AAPC CPB Practice Exam With Verified Questions & Answers 2024, Exams of Public Policy

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AAPC CPB Practice Exam With

Verified Questions & Answers 2024 (GRADED

A+)

The office policy for claims follow-up is to prioritize the insurance balance accounts past 90 days by highest outstanding balance. Based on the A/R report provided, which payer type and aging category would be one of the top priorities on which to focus collection efforts? - CORRECT CORRECT ANSWER>>workers' compensation, 121+ days

Using the fee schedule and the payment policy provided, what is the expected reimbursement (including patient responsibility) when a provider performs a nasal endoscopy and dilation of the left maxillary sinus (31295) and a diagnostic nasal endoscopy of the right maxillary sinus (31233)? - CORRECT CORRECT ANSWER>>$

Policy applies to all professional services performed in an office place of service: When a significant, separately identifiable E/M service (appended with modifier

25. and any service that has a global period indicator—as designated by CMS of 0, 10, 90 or YYY—is performed on the same day, the E/M service will be reimbursed at 50% of the contracted allowable. When performed in a facility, both services are paid at 100%. When the E/M value is greater than the procedure, the reduction will be applied to the global procedure code.

Based on the remittance advice and the payment policy provided, what action is required for this claim? - CORRECT CORRECT ANSWER>>D. The claim did not pay correctly. Both services should be paid at 100%. Contact the payer to reprocess the claim for full payment. Balloon Sinusplasty Medical Coverage Policy

According to the LCD, how is an extracapsular cataract surgery with insertion of an intraocular lens for a drug induced cataract in the left eye reported? - CORRECT CORRECT ANSWER>>66984, H26.32, T38.0X5A

I. Primary insurance II. Primary insurance ID number III. Relationship to the insured IV. Place of service V. Provider NPI VI. CPT® code(s) VII. Modifier VIII. Diagnosis code correlation IX. Units of service X. Service Facility Location Information

(Robert Roberts) - CORRECT CORRECT ANSWER>>VI , VIII and X

The provider performs an office visit with an expanded problem focused history, expanded problem focused exam and low MDM to manage the patient's

hypertension. The provider also destroys two plantar warts. How is this reported?

• CORRECT CORRECT ANSWER>>99213-25, 17110

What is the correct HCPCS Level II code for Depo-Provera (medroxyprogesterone acetate) injection of 100 mg? - CORRECT CORRECT ANSWER>>J1050 x 100

55-year-old female presents to the office with ongoing history of type I diabetes which has been controlled with insulin. During the exam the physician notes that gangrene has set in due to the diabetic peripheral angiopathy on her left great toe. Patient is recommended to see a general surgeon for treatment of the gangrene on her left great toe. - CORRECT CORRECT ANSWER>>E10.

A dermatologist performed an excision of a squamous cell carcinoma from the patients forehead with a 1.2 cm excised diameter. The excision site required an intermediate wound closure measuring 1.8 cm. What is/are the correct code(s)? - CORRECT CORRECT ANSWER>>C. 11642, 12051-

Procedures Performed: 1. Bilateral tympanotomy with insertion of ventilation tubes (69436 RVU 4.62) 2. Adenotonsillectomy (42820 RVU 8.41) What is/.are the correct code(s) and proper billing sequence for the following procedures performed by a physician? Procedures Performed: Bilateral tympanostomy with insertion of ventilationg tubes (69436 RVU 4.63582) Adenotonsillectomy ( RVU 8.45321) - CORRECT CORRECT ANSWER>>A. 42820, 69436

When you respond to a patient with "How may I help you, Mrs Jones?", the use of the patient's name: - CORRECT CORRECT ANSWER>>C. Indicates to the caller you are interested and listening

Ms. Turner had surgery one month ago for hernia repair. She is still in the post- operative period and comes in today to the see the same physician that performed the hernia repair surgery about a lump that she has noticed on her tailbone. The physician performs an examination and the diagnosis is that she has a pilonidal cyst which is unrelated to the surgery. Can the physician bill an E/M service for today's visit during the post-operative period? - CORRECT CORRECT ANSWER>>Yes, the E/M service can be reported with modifier 24 to indicate it is unrelated to the surgery.

CMS has a standard enrollment form in which the provider agrees to: I. Submit claims to Medicare II. Have authorization from the Medicare beneficiary to file claims III. Retain all source documentation and medical records IV. Submit claims within 60 days of the date of service V. Submit all claims with a group NPI number VI. Research and correct claim discrepancies. - CORRECT CORRECT ANSWER>>D. I, II, III, and VI

Incorrect entry of the patient demographics can have an affect on many areas of the practice. What documents are necessary to verify demographics? I. Photo Identification II. Insurance card III. Credit card information IV. Social Security card V. Patient completed demographic form - CORRECT CORRECT ANSWER>>I, II, and V

What should a biller do when a claim is denied for not being submitted within the timely filing period? - CORRECT CORRECT ANSWER>>Track the transmission date of the claim. If within the timely filing period, provide the information to the payer to reprocess the claim.

Which of the following steps should be completed when filling an appeal?

I. Submit in the format required by the payer. II. Review the reason for the denial and determine if the payer made an error. III. Provide supporting documentation from an official source to support your reason for appeal. IV. Keep a copy of the information submitted to the payer for the appeal. V. Appeal the claim as soon as a denial is received. VI. Appeal the claim as soon as you are certain the payer denied in error and the claim can not be reprocessed. - CORRECT CORRECT ANSWER>>C. I, II, III, IV, and VI

A patient with an acute myocardial infarction is brought by ambulance to the emergency department. The patient is taken into the cardiac catheterization lab. Angioplasty and a stent was placed in the LAD. The patient's insurance requires preauthorization for all surgical procedures. Which of the following statements is true for most payers? - CORRECT CORRECT ANSWER>>Because this was an emergency, it is acceptable to obtain authorization following the surgery.

According to this clearinghouse rejections report, what action should be taken on the claims for Jerry McMahon, Date of Service 11/09/XX? - CORRECT CORRECT ANSWER>>. C44.50 requires an additional character. Review the medical record for the correct sixth character, correct the claim in your system and re-file electronically.

Which of the following is an allowed collection policy after a patient files for bankruptcy? - CORRECT CORRECT ANSWER>>Unpaid insurance claims for dates of service occurring after the date of the bankruptcy can be collected.

Which statement is TRUE regarding the Fair Debt Collection Practices Act (FDCPA)? - CORRECT CORRECT ANSWER>>Collectors are not allowed to contact debtors at odd hours.

There is a written office policy to write off patients co-insurance and copayment amounts as a professional courtesy. Is this appropriate? - CORRECT CORRECT ANSWER>>No, it is considered fraud to write off the patients' responsibility for all patients

Which Act protects information collected by consumer reporting agencies? - CORRECT CORRECT ANSWER>>Fair Credit Reporting Act

Provided above is a sample of a report containing accounts with an outstanding balance. The office policy is to follow up on the oldest accounts with the highest dollar amount. Which statement below is true? - CORRECT CORRECT

ANSWER>>Review the account for Bridget Smith to determine the adjustment and patient responsibility if the payment is from Medicare. Follow up with Medicare if the payment is from the patient.

Which of the following is true regarding provider credentialing? - CORRECT CORRECT ANSWER>>A provider can complete an application with CAQH which handles credentialing for many payers.

An example of an overpayment that must be refunded is _____________? - CORRECT CORRECT ANSWER>>Duplicate processing of a claim

Dr. Taylor's office has a new medical assistant (MA) who is responsible for blood collection for lab specimens. Because the MA is new, she often misses when obtaining blood on the first stick. To be sure the office is billing for all services, the office now has a rule that all patients will be billed a minimum of two blood draws to demonstrate the work that is being done for lab collection. Which statement is true regarding this rule? - CORRECT CORRECT ANSWER>>The rule is fraudulent because the office is billing for services not performed and services that are a result of provider error.

Security involves the safekeeping of patient information by:

I. Setting office policies to protect PHI from alteration, destruction, tampering, or loss II. Allowing full access to all employees to the electronic medical records

III. Giving employees a policy on confidentiality to read IV. Requiring employees to sign a confidentiality statement that details the consequences of not maintaining patient confidentiality, including termination - CORRECT CORRECT ANSWER>>I and IV

Pam works for a medical practice. She discovered a claim was overpaid by Medicare. What Act requires the money to be refunded? - CORRECT CORRECT ANSWER>>False Claims Act

Which of the following indicates the frequency of care on a UB-04 claim form? - CORRECT CORRECT ANSWER>>Type of Bill

Electronic Healthcare Transactions and code sets are required to be used by health plans, healthcare clearinghouses and healthcare providers that participate in electronic data interchanges. Which of the following are requirements for the code sets?

I. Dental services are reported with CDT codes

II. Inpatient procedures are reported with HCPCS Level II codes

III. Diagnosis codes are reported with ICD-10-CM and ICD-10-PCS codes

IV. Outpatient services are reported with CPT® and HCPCS Level II codes

V. Physician services are reported with ICD-10-PCS codes - CORRECT CORRECT ANSWER>>I and IV

A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate? - CORRECT CORRECT ANSWER>>The code can only be reported for one unit of service on a single date of service

Which CPT® code below can be reported with modifier 51? - CORRECT CORRECT ANSWER>>

According to CMS, which of the following services are included in the global package for surgical procedures?

I. Surgical procedure performed II. E/M visits unrelated to the diagnosis for which the surgical procedure is performed III. Local infiltration, digital block, or topical anesthesia IV. Treatment for postoperative complication which requires a return trip to the operating room (OR) V. Writing Orders VI. Postoperative infection treated in the office - CORRECT CORRECT ANSWER>>I, III, V, VI

CPT® codes 12032 and 12001 were reported together for a 2.6 cm intermediate repair of a laceration to the right arm and a 2.5 cm simple repair of a laceration to

the left arm. 12001 was denied as a bundled service. What action should be taken by the biller (following the CPT® guidelines)? - CORRECT CORRECT ANSWER>>Resubmit a corrected claim as 12032, 12001-59.

A new patient presents for her annual exam and has no complaints. She is scheduled to see the physician assistant (PA). How should services be billed? - CORRECT CORRECT ANSWER>>Bill under the PA

A claim for CPT® codes 58260 and 58720 was filed to the patient's insurance. The claim was returned with 58260 paid and 58720 denied as inclusive. How should the claim be handled? - CORRECT CORRECT ANSWER>>A corrected claim should be filed with CPT® code 58262

What is an Accountable Care Organization (ACO)? - CORRECT CORRECT ANSWER>>Groups of doctors, hospitals, and other health care providers who coordinate high quality care to Medicare patients

A document provided to Medicare patients explaining their financial responsibility if Medicare denies a service is a(n): - CORRECT CORRECT ANSWER>>Advance Beneficiary Notice

What forms need to be submitted when billing for a work-related injury? - CORRECT CORRECT ANSWER>>First Report of Injury form, progress reports, and CMS-1500 claim form

A female patient who was involved in an auto accident presents to the emergency department (ED) for evaluation. She does not have any complaints. The provider evaluates her and determines there are no injuries. The provider informs the patient to come back to the ED or see her primary care physician if she develops any symptoms. How is the claim processed for this encounter? - CORRECT CORRECT ANSWER>>The auto insurance is billed primary and the medical insurance is billed secondary

Which of the following services is covered by Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)? - CORRECT CORRECT ANSWER>>Pediatric check ups

Which guidelines must all billing personnel be knowledgeable about in order to ensure compliance with Medicaid programs - CORRECT CORRECT ANSWER>>A. Federal guidelines

B. State guidelines

C. ** Both A and B

D. None

When a patient has Medicare primary and AARP as Medigap, what is entered on the CMS-1500 claim form in item 9d for the Insurance Plan Name or Program

Name for Medicare to cross over the claim? - CORRECT CORRECT ANSWER>>COBA Medigap claim-based identifier (ID)

In which of the following scenarios is Medicare the secondary payer?

I. A 65 year-old patient who is collecting her deceased spouse's Medicare benefits and has a supplemental insurance

II. A 72 year-old patient who participates in the group health insurance of his employer

III. A 66 year-old patient is injured at work and the employer does not offer health insurance as a benefit of employment

IV. A 55 year-old patient who is on disability through Social Security and qualifies for Medicaid and Medicare - CORRECT CORRECT ANSWER>>II and III

In addition to the information found on a Medicare beneficiary's Medicare card, what is needed to verify eligibility using Electronic Data Interchange (EDI)? - CORRECT CORRECT ANSWER>>Beneficiary's gender

Which of the following TRICARE options is/are available to active duty service members? - CORRECT CORRECT ANSWER>>TRICARE Prime

When a nonparticipating provider files a claim for a patient to BC/BS, how is the payment processed? - CORRECT CORRECT ANSWER>>The payment is sent to the patient and the patient must pay the provider.

A patient covered by a PPO is scheduled for knee replacement surgery. The biller contacts the insurance carrier to verify benefits and preauthorize the procedure. The carrier verifies the patient has a $500 deductible which must be met. After the deductible, the PPO will pay 80% of the claim. The contracted rate for the procedure is $2,500. What is the patient's responsibility? - CORRECT CORRECT ANSWER>>$

Which type of managed care insurance allows patients to self-refer to out-of- network providers and pay a higher co-insurance/copay amount?

I. HMO II. PPO III. EPO IV. POS V. Capitation - CORRECT CORRECT ANSWER>>II and IV

Joe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4,

1974. Using the birthday rule, who carries the primary insurance for their children for billing? - CORRECT CORRECT ANSWER>>Joe, because his birth month and day are before Mary's birth month and day.