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AAPC CPB EXAM/85 QUESTIONS AND ANSWERS
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AAPC CPB EXAM/85 QUESTIONS AND ANSWERS
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AAPC CPB EXAM/85 QUESTIONS ANDANSWERS
What is the term for the total amount of covered medical expenses a
policyholder must pay each year out-of-pocket before the health insurance
company begins to pay any benefits? - -A deductible is the amount a
policyholder pays for health care services before the health insurance begins
to pay.
-Which type of insurance covers physicians and other healthcare
professionals for liability as to claims arising from patient treatment? - -
Medical malpractice insurance is a type of liability insurance that covers
physicians and other healthcare professionals for liability as to claims arising
from patient treatment.
-Which of the following does NOT fall under group policy insurance?
I. The premium is paid for by the employee.
II. The premium is paid for (or partially paid for) by an employer.
III. The employer selects the plan(s) to offer to employees.
IV. Physical exams and medical history questionnaires are a mandatory part
of the application process.
V. Employee can make changes to the policy.
VI. The employee's spouse and children are not eligible for coverage. - -I, IV,
V, and VI, Group health insurance coverage is a type of health policy that is
purchased by an employer and is offered to eligible employees of the
company, and to eligible dependents of employees. With group health
insurance, the employer selects the plan (or plans) to offer to employees.
With an individual policy, you are the only one who can make changes to
your policy and you are the only one who can cancel the coverage. You have
full control over your own policy. Applicants for individual health insurance
will need to complete a medical history questionnaire and have a physical
exam when applying for coverage.
-Dr. Wallace is in a capitation contract with Belleview Managed Care Health
Plan. He received $25,000 from the health plan to provide services for the
175 enrollees on the health plan. The services provided by Dr. Wallace to the
enrollees cost $23,000. Based on the information, what must be done? - -Dr.
Wallace can keep the $2,000 profit under the terms of the capitated plan
-What is the deadline for filing a Medicare claim? - -One year from the date
of service
-A provider sees a patient who has TRICARE Select. The provider is not
contracted with TRICARE but is certified by the regional TRICARE Managed
, Care Support Contractor (MCSC). The provider charges $200 for the office
visit. TRICARE allows $160 and pays $140. How much can the provider bill
the patient for? - -. $60.00
-What organization is responsible in evaluating the medical necessity,
appropriateness, and efficiency of the use of healthcare services and
procedures? - -Utilization Review Organization
-Medicaid providers are forbidden by law to: - -Balance bill patients
-Which statement is FALSE about Local Coverage Determinations (LCDs)? - -
CMS develops LCDs when there is no National Coverage Determination
-When a minor procedure is performed on a Medicare patient, what is the
global period and what time frame is covered? - -10-day global period - the
day of the procedure and 10 days following the procedure.
View Rationale
Question 11
-If add-on procedure code 11103 is performed twice during an office visit,
how is it indicated on the CMS-1500 claim form? - -Code 11103 is reported
once with the number 2 in box 24G
-Which set of documentation guidelines can be used for E/M services
submitted to Medicare for a physician assistant (PA)? - -Either 1995 or 1997
CMS documentation guidelines
-Select the scenario that meets the incident-to requirements - -Care is
delivered to an established patient by the physician assistant as part of the
physician's treatment plan while the physician is seeing another patient in
the same office suite in a different room.
-Medicare beneficiary is having a screening colonoscopy performed. How is
the service reported to Medicare? - -G0121
-Which providers submit the CMS-1500 claim form?
I. Independent diagnostic testing facilities (IDTFs)
II. Emergency department physicians
III. Hospice organizations
IV. Ambulance companies submitting under their own Medicare number
V. Physicians in a group practice
VI. Ambulatory surgery centers - -I, II, IV, V and VI
-According to CPT® Radiology Guidelines, if a patient is given oral contrast
for a CT scan of the abdomen which code is reported? - -74150 Computed
tomography, abdomen; without contrast material
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