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AAPC CPB - Chapter 9 ReviewA ______ indicates the location or type of service provided for an inpatient and is reported with _______. a. Revenue code; four-digit code b. Revenue code; three-digit code c. CPT code; five-digit code d. MSDRG code; three-digit code - correct answer a. Revenue code; four-digit code Which of the following documentation is NOT needed for an audit? a. Encounter form b. Medical record c. Explanation of Benefits d. CMS-1500 claim form - correct answer c. Ex...

AAPC CPB - Chapter 10 ReviewWhich statement is TRUE regarding the Prompt Payment Act? a. Patients are required to pay patient balances within 30 days. b. Patient balances are dismissed if a statement is not sent to the patient within 30 days. c. Federal agencies are not required to respond to all clean claims within 30 days of receipt. d. Federal agencies are required to pay clean claims within 30 days of receipt. - correct answer d. Federal agencies are required to pay clean claims within...

AAPC CPB - Chapter 10 Terminology Bad Debt - correct answer Accounts receivable or money owed that will likely remain uncollectable and will be written off Bankruptcy - correct answer Legal proceeding involving a person who is unable to repay outstanding debts Coordination of Benefits - correct answer Used to ensure that insurance claims are not being paid multiple times Coverage Terminated - correct answer This denial occurs when the patient does not have coverage with the insurance c...

AAPC CPB - Chapter 11 QuizWhich coverage under TRICARE is a Medicare wrap around plan? a. TRICARE for Life b. TRICARE Reserve Select c. TRICARE Prime d. CHAMPVA - correct answer a. TRICARE for Life 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 b...

AAPC CPB - Chapter 11 ReviewMedicare's payment amount for services are determined by which of the following formulas? a. Sustainable growth rate (SGR) X Geographic Practice Cost Index (GPCI) = Medicare payment b. Total RVU X Conversion factor = Medicare payment c. Total Practice Expense (PE) X Conversion factor = Medicare payment d. Total Malpractice insurance (MP) X Conversion factor (CF) = Medicare payment - correct answer b. Total RVU X Conversion factor = Medicare payment The total...

AAPC CPB - Chapter 12 QuizWhich type of insurance plan is a federal and state program that provides coverage to the low-income population? a. Medicare b. HMO c. Medicaid d. PPO - correct answer c. Medicaid Response Feedback: Medicaid is a joint federal and state program that provides hospital expense and medical expense coverage to the low-income population and certain aged and disabled individuals. What is the correct action when a claim has been submitted to BCBS but the provide...

AAPC CPB - Chapter 12 ReviewThe term for the set payment that the member pays to the healthcare provider on the day of service is the: a. office visit fee. b. co-insurance. c. copay. d. co-signer. - correct answer c. copay. Response Feedback: A copayment or copay is the set amount the insured member pays the healthcare provider on the day of service. Blue Cross/Blue Shield identifies the individual or employee who pays for healthcare insurance coverage as the: a. Member b. Gro...

AAPC CPB - Chapter 13 QuizWhich of the following denials is one of the leading reasons a claim is denied and can be prevented by accurate intake information being collected every time? a. Medical necessity b. Coordination of Benefits c. Request for medical records not received d. Incorrect patient information - correct answer d. Incorrect patient information Response Feedback: Submitting incorrect patient demographic information to the insurance payer is one of the leading reasons a ...

AAPC CPB - Chapter 13 Review 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 - correct answer b. Invalid CPT code for DOS Response Feedback: Rationale: CPT™ code 10022 was deleted in 2019. CPT® codes should only be reported for dates of s...

AAPC CPB - Chapter 14 QuizWhat type of state worker's compensation coverage allows an employer to set aside money to cover medical expenses and other related benefits for its employees? a. State insurance fund b. Self-insurance plans c. Commercial workers' compensation insurance d. Combination program - correct answer b. Self-insurance plans Under Workers' Compensation, when is a worker covered for an injury that occurred on-the-job? a. Only if the employer was negligent b. Only ...