AAPC Certified Professional Biller (CPB) Practice EXAM
LATEST 450 QUESTIONS AND 100% Verified ANSWERS
Which of the following service type providers is required to accept assignment on Medicare claims?
I. Clinical diagnostic laboratory services
II. Specialized radiology services
III. Services provided to Medicare/Medicaid patients
IV. Simplified billing roster for influenza virus vaccine and pneumococcal vaccine
V. Physical therapy services
A. I, III, and IV
B. I, II, and V
C. III, IV, and V
D. I, III, and V - answer>>A. I, III, and IV
A Medicare patient comes in for a consultation from the orthopedist. The patient was referred by her
primary care provider due to right hip pain. The orthopedist documents a detailed history and an
expanded problem focused exam. An X-Ray of the hip is ordered. The medical decision making was
moderately complex. The orthopedist provides a report back to the primary care provider with
recommendations for physical therapy and potential hip replacement. What codes are reported by the
orthopedist?
A. 99203, M79.651
B. 99242, M25.551
C. 99243, M79.651
D. 99202, M25.551 - answer>>D. 99202, M25.551
Which of the following scenarios is the best example of fraud?
,A. Asking a patient presenting for their initial visit with the practice to pay their copayment prior to the
visit.
B. Submitting a claim for services prior to the physician performing the scheduled service.
C. Providing a chest x-ray without prior authorization from Medicare.
D. Requiring a patient to sign an ABN prior to providing a service that may be denied by Medicare. -
answer>>B. Submitting a claim for services prior to the physician performing the scheduled service.
A medical practice assesses a finance charge for patient balances past 90 days. This practice has failed
to disclose to patients the percentage rate that will be charged on past due balances. This is a violation
of which federal law?
A. Truth in Lending Act
B. False Claims Act
C. Anti-Kickback Statute
D. Criminal Health Care Fraud Statute - answer>>A. Truth in Lending Act
A large group practice has implemented an electronic medical record system. They are setting up
security groups and want to be sure access is correctly established to comply with HIPAA's minimum
necessary requirements. Which of the following positions would generally not need to have access to
the clinical notes of a patient's medical record?
A. Biller
B. Receptionist
C. Office Manager
D. All of these positions need to have full access to patient's' medical records. - answer>>B.
Receptionist
Payments may be denied by the payer because:
,I. The service is not medically necessary.
II. The claim was coded incorrectly.
III. The conditions of the payment policy were not met.
IV. The patient's insurance was terminated following the service.
V. The provider is credentialed with multiple insurance plans.
VI. The incorrect place of service was submitted.
VII. The NPI for the provider is incorrect.
VIII. More than one modifier was appended to a procedure code.
A. I, II, IV, VI, VII, VII
B. I, II, III, VI, VII
C. I, II, III, IV, V, VII, VIII
D. I-VIII - answer>>B. I, II, III, VI, VII
Hospitals billing for inpatient services are based on which of the following reimbursement?
A. Ambulatory Payment Classifications (APC)
B. Medicare Severity-Diagnosis Related Groups (MS-DRG)
C. Fee for Service
D. Outpatient Prospective Payment System (OPPS) - answer>>B. Medicare Severity-Diagnosis Related
Groups (MS-DRG)
External cause codes report the circumstances surrounding an injury or illness. Which statement is
TRUE regarding external cause codes?
A. External cause codes will always be rejected by commercial carriers.
B. All external cause codes contain seven characters.
C. External cause codes are only reported on the initial encounter.
, D. Payer policy may dictate how external cause codes are reported. - answer>>D. Payer policy may
dictate how external cause codes are reported.
A "reasonable" charge in UCR is:
A. What Medicare deems reasonable
B. A computer calculation for a particular service based on all the claims data submitted by individual
doctors and group practices.
C. A fee which meets the criteria of usual and customary charges or (after appropriate peer review) is
justified because of the special circumstances of a case.
D. The fee generally charged by an individual doctor or group for a particular service (the claim form
charge). - answer>>C. A fee which meets the criteria of usual and customary charges or (after
appropriate peer review) is justified because of the special circumstances of a case.
A 35-year-old female member of an HMO decides to go to an out-of-network specialty clinic for
evaluation and surgery because she heard that this clinic provides superior services. The clinic submits
claims totaling $15,000 for all services provided to this member. The insurance would typically have
paid $10,000 for an in-network provider for the same services. This insurance would most likely pay as
follows:
A. Pay the $10,000 it would have paid leaving the patient responsible for the balance
B. Pay the $15,000 since it was reasonable for the patient to go to a superior facility
C. Pay nothing as this provider was out-of-network
D. Negotiate with the provider to accept the $10,000 as payment in full - answer>>C. Pay nothing as
this provider was out-of-network
At the end of each day, daily deposits should be balanced. Which of the following items should the
daily deposits be balanced against?
I. Charges
II. Personal payment receipts
LATEST 450 QUESTIONS AND 100% Verified ANSWERS
Which of the following service type providers is required to accept assignment on Medicare claims?
I. Clinical diagnostic laboratory services
II. Specialized radiology services
III. Services provided to Medicare/Medicaid patients
IV. Simplified billing roster for influenza virus vaccine and pneumococcal vaccine
V. Physical therapy services
A. I, III, and IV
B. I, II, and V
C. III, IV, and V
D. I, III, and V - answer>>A. I, III, and IV
A Medicare patient comes in for a consultation from the orthopedist. The patient was referred by her
primary care provider due to right hip pain. The orthopedist documents a detailed history and an
expanded problem focused exam. An X-Ray of the hip is ordered. The medical decision making was
moderately complex. The orthopedist provides a report back to the primary care provider with
recommendations for physical therapy and potential hip replacement. What codes are reported by the
orthopedist?
A. 99203, M79.651
B. 99242, M25.551
C. 99243, M79.651
D. 99202, M25.551 - answer>>D. 99202, M25.551
Which of the following scenarios is the best example of fraud?
,A. Asking a patient presenting for their initial visit with the practice to pay their copayment prior to the
visit.
B. Submitting a claim for services prior to the physician performing the scheduled service.
C. Providing a chest x-ray without prior authorization from Medicare.
D. Requiring a patient to sign an ABN prior to providing a service that may be denied by Medicare. -
answer>>B. Submitting a claim for services prior to the physician performing the scheduled service.
A medical practice assesses a finance charge for patient balances past 90 days. This practice has failed
to disclose to patients the percentage rate that will be charged on past due balances. This is a violation
of which federal law?
A. Truth in Lending Act
B. False Claims Act
C. Anti-Kickback Statute
D. Criminal Health Care Fraud Statute - answer>>A. Truth in Lending Act
A large group practice has implemented an electronic medical record system. They are setting up
security groups and want to be sure access is correctly established to comply with HIPAA's minimum
necessary requirements. Which of the following positions would generally not need to have access to
the clinical notes of a patient's medical record?
A. Biller
B. Receptionist
C. Office Manager
D. All of these positions need to have full access to patient's' medical records. - answer>>B.
Receptionist
Payments may be denied by the payer because:
,I. The service is not medically necessary.
II. The claim was coded incorrectly.
III. The conditions of the payment policy were not met.
IV. The patient's insurance was terminated following the service.
V. The provider is credentialed with multiple insurance plans.
VI. The incorrect place of service was submitted.
VII. The NPI for the provider is incorrect.
VIII. More than one modifier was appended to a procedure code.
A. I, II, IV, VI, VII, VII
B. I, II, III, VI, VII
C. I, II, III, IV, V, VII, VIII
D. I-VIII - answer>>B. I, II, III, VI, VII
Hospitals billing for inpatient services are based on which of the following reimbursement?
A. Ambulatory Payment Classifications (APC)
B. Medicare Severity-Diagnosis Related Groups (MS-DRG)
C. Fee for Service
D. Outpatient Prospective Payment System (OPPS) - answer>>B. Medicare Severity-Diagnosis Related
Groups (MS-DRG)
External cause codes report the circumstances surrounding an injury or illness. Which statement is
TRUE regarding external cause codes?
A. External cause codes will always be rejected by commercial carriers.
B. All external cause codes contain seven characters.
C. External cause codes are only reported on the initial encounter.
, D. Payer policy may dictate how external cause codes are reported. - answer>>D. Payer policy may
dictate how external cause codes are reported.
A "reasonable" charge in UCR is:
A. What Medicare deems reasonable
B. A computer calculation for a particular service based on all the claims data submitted by individual
doctors and group practices.
C. A fee which meets the criteria of usual and customary charges or (after appropriate peer review) is
justified because of the special circumstances of a case.
D. The fee generally charged by an individual doctor or group for a particular service (the claim form
charge). - answer>>C. A fee which meets the criteria of usual and customary charges or (after
appropriate peer review) is justified because of the special circumstances of a case.
A 35-year-old female member of an HMO decides to go to an out-of-network specialty clinic for
evaluation and surgery because she heard that this clinic provides superior services. The clinic submits
claims totaling $15,000 for all services provided to this member. The insurance would typically have
paid $10,000 for an in-network provider for the same services. This insurance would most likely pay as
follows:
A. Pay the $10,000 it would have paid leaving the patient responsible for the balance
B. Pay the $15,000 since it was reasonable for the patient to go to a superior facility
C. Pay nothing as this provider was out-of-network
D. Negotiate with the provider to accept the $10,000 as payment in full - answer>>C. Pay nothing as
this provider was out-of-network
At the end of each day, daily deposits should be balanced. Which of the following items should the
daily deposits be balanced against?
I. Charges
II. Personal payment receipts
