AAPC CPB - Chapter 2 Review/ Questions with Certified Solutions., Exams of Nursing

Download AAPC CPB - Chapter 2 Review/ Questions with Certified Solutions. and more Exams Nursing in PDF only on Docsity! AAPC CPB - Chapter 2 Review/ Questions with Certified Solutions. A new physician comes into the practice that is just out of medical school. He will need to be able to see patients in the office and at the hospital. What process will he need to undergo in order to be able to participate with Medicare and other health plans? a. Credentialing b. Privileging c. Contract negotiations d. Board certification - Answer: a. Credentialing The following is a capitation schedule for a pediatric practice. Member's Age Capitation per Member, per Month 0-1 $25.00 2-4 $10.00 5-20 $5.00 Page 1 of 9 The practice has 300 members age 0-1, 500 members age 2-4, and 2000 members age 5-20 that stay with the practice for an entire year. If the practice also performs "carve-out" services worth $20,000, how much money will they earn over the course of a year? a. 270,000 b. 250,000 c. 290,000 d. 300,000 - Answer: c. 290,000 A patient needs to see a specialist for a cardiac condition. She references her insurance handbook for a list of network providers that belong to that specialty. She may choose any physician she wishes and does not need a referral from her Internist to see the specialist. If she chooses an out-of-network physician, she will have to pay a higher co-insurance amount to see them. What type of insurance does this patient have? a. HMO b. PPO c. Medicare d. Medicaid - Answer: b. PPO NPI is an abbreviation for a unique number that is required by HIPAA. What does NPI stand for? a. National Physician Identifier b. National Provider Insurance c. National Provider Identifier d. National Participating Identifier - Answer: c. National Provider Identifier Page 2 of 9 c. Part C d. Part D - Answer: c. Part C When a patient is enrolled in an HMO, which options below are the responsibilities of the primary care physician (PCP)? I. Manage the member's treatment II. Be the only provider for all of the patient's healthcare III. Provide referrals to specialists IV. Approve emergency department visits V. Provide referrals for inpatient admissions a. I, II b. I, II, III c. I, III, IV d. I, III, V - Answer: d. I, III, V Which of the following is NOT evaluated in the credentialing process? a. Physician's education b. Physicians residency c. Physician's request for privileges d. Physician's license(s) - Answer: c. Physician's request for privileges What type of plan allows an insurer to administer straight indemnity insurance, an HMO, or a PPO insurance plans to its members? a. Triple option plan b. Full option plan c. Integrated provider plan Page 5 of 9 d. Management service organization - Answer: a. Triple option plan If a provider decides not to participate with Medicare what is one of the disadvantages? a. Services provided by non-participating providers are not paid by Medicare. b. Providers who do not participate with Medicare cannot see Medicare patients. c. Non-participating providers do not have to file a claim. d. The patient receives the reimbursement. - Answer: d. The patient receives the reimbursement. What is the largest health program in the United States? a. Blue Cross Blue Shield b. Medicare c. Medicaid d. TRICARE - Answer: b. Medicare Which of the following services is NOT covered under Medicare Part B? a. cardiovascular disease screening b. Diabetes self-management c. Nutrition therapy services d. Home Health services - Answer: d. Home Health services Health Savings Account (HSA) is ____________________ to employees. a. tax-free income b. taxed income c. a monthly contribution only made by employers Page 6 of 9 d. only for medical coverage, excluding dental and vision expense - Answer: a. tax-free income Managed Care Organizations (MCOs) place the physician at financial risk for the care of the patient and are reimbursed by: a. Capitation b. Fee-for-service c. Reimbursement account d. Patient payments - Answer: a. Capitation A Medicare patient presents after slipping and falling in a neighbor's walkway. The cement had a large crack, which caused the pavement to raise and be unsteady. The neighbor has contacted his homeowner's insurance and they are accepting liability and have initiated a claim. How should the visit be billed? a. Bill the Homeowner's insurance only. Medicare will not pay anything. b. Bill Medicare, then the Homeowner's insurance as secondary. c. File to both at the same time and see which pays more. d. Bill the Homeowner's first, then Medicare secondary if it is not paid within 120 days. - Answer: d. Bill the Homeowner's first, then Medicare secondary if it is not paid within 120 days. What are some of the ways that managed care organizations (MCOs) offer provisions that provide insurers with ways to manage the cost, use, and quality of healthcare services received by a member? I. Utilization review II. Coverage restrictions III. Arbitration IV. Non-emergency weekend admission restrictions Page 7 of 9