AAPC CPB - CHAPTER 2: QUESTIONS WITH CORRECT ANSWERS
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Course
CPB
Institution
CPB
AAPC CPB - CHAPTER 2: QUESTIONS
WITH CORRECT ANSWERS
Why must a provider obtain an NPI number?
I. To submit claims
II. To prove that he is licensed
III. To be HIPAA compliant
IV. To guarantee payment by a health plan
a. I, II, III
b. II, III, IV
c. I, II, III, IV
d. I, III - ANSWER-d. I, ...
(Capitation payments are used by managed care organizations (MCOs) to control healthcare costs by
putting the physicians at financial risk for services provided to patients. Payments are based on a per-
person rate, rather than a fee-for-service rate.)
A family practitioner sees a Medicare patient and bills a 99213. This provider has opted-out of Medicare.
His fee for the service is $125.00. Medicare's approved amount is $73.08, and the patient has met $0 of
his deductible. What can the provider bill the patient?
a. $125.00
b. $73.08
c. $14.62
d. $58.46 - ANSWER✔✔-a. $125.00
(Providers that opt-out of Medicare are not limited to any specific charge limit on their patients. The
patient is responsible for payment in full for services as Medicare will not pay any amount to either the
patient or provider in this situation.)
What are the options for a provider with regards to participation with Medicare?
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