1. a. The worker's compensation is primary, and Medicare is secondary
Rationale: If an individual is entitled to Medicare and is covered under Workers' Compensation because of a job-related illness or injury, Workers' Compensation is the primary for healthcare items or services re-lated to job-r...
AAPC CPB Chapter 11 Review
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1. a. The worker's compensation is primary, and Medicare is secondary
Rationale: If an individual is entitled to Medicare and is covered under Work-
ers' Compensation because of a job-related illness or injury, Workers' Com-
pensation is the primary for healthcare items or services re-lated to job-related
illness or injury claims.: 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
2. a. TRICARE for Life
TRICARE for Life is a Medicare-wrap around coverage for TRICARE eligible
beneficiaries who have Medicare Part A and B. Enrollment is automatic if the
member has Medicare Part A and B, but you must pay Medicare Part B premi-
ums. TRICARE for Life pays after Medicare in the U.S. and U.S. Territories but
is the first payer in all other overseas areas.: Which coverage under TRICARE
is a Medicare wrap around plan?
a. TRICARE for Life
b. TRICARE Reserve Select
c. TRICARE Prime
d. CHAMPVA
3. c. No, because the patient is not under the age of 21.
The EPSDT benefit provides comprehensive and preventive healthcare ser-
vices for enrolled children under the age of 21.: 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.
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c. No, because the patient is not under the age of 21.
d. Yes, all services are covered under Medicaid.
4. b. The biller must file the secondary insurance as the cross-over claim is not
going to be sent due to missing information.
When information is missing or incorrect in block 9, MACs do not forward a
transaction record to the Medigap carrier and the following remittance notice
is sent on the EOMB: MA19—Information was not sent to the Medigap insurer
due to incorrect/invalid information you submitted concerning the insurer.
Please verify your information and submit your secondary claim directly to
that insurer.: 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.
5. b. They cover deductibles, copayments, and coinsurances usually.
Medigap refers to a Medicare supplemental policy that is sold by private
insurance companies to help cover some of the costs that original Medicare
does not cover, like deductibles, copayments, and coinsurances.: 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.
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6. c. Code 12034 may not be billed with modifier 62.
Modifier 62 is the modifier to indicate two surgeons shared a surgery. The
co-surgery status code for 12034 is a 0, indicating that co-surgery is not
permitted. Code 12032 has a status code of A, indicating it is an active
code that is payable under the fee schedule. Code 12035 has a status code
for bilateral procedures of 0, indicating that bilateral billing of this code is
inappropriate. Code 12037 has a status code for co-surgery of 1, indicating
that a co-surgery may be paid with supporting documentation that supports
medical necessity.: Using the portion of the schedule above, what is true about the
codes?
a. Code 12032 has restricted coverage.
b. Code 12035 may be billed with modifier 50.
c. Code 12034 may not be billed with modifier 62.
d. Code 12037 can never be billed as a co-surgery under any circumstances.
7. b. 12 months
The Patient Protection and Affordable Care Act (ACA) amended the time period
for filing Medicare fee-for service claims. Claims must be filed within one
calendar year, 12 months, after the date of service.: 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
8. d. Part D
Medicare Part A is hospital insurance, Part B is medical insurance, Part C
is Medicare Advantage, and Part D is the prescription drug plan.: A Medicare
patient has prescription drug coverage, but does not have Medicare Advantage.
What Medicare coverage does the patient have for his medications?
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