers

IV. Psychiatric hospitals

a. I, II, III

b. I, III, IV

c. II, III, IV

d. I, II, III, IV

d. I, II, III, IV

When a practice sends an electronic claim to a commercial health plan for payment, what is this considered?

a. A code set

b. A transaction

c. A data set

d. Minimum necessary

b. A transaction

According to the Privacy Rule, what must a Business Associate and covered entity have in order to do business?

a. A mutually exclusive agreement describing the services that will be rendered by the business associate

b. A notice of privacy

c. A background check of both parties to ensure full disclosure

d. A contract with specific safeguards on the individually identifiable health information used or disclosed by the business associate

d. A contract with specific safeguards on the individually identifiable health information used or disclosed by the business associate

A records request is received from a health plan for three dates of service in a chart months apart. What should the biller do?

a. Copy the entire chart and send it to make sure that the health plan has everything they need and will not request more records.

b. Copy everything from the first date through the third date, even if it is not included to cover the timeframe the health plan is looking at for the request.

c. Copy each date of service and black out all identifying information in the copies before sending to the health plan.

d. Copy each date of service individually and send to the health plan.

d. Copy each date of service individually and send to the health plan

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. A breach

b. A minimum necessary violation

c. A disclosure violation

d. Fraud

a. A breach

Which of the following situations allow the release of PHI without authorization from the patient?

a. Request for life insurance

b. Workers' compensation

c. Physician's office to release to a family member

d. Request from family member

b. Workers' compensation

What were the eight standard transactions for electronic data interchange adopted under?

a. The Truth in Lending Act

b. HIPAA

c. The Social Security Act

d. Anti-Kickback Statute

b. HIPAA

A private practice hires a consultant to come in and audit some medical records. Under the Privacy Rule, what is this consultant considered?

a. An employee

b. A business associate

c. A covered entity

d. A clearinghouse

b. A business associate

HIPAA mandated what entity to adopt national standards for electronic transactions and code sets?

a. CMS

b. Congress

c. HHS

d. AMA

c. HHS

If a provider is excluded from federal health plans, what does that mean?

I. They may not participate in Medicare, but may participate in Medicaid to help the needy.

II. They may not participate in Medicare, Medicaid, VA programs or TRICARE.

III. They cannot bill for services, provide services, order services, or prescribe medication to any beneficiary of a federal plan.

IV. They cannot bill for services or provide services, but may give Medicare patients referrals to receive services somewhere else.

a. II, IV

b. I, III

c. II, III

d. I, III, IV

c. II, III

According to the Privacy Rule, what health information may not be de-identified?

a. Patient social security number

b. Medical record number

c. Patient home address

d. Physician provider number

d. Physician provider number

Health plans, clearinghouses, and any entity transmitting health information is considered by the Privacy Rule to be a:

a. Health entity

b. Business entity

c. Covered entity

d. Protected entity

c. Covered entity

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?

a. HIPAA

b. Social Security Act

c. ADA

d. Health Information Act

a. HIPAA

Which of the following actions is considered under the False Claim Act?

a. Submitting claims for drugs

b. Filing Incident-to claims

c. Releasing records without authorization

d. Upcoding or unbundling services

d. Upcoding or unbundling services

Individuals have the right to review and obtain copies of their PHI. What is excluded from the right of access?

a. Diagnosis

b. All lab results

c. Psychotherapy notes

d. Results of diagnostic tests

c. Psychotherapy notes

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 services that were not performed.

a. Fraud

b. Abuse

c. a Stark violation

d. an Anti-kickback

a. Fraud

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?

a. Truth in Lending Act

b. False Claims Act

c. HIPAA

d. Social Security Act

a. Truth in Lending Act

What standard transactions is NOT included in EDI and adopted under HIPAA?

a. Referrals and Authorizations

b. Eligibility in the health plan

c. Healthcare claim status

d. Waiver of liability

d. Waiver of liability

A practice agrees to pay $250,000 to settle a lawsuit alleging that the practice used X-rays of one patient to justify services on multiple other patients' claims. The manager of the office brought the civil suit. What type of case is this?

a. Qui Tam

b. Stark case

c. Anti-Kickback

d. HIPAA

a. Qui Tam

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?

a. Covered entity

b. Minimum necessary

c. Conditions of Participation

d. Truth in Lending

b. Minimum necessary