AAPC CPB Chapter 11-14.pdf file:///C:/Users/HP/Desktop/New%20folder%20(2)/AAPC%20CPB
AAPC CPB Chapter 11-14 Questions &
Answers
1. Which coverage under TRICARE is a Medicare wrap around plan?
a. TRICARE for Life
b. TRICARE Reserve Select
c. TRICARE Prime
d. CHAMPVA
Answer a. TRICARE for Life
2. 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.
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,AAPC CPB Chapter 11-14.pdf file:///C:/Users/HP/Desktop/New%20folder%20(2)/AAPC%20CPB
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.
Answer b.Thebiller must file the secondary insurance as the cross-over claim is not
going to be sent due to missing information.
3. A Medicare patient receives services from a participating provider on Jan-
uary 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
Answer b. 12 months
4. What is true regarding Medigap policies?
a. They cover everything that Medicare does not.
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,AAPC CPB Chapter 11-14.pdf file:///C:/Users/HP/Desktop/New%20folder%20(2)/AAPC%20CPB
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.
Answer b. They cover deductibles, copayments, and coinsurances usually.
5. 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.
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,AAPC CPB Chapter 11-14.pdf file:///C:/Users/HP/Desktop/New%20folder%20(2)/AAPC%20CPB
d. Yes, all services are covered under Medicaid.
Answer c.No, because the patient is notunder the age of 21.
6. 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
Answer d. Part D
7. 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 checkingout,
the front desk rep has her sign an ABN. The service is billed and deniedfor
frequency. Can the patient be balance billed? Why?
a. Yes. It does not matter when you get an ABN signed.
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AAPC CPB Chapter 11-14 Questions &
Answers
1. Which coverage under TRICARE is a Medicare wrap around plan?
a. TRICARE for Life
b. TRICARE Reserve Select
c. TRICARE Prime
d. CHAMPVA
Answer a. TRICARE for Life
2. 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.
1 of 93 10/30/2024, 9:35
,AAPC CPB Chapter 11-14.pdf file:///C:/Users/HP/Desktop/New%20folder%20(2)/AAPC%20CPB
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.
Answer b.Thebiller must file the secondary insurance as the cross-over claim is not
going to be sent due to missing information.
3. A Medicare patient receives services from a participating provider on Jan-
uary 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
Answer b. 12 months
4. What is true regarding Medigap policies?
a. They cover everything that Medicare does not.
2 of 93 10/30/2024, 9:35
,AAPC CPB Chapter 11-14.pdf file:///C:/Users/HP/Desktop/New%20folder%20(2)/AAPC%20CPB
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.
Answer b. They cover deductibles, copayments, and coinsurances usually.
5. 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.
3 of 93 10/30/2024, 9:35
,AAPC CPB Chapter 11-14.pdf file:///C:/Users/HP/Desktop/New%20folder%20(2)/AAPC%20CPB
d. Yes, all services are covered under Medicaid.
Answer c.No, because the patient is notunder the age of 21.
6. 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
Answer d. Part D
7. 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 checkingout,
the front desk rep has her sign an ABN. The service is billed and deniedfor
frequency. Can the patient be balance billed? Why?
a. Yes. It does not matter when you get an ABN signed.
4 of 93 10/30/2024, 9:35
