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AAPC CPB Chapter 11-14
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AAPC CPB Chapter 11-14
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AAPC CPB Chapter 11-14Which coverage under TRICARE is a Medicare wrap around plan?
a. TRICARE for Life
b. TRICARE Reserve Select
c. TRICARE Prime
d. CHAMPVA - -a. TRICARE for Life
-A patient has Medicare and a Medigap policy. Box 13, signature on file, is
checked off on the electronic claim submission. An EOMB is received with
remittance notice MA19. What does the office need to do?
a. Nothing. This means the claim has been crossed over to the Medigap plan.
b. The biller must file the secondary insurance as the cross-over claim is not
going to be sent due to missing information.
c. The biller must check the claim filed for missing information, add the
missing information, and send back to Medicare for processing.
d. Nothing. The notice means that the patient is responsible for the bill. - -b.
The biller must file the secondary insurance as the cross-over claim is not
going to be sent due to missing information.
-A Medicare patient receives services from a participating provider on
January 6, 2016, but the charges are missed and don't get entered in to the
computer. How long does the office have to bill Medicare for the services?
a. 3 months
b. 12 months
c. 6 months
d. 1 month - -b. 12 months
-What is true regarding Medigap policies?
a. They cover everything that Medicare does not.
b. They cover deductibles, copayments, and coinsurances usually.
c. All Medigap policies are the same and offer the same coverage.
d. Medigap policies must cover patients if they injured outside the United
States. - -b. They cover deductibles, copayments, and coinsurances usually.
-A 21 year-old patient presents for fillings for two if his teeth. Are these
services covered under EPSDT?
a. No, because these types of services are not covered.
b. Yes, if the patient lives in a state that covers dental services.
c. No, because the patient is not under the age of 21.
,d. Yes, all services are covered under Medicaid. - -c. No, because the patient
is not under the age of 21.
-A Medicare patient has prescription drug coverage, but does not have
Medicare Advantage. What Medicare coverage does the patient have for his
medications?
a. Part A
b. Part B
c. Part C
d. Part D - -d. Part D
-A Medicare patient presents for her pelvic, pap, and breast examination
(PPB). The patient is not sure when she had her last PPB. As she is checking
out, the front desk rep has her sign an ABN. The service is billed and denied
for frequency. Can the patient be balance billed? Why?
a. Yes. It does not matter when you get an ABN signed.
b. No. The ABN must be signed before the service is performed.
c. Yes, as long as the patient has met her deductible.
d. No. An ABN is not required, but the patient is required to pay at time of
service or the bill has to be written off. - -b. No. The ABN must be signed
before the service is performed.
-A Medicare patient presents with an injury sustained at his part-time job.
His injury status is verified by his company. After services are rendered, in
what order are the claims submitted?
a. The worker's compensation is primary, and Medicare is secondary
b. Either may be filed first, whichever pays better
c. Medicare is primary, and Worker's compensation is secondary
d. The patient must pay for services and files claims himself - -a. The
worker's compensation is primary, and Medicare is secondary
-A Medicare patient is seen by her physician. The physician has opted out of
the Medicare program. The patient and physician have a private contract.
The charges for the services rendered are $300.00. Medicare's approved
amount would be $200.00. What can the office charge this patient?
a. $160.00 (80 percent of the approved amount)
b. $218.50 (115 percent of the approved amount for non-Par providers)
c. $300.00
d. $250.00 - -c. $300.00
-Medicare's payment amount for services are determined by which of the
following formulas?
,a. Sustainable growth rate (SGR) X Geographic Practice Cost Index (GPCI) =
Medicare payment
b. Total RVU X Conversion factor = Medicare payment
c. Total Practice Expense (PE) X Conversion factor = Medicare payment
d. Total Malpractice insurance (MP) X Conversion factor (CF) = Medicare
payment - -b. Total RVU X Conversion factor = Medicare payment
-The total RVU is composed of which of the following components:
a. Conversion factor (CF), practice expense (PE), and malpractice insurance
(MP)
b. Physician work, practice expense (PE), and malpractice insurance (MP)
c. Sustainable growth rate (SGR), conversion factor (CF), and malpractice
insurance (MP)
d. Sustainable growth rate (SGR), practice expense (PE), and physician work.
- -b. Physician work, practice expense (PE), and malpractice insurance (MP)
-Medicare Supplement Insurance policies or Medigap is sold by:
a. Medicare
b. Medicaid
c. Private insurance companies
d. Healthcare providers - -c. Private insurance companies
-Medicare statutorily excluded services are:
a. Non-covered items and services
b. Not reimbursed by Medicare
c. Reimbursed on a case-by-case basis.
d. Both A & B - -d. Both A & B
-Albert has purchased a Medigap policy to supplement his Medicare
benefits. To which entity will Albert pay his monthly premium for this policy?
a. Medicare
b. MAC
c. Medicaid
d. Medigap insurance company - -d. Medigap insurance company
-The term for a supplemental policy for Medicare is:
a. Medifill
b. Medicare Plus
c. Medigap
d. Medicare Secondary - -c. Medigap
, -Dr. Allen who is a non-PAR provider performs an appendectomy on a 67
year-old Medicare patient. The physician's UCR for the surgery is $1500.
Medicare's approved fee for this procedure is $1100. What is the limiting
charge that this non-PAR provider can charge to this Medicare patient?
a. $1265
b. $1100
c. $1500
d. $1201.75 - -d. $1201.75
-MAC is the acronym for:
a. Medicare Administrative Contractor
b. Medicare Advantage Contractor
c. Medical Access Center
d. Medicare Administrative Contact - -a. Medicare Administrative Contractor
-Andrew has selected TRICARE Prime as his health plan. Who will be
responsible for coordinating his health care, maintaining his medical records
and referrals to specialists when needed?
a. PCP - Primary Care Provider
b. PCC - Primary Care Coordinator
c. PCM - Primary Care Manager
d. PCN - Primary Care Networker - -c. PCM - Primary Care Manager
-To determine the Medicare coverage and payment policy for a service or
procedure, which of the following resources will indicate if a service is
payable, noncovered, or bundled into another service?
a. PC/TC indicator
b. Global surgery indicators
c. Status codes
d. Both A & B - -c. Status codes
-TRICARE and CHAMPVA timely filing is
a. 180-days from date of service
b. 1-year from the date of service
c. 90-days from the date of service
d. 120-days from the date of service - -b. 1-year from the date of service
-Barbara's late husband, Joe, was a lieutenant in the Navy. He served for 30
years, retiring 10 years prior to his death that was related to service
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