AAPC CPB - Chapter 10 Review Updated 2024/2025 Actual Questions and answers with complete solutions
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Course
AAPC CPB
Institution
AAPC CPB
A provider removes a skin lesion in an ASC and receives a denial from the insurance carrier that states
"Lower level of care could have been provided." What steps should the biller take?
a. Write-off the charge.
b. Check with the provider and write an appeal to the insurance carrier explaining w...
AAPC CPB - Chapter 10 Review A provider removes a skin lesion in an ASC and receives a denial from the insurance carrier that states "Lower level of care could have been provided." What steps should the biller take? a. Write -off the charge. b. Check with the provider and write an appeal to the insurance carrier explaining why the service was provided in the ASC. c. Check with the provider and write an appeal to the insurance carrier explaining why the service was not an inpatient service. d. Submit the CMS -1500 claim form with a different place of service code. - Answer -b. Check with the provider and write an appeal to the insurance carrier explaining why the service was provided in the ASC. How often should the patient's insurance coverage be verified? a. every visit b. once a month c. once a year d. at the initial visit and when the insurance coverage changes - Answer -a. every visit Once a credit balance for an insurance carrier has been identified, what action should the biller take? a. Research to determine if it is a true overpayment, then submit a refund to the insurance carrier for the overpayment. b. Research to determine if it is a true overpayment, then submit a refund to the patient for the overpayment. c. Post an adjustment to zero balance the account. d. Make a note in the practice management system and let the insurance carrier identify it. - Answer -a. Research to determine if it is a true overpayment, then submit a refund to the insurance carrier for the overpayment. Review the following Accounts Receivable Management Policy: 1-Insurance claims will be created daily for manual and electronic filing. This should ensure that all insurance claims are submitted within two days of charge entry. 2-Guarantor statements will be created weekly to ensure timely initial billing of personal balances. Patients will receive one statement per month for personal balances. Each charge on which there is an unpaid personal balance will be billed a minimum of t hree times. 3-Insurance balances will be referred to internal follow -up staff for follow -up at 45 days post initial claim, and personal balances will be referred at the time the patient becomes responsible for payment. The collection services department becomes respon sible for all balances as soon as the charge is entered. 4-Personal balances will be eligible for referral to an outside collection agency after three statements have been sent. - Answer -c. 45 days post initial claim. Review the following financial policy: Collections Policy: Invoices not paid within 60 days begin our collection process. Invoices not paid within 120 days are subject to patient dismissal and submission to our Collection Agency and notification to your insurance plan. A claim has been denied as not medically necessary by Medicare. The biller has checked the patient's medical record and the patient's insurance policy. No ABN was signed. What is the next action the biller should take? I. Write -off the charge II. Check with the provider to appeal the claim III. Transfer the charge to the patient's account a. I b. II or III c. III
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