AAPC CPB BUNDLED EXAMS SOLVED BY EXPERTS 100% GUARANTEED SUCCESS

Which 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 submissi...

A Medicare patient presents with an injury sustained at his part-time job. His injury status is verified by his company. After services are rendered, in what order are the claims submitted? a. The worker's compensation is primary, and Medicare is secondary b. Either may be filed first, whiche...

Use CPB Chapter 11_Case to answer questions 1 & 2. After review of the information provided, are there any errors on the claim form? If so, which elements are incorrect? I. The provider must accept assignment II. Provider name conflict III. Medicare ID number is missing information IV. Med...

What is the first step in working a denied claim? a. Resubmit the claim b. Contact the carrier c. Appeal the claim d. Determine and understand why the claim was denied - correct answer d. Determine and understand why the claim was denied The first step in working a denied claim is to unders...

A patient with ABC insurance is seen on May 1st, and the claim is submitted on July 15 of the same year. Has the claim met the timely filing deadline? a. Yes. All payers have the same timely filing deadline of one year from date of service. b. No. All payers have a 30-day timely filing deadlin...

Who were the NCCI edits originally developed to be used by? a. Commercial Carriers b. Medicare Administrative Contractors c. Self-pay patients d. Medicare beneficiaries - correct answer b. Medicare Administrative Contractors The NCCI edits have column 1 and Column 2 codes and provide an ind...

Patient is given 15 mg of methotrexate sodium IM for rheumatoid arthritis given from 5 mg vials. What HCPCS Level II code and unit(s) is reported? a. J8610 x 6 b. J9260 c. J9250 x 5 d. J9250 x 3 - correct answer d. J9250 x 3 Look in the HCPCS Level II Table of Drugs for Methotrexate Sodium,...

Acute - correct answer A condition with a rapid and short course. Anatomical - correct answer Body site. And - correct answer Can mean either "and" or "or" when it is in the code description. Brackets [ ] - correct answer Symbol to enclose synonyms, alternate wording, or explanatory phr...

How many chapters does ICD-10-CM contain? a. 17 b. 19 c. 22 d. 20 - correct answer c. 22 What is/are the correct code(s) for a patient with type 1 diabetic neuropathy? a. E11.40 b. E90.40 c. E10.9, G62.9 d. E10.40 - correct answer d. E10.40 What are the correct codes for benign hyp...

Eight standard transactions were adopted for Electronic Data Interchange (EDI) under HIPAA. Which of the following is NOT included as a standard transaction? a. Payment and remittance advice b. Eligibility in a health plan c. Coordination of benefits d. Physician unique identifier number - co...

FCA - correct answer False Claims Act (FCA): {"knowing" and "knowingly"}-Federal statue setting civil and criminal penalties to protect the government from being overcharged or sold substandard goods or services: -falsely billing the government -over-representing the amount of a delivered pro...

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. Copayment B. Deductible C. Secondary Payment D. Coinsurance - correct answer B. Deductible Which type of i...

__________ sets standards and directives to protect workers against transmission of infectious agents. a. HIPAA b. JCAHO c. NCHS d. OSHA - correct answer d. OSHA For OSHA, which employees are included as healthcare workers? I. medical staff II. maintenance staff III . housekeeping IV. f...

What 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 answe...

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 ...

Which 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...

The 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. Blue Cross/Blue Shield identifies the individual or employee who pays for healthcare insurance ...

Which 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 What is the correct action when a claim has been submitted to BCBS but the provider has not received a response...

Medicare'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 = Medicar...

Which 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 da...

What is the first step in working a denied claim? a. Resubmit the claim b. Contact the carrier c. Appeal the claim d. Determine and understand why the claim was denied - correct answer d. Determine and understand why the claim was denied Which of the following is the highest level of the ap...

A ______ 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 ...

When a claim has been paid, an EOB is sent to: a. the clearinghouse. b. the patient. c. the provider. d. the insurance company. - correct answer b. the patient. Cost based fee schedules are developed using which of the following: a. RBRVS methodology b. total costs of every procedure o...

Which statement is TRUE regarding condition codes for the UB-04 claim form? Selected Answer: d. a. A condition code identified the department for the revenue of the procedure. b. Condition codes are listed in the order of occurrence instead of numerical order. c. Condition codes are reported o...

Prior authorization is reported in Item 23. What other information can be reported in this area of the CMS-1500 claim form? a. Unlisted CPT® code(s) b. mammography pre-certification number c. patient identification number d. patient account number - correct answer b. mammography pre-certifica...

Using the information in CPB Chapter 8 Case 1 to answer questions 1 and 2. After review of the information provided, are there any errors on the claim form? If so, which elements are incorrect? I Date of birth II Date of service III Primary insurance policy number IV Primary insurance group n...

MUE is the acronym for: a. Medicare Unlikely Edits b. Medically Unnecessary Edits c. Medicare Unnecessary Edits d. Medically Unlikely Edits - correct answer d. Medically Unlikely Edits Based on NCCI edits, when a procedure is bundled and has a CCM indicator of 0 - which of the following Mod...

A patient has a breast biopsy with placement of localization device (19083) with subsequent mastectomy (19301) at the same session after the biopsy is proven to be malignant. What modifier would be used for this scenario? a. 59 b. 58 c. 25 d. 78 - correct answer b. 58 Medicare will consider...

Use CPB Chapter 7_Case to answer questions 1 & 2. A 40-year-old patient is trying Botox® for her chronic migraines. According to the policy, what are the symptom parameters that must be documented? a. The patient has chronic migraines more than 15 days per month, with headaches lasting 4 hou...

A 65 year-old patient is seen in her physician's office with a laceration on her forehead. The cut is not deep for a suture repair. The physician decides to repair the wound with tissue adhesive. How would this be billed? a. A4364 b. A4452 c. G0168 d. C1765 - correct answer c. G0168 What i...

A female patient is getting a right and left breast mastectomy bra with integrated form breast prosthesis. What HCPCS Level II code is reported? a. L8002 b. L8002-50 c. L8001-50 d. L8000 - correct answer a. L8002 Patient is given 15 mg of methotrexate sodium IM for rheumatoid arthritis giv...

A patient is new to Medicare this year and sees his local family physician for his initial preventive physical for Medicare. What CPT or HCPCS Level II code is reported? a. 99397 b. 99387 c. G0402 d. G0438 - correct answer c. G0402 What is the route of administration for the drug Vancomycin...

Add-on Code - correct answer CPT code used to report a supplemental or additional procedure appended to a primary procedure (stand-alone) code. Add-on codes are recognized by the CPT symbol +used throughout the CPT code book Centers for Medicare and Medicaid Services (CMS) - correct answer Agency...

Patient is seen for destruction of 2 skin lesions that were diagnosed as actinic keratosis (AK). Which of the following is the correct billing for removal of skin lesions? a. 17000, 17003, 17004-59 b. 17000, 17003-51 c. 17000, 17003 d. 17004, 17003 - correct answer c. 17000, 17003 Sally is ...

A 43-year-old established patient is seen for his annual preventive exam by the family physician. A comprehensive history, comprehensive exam, and medical decision making of low complexity is performed. What E/M code is reported? a. 99215 b. 99396 c. 99386 d. 99402 - correct answer b. 99396 ...

A patient comes into the office for follow up of neck pain. The provider documents an expanded problem focused history, a problem focused exam and medical decision making of low complexity. What E/M code is reported for this visit? a. 99212 b. 99213 c. 99202 d. 99201 - correct answer b. 99213 ...

What is the ICD-10-CM code for a sore throat? a. J02.8 b. J02.0 c. J02.9 d. J31.2 - correct answer c. J02.9 Patient is diagnosed with right bundle branch block. What ICD-10-CM code is reported? a. I45.10 b. I45.19 c. I45.5 d. I45.9 - correct answer a. I45.10 Patient is diagnosed wi...

What is/are the correct code(s) for a patient with acute on chronic maxillary sinusitis? a. J01.00, J32.0 b. J01.00 c. J32.0, J01.00 d. J01.01 - correct answer a. J01.00, J32.0 Which sections of ICD-10-CM does a biller use to code for a physician's office? a. ICD-10-CM Alphabetic Index...

A patient was seen for a left ear infection. The provider diagnosed the patient with Swimmer's Ear in the left ear. The biller received a denial from XYZ Insurance Company stating H60.33 is an invalid diagnosis code. Why is this an invalid code? a. H60.33 requires an additional character; the co...

What information can be released based on this Disclosure form? AAPC Physician Practice are authorized to make the disclosure. The type of information to be used or disclosed is as follows: ____ Problem list ____ Medication list ____ List of allergies ____ Immunization records ____ Most ...

Listed below are examples of patient reminders for appointments. Which one is HIPAA compliant? a. "This is the obstetrical office calling to remind you of your appointment Tuesday, April 12 at 9 am for your annual exam." b. "This is Dr. Smith's office calling to remind you of your appointmen...

Which of the following does NOT qualify a patient for coverage under Medicare? a. End Stage Renal Disease (ESRD) b. Age 65 or older c. Under age 65 with disabilities d. Low income individual - correct answer d. Low income individual The insurance claim process begins with: a. Patient inf...

Use the CPB Chapter 3_Case to answer questions 1 & 2. 1. Susan smith arrives at her in-network primary care physician's office for her annual preventive visit. What is her copay? a. $15.00 b. $50.00 c. $75.00 d. The patient does not have a copay for preventive visits. - correct answer d. ...

Accountable Care Organization (ACO) - correct answer A healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for assigned population of patients Capitation - correct answer F...

What is the largest health program in the United States? a. Blue Cross Blue Shield b. Medicare c. Medicaid d. TRICARE - correct answer b. Medicare Which of the following services is NOT covered under Medicare Part B? a. Cardiovascular disease screening b. Diabetes self-management c. Nu...

A patient presents to be seen in the office. He does not pay at the time the services are rendered as the provider is his primary care provider, or gatekeeper. The large group practice has 800 covered members under this plan as is paid on a monthly basis with a set amount that is based on the number...

Why must a provider obtain an NPI number? I. To submit claims II. To prove that he is licensed III. To be HIPAA compliant IV. To guarantee payment by a health plan a. I, II, III b. II, III, IV c. I, II, III, IV d. I, III - correct answer d. I, III A patient has receipts for her dental c...

What does the acronym PHI stand for? a. Patient Healthcare Information b. Patient History of Illness c. Protected Health Information d. Protected Healthcare Index - correct answer c. Protected Health Information A new radiology company opens in town. The manager calls your practice and offe...

Eight standard transactions were adopted for Electronic Data Interchange (EDI) under HIPAA. Which of the following is NOT included as a standard transaction? a. Payment and remittance advice b. Eligibility in a health plan c. Coordination of benefits d. Physician unique identifier number - cor...

Eight standard transactions were adopted for Electronic Data Interchange (EDI) under HIPAA. Which of the following is NOT included as a standard transaction? a. Payment and remittance advice b. Eligibility in a health plan c. Coordination of benefits d. Physician unique identifier number - cor...

Use CPB Chapter 14_Case to answer questions 1 & 2. After review of the information provided, are there any errors on the claim form? If so, which elements are incorrect? I. Insured's name II. Secondary insurance III. Primary insurance policy number IV. Date of birth V. Date of injury VI...