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AAPC CPB EXAM / AAPC CPB ACTUAL EXAM
TEST BANK ALL 200 REAL EXAM QUESTIONS
WITH WELL ELABORATED ANSWERS
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 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 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 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 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 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 ANSWER>>99213-25, 17110
What is the correct HCPCS Level II code for Depo-Provera (medroxyprogesterone acetate) injection of 100 mg? - 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 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
What should a biller do when a claim is denied for not being submitted within the timely filing period? - 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 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 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 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 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 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 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 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 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 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 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
IV. Outpatient services are reported with CPT® and HCPCS Level II codes
V. Physician services are reported with ICD- 10 - PCS codes - CORRECT ANSWER>>I and IV
A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate? - 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 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 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 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 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 ANSWER>>A corrected claim should be filed with CPT® code 58262
What is an Accountable Care Organization (ACO)? - 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 ANSWER>>Advance Beneficiary Notice
What forms need to be submitted when billing for a work-related injury? - 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 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 ANSWER>>Pediatric check ups
Which guidelines must all billing personnel be knowledgeable about in order to ensure compliance with Medicaid programs - CORRECT ANSWER>>A. Federal guidelines
B. State guidelines
When a nonparticipating provider files a claim for a patient to BC/BS, how is the payment processed? - 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?
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 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 ANSWER>>Joe, because his birth month and day are before Mary's birth month and day.
