AAPC CPB - Chapter 13 Review 100%
Correct!!
On 05/02/19, a claim for a fine needle aspiration biopsy with ultrasound guidance was
reported with CPT code 10022, ICD-10-CM code D49.2 for DOS 05/01/2019. Why
would the claim be denied?
a. Not medically necessary
b. Invalid CPT code for DOS
c. Invalid ICD-10-CM code for DOS
d. Timely filing - ANSWERSb. Invalid CPT code for DOS
CPT codes 11400 and 12031 were reported on a claim. The insurance carrier denied
12031 as bundled with 11400. According to CPT® guidelines for Excision for Benign
Lesions what action should the biller take?
a. Write-off 12031 as repairs are included in excisions.
b. Add modifier 59 to 12031 and submit a corrected claim.
c. Add modifier 51 to 12031 and submit a corrected claim.
d. Appeal the claim. - ANSWERSd. Appeal the claim.
What is one way to assist in lowering denials for non-covered services?
a. Keep every payer policy on file
b. Call insurance companies after any services are rendered
c. Be aware of the most common exclusions in the office's major plans
d. Appeal all non-covered service denials - ANSWERSc. Be aware of the most common
exclusions in the office's major plans
A patient is involved in an accident at work and their commercial insurance is billed.
What type of denial will be received?
a. Coordination of benefits issue
b. Other Coverage issue
c. Prior authorization issue
d. Non-covered service - ANSWERSb. Other Coverage issue
What rejections/denials are the easiest to prevent with good front office policy?
I. Incorrect patient information
II. Eligibility expiration
III. Medical necessity
IV. Liability denials
, a. I, II
b. I, II, IV
c. I, III, IV
d. I, IV - ANSWERSb. I, II, IV
If a claim is denied, investigated, and found to be denied in error, what should a biller
do?
a. Appeal the claim
b. Write the claim off
c. Balance bill the patient
d. Refile the claim - ANSWERSa. Appeal the claim
Under what Federal Act must insurance companies implement effective appeals
processes?
a. The Social Security Act
b. The Health Insurance Policies Act
c. The Federal Records Act
d. The Patient Protection and Affordable Care Act - ANSWERSd. The Patient Protection
and Affordable Care Act
An initial denial is received in the office from Aetna. The denial is investigated and the
office considers that the payment was not according to their contract. According to
Aetna's policy, what must the biller do?
a. Refile the claim
b. Submit a Level 1 appeal
c. Submit a Level 2 appeal
d. Submit a Reconsideration - ANSWERSd. Submit a Reconsideration
According to Aetna's published guidelines, what is the timeframe for filing an appeal?
a. Within 60 calendar days of the initial claim decision
b. Within 180 calendar days of the initial claim decision
c. Within 60 calendar days of the previous decision
d. Within 30 calendar days of the previous decision - ANSWERSc. Within 60 calendar
days of the previous decision
A denial is received in the office indicating that a service was billed and denied due to
bundling issues. The medical record is obtained and, upon review, it is documented that
the second procedure is a staged procedure that was planned at the time of the initial
procedure. When the claim is reviewed, no modifier was attached to the codes on the
claim. What should be done to resolve the claim?
a. Write the claim off
Correct!!
On 05/02/19, a claim for a fine needle aspiration biopsy with ultrasound guidance was
reported with CPT code 10022, ICD-10-CM code D49.2 for DOS 05/01/2019. Why
would the claim be denied?
a. Not medically necessary
b. Invalid CPT code for DOS
c. Invalid ICD-10-CM code for DOS
d. Timely filing - ANSWERSb. Invalid CPT code for DOS
CPT codes 11400 and 12031 were reported on a claim. The insurance carrier denied
12031 as bundled with 11400. According to CPT® guidelines for Excision for Benign
Lesions what action should the biller take?
a. Write-off 12031 as repairs are included in excisions.
b. Add modifier 59 to 12031 and submit a corrected claim.
c. Add modifier 51 to 12031 and submit a corrected claim.
d. Appeal the claim. - ANSWERSd. Appeal the claim.
What is one way to assist in lowering denials for non-covered services?
a. Keep every payer policy on file
b. Call insurance companies after any services are rendered
c. Be aware of the most common exclusions in the office's major plans
d. Appeal all non-covered service denials - ANSWERSc. Be aware of the most common
exclusions in the office's major plans
A patient is involved in an accident at work and their commercial insurance is billed.
What type of denial will be received?
a. Coordination of benefits issue
b. Other Coverage issue
c. Prior authorization issue
d. Non-covered service - ANSWERSb. Other Coverage issue
What rejections/denials are the easiest to prevent with good front office policy?
I. Incorrect patient information
II. Eligibility expiration
III. Medical necessity
IV. Liability denials
, a. I, II
b. I, II, IV
c. I, III, IV
d. I, IV - ANSWERSb. I, II, IV
If a claim is denied, investigated, and found to be denied in error, what should a biller
do?
a. Appeal the claim
b. Write the claim off
c. Balance bill the patient
d. Refile the claim - ANSWERSa. Appeal the claim
Under what Federal Act must insurance companies implement effective appeals
processes?
a. The Social Security Act
b. The Health Insurance Policies Act
c. The Federal Records Act
d. The Patient Protection and Affordable Care Act - ANSWERSd. The Patient Protection
and Affordable Care Act
An initial denial is received in the office from Aetna. The denial is investigated and the
office considers that the payment was not according to their contract. According to
Aetna's policy, what must the biller do?
a. Refile the claim
b. Submit a Level 1 appeal
c. Submit a Level 2 appeal
d. Submit a Reconsideration - ANSWERSd. Submit a Reconsideration
According to Aetna's published guidelines, what is the timeframe for filing an appeal?
a. Within 60 calendar days of the initial claim decision
b. Within 180 calendar days of the initial claim decision
c. Within 60 calendar days of the previous decision
d. Within 30 calendar days of the previous decision - ANSWERSc. Within 60 calendar
days of the previous decision
A denial is received in the office indicating that a service was billed and denied due to
bundling issues. The medical record is obtained and, upon review, it is documented that
the second procedure is a staged procedure that was planned at the time of the initial
procedure. When the claim is reviewed, no modifier was attached to the codes on the
claim. What should be done to resolve the claim?
a. Write the claim off
