AAPC CPB CHAPTER 9 EXAM
QUESTIONS AND ANSWERS
When creating a fee schedule for a practice, which of the following can be used to set
the fees?
a. National Correct Coding Initiatives (NCCI)
b. Local Coverage Determination (LCD)
c. Current Procedural Terminology (CPT®)
d. Relative Value Units (RVU) - Answer- d. Relative Value Units (RVU)
When a batch of claims is submitted electronically to a clearinghouse a report is sent to
the provider. Which feedback does this report from the clearinghouse identify?
a. Shows improper Medicare payments paid to the provider.
b. Patient claims that will be sent to collections.
c. All claims sent to the payer and all rejected claims.
d. Patient claims that have not been paid within a certain time frame. - Answer- c. All
claims sent to the payer and all rejected claims.
What is a clean claim?
a. A blank claim form
b. A claim that meets medical necessity
c. A claim that has all of the information required to be processed
d. A claim that is paid on time - Answer- c. A claim that has all of the information
required to be processed
Which of the following can be done to reduce payment delay?
a. Verify patient's insurance information on each patient visit.
b. Submit a paper and electronic claim for a patient's visit.
c. Wait for the clearinghouse to send you a status report.
d. Always submit medical record documentation with every claim. - Answer- a. Verify
patient's insurance information on each patient visit.
Which regulation established claim standards for electronic filing requirements when a
provider uses a computer with software to submit an electronic claim?
, a. Health Insurance Portability and Accountability Act (HIPAA)
b. Affordable Care Act (ACA)
c. OIG Work Plan
d. Social Security Act - Answer- a. Health Insurance Portability and Accountability Act
(HIPAA)
Payments due from patients, payers, or other guarantors that are owed to the practice
for services rendered are considered
a. Collections
b. Bad Debt
c. Accounts Receivable
d. None of the above - Answer- c. Accounts Receivable
Which information is NOT required for prior authorization?
a. Site where the service will be performed
b. ICD-10-CM and CPT® code(s)
c. Ordering physician
d. Patient's finances - Answer- d. Patient's finances
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 - 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 - Answer- c. Explanation of Benefits
A clearinghouse is an entity that provides which of the following services?
a. Converts nonstandard data received from payers to standard transaction data to
meet HIPAA requirements.
b. Pursues payments of debts owed by individuals or businesses.
c. Assists providers in the collection of appropriate reimbursement for services
rendered.
QUESTIONS AND ANSWERS
When creating a fee schedule for a practice, which of the following can be used to set
the fees?
a. National Correct Coding Initiatives (NCCI)
b. Local Coverage Determination (LCD)
c. Current Procedural Terminology (CPT®)
d. Relative Value Units (RVU) - Answer- d. Relative Value Units (RVU)
When a batch of claims is submitted electronically to a clearinghouse a report is sent to
the provider. Which feedback does this report from the clearinghouse identify?
a. Shows improper Medicare payments paid to the provider.
b. Patient claims that will be sent to collections.
c. All claims sent to the payer and all rejected claims.
d. Patient claims that have not been paid within a certain time frame. - Answer- c. All
claims sent to the payer and all rejected claims.
What is a clean claim?
a. A blank claim form
b. A claim that meets medical necessity
c. A claim that has all of the information required to be processed
d. A claim that is paid on time - Answer- c. A claim that has all of the information
required to be processed
Which of the following can be done to reduce payment delay?
a. Verify patient's insurance information on each patient visit.
b. Submit a paper and electronic claim for a patient's visit.
c. Wait for the clearinghouse to send you a status report.
d. Always submit medical record documentation with every claim. - Answer- a. Verify
patient's insurance information on each patient visit.
Which regulation established claim standards for electronic filing requirements when a
provider uses a computer with software to submit an electronic claim?
, a. Health Insurance Portability and Accountability Act (HIPAA)
b. Affordable Care Act (ACA)
c. OIG Work Plan
d. Social Security Act - Answer- a. Health Insurance Portability and Accountability Act
(HIPAA)
Payments due from patients, payers, or other guarantors that are owed to the practice
for services rendered are considered
a. Collections
b. Bad Debt
c. Accounts Receivable
d. None of the above - Answer- c. Accounts Receivable
Which information is NOT required for prior authorization?
a. Site where the service will be performed
b. ICD-10-CM and CPT® code(s)
c. Ordering physician
d. Patient's finances - Answer- d. Patient's finances
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 - 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 - Answer- c. Explanation of Benefits
A clearinghouse is an entity that provides which of the following services?
a. Converts nonstandard data received from payers to standard transaction data to
meet HIPAA requirements.
b. Pursues payments of debts owed by individuals or businesses.
c. Assists providers in the collection of appropriate reimbursement for services
rendered.
