AAPC CPB - Chapter 11 Review Exam Questions with correct Answers

Medicare's payment amount for services are determined by which of the following formulas? a. Sustainable growth rate (SGR) X Geographic Practice Cost Index (GPCI) = Medicare payment b. Total RVU X Conversion factor = Medicare payment c. Total Practice Expense (PE) X Conversion factor = Medicare payment d. Total Malpractice insurance (MP) X Conversion factor (CF) = Medicare payment - Answer- b. Total RVU X Conversion factor = Medicare payment The total RVU is composed of which of the following components: a. Conversion factor (CF), practice expense (PE), and malpractice insurance (MP) b. Physician work, practice expense (PE), and malpractice insurance (MP) c. Sustainable growth rate (SGR), conversion factor (CF), and malpractice insurance (MP) d. Sustainable growth rate (SGR), practice expense (PE), and physician work. - Answer- b. Physician work, practice expense (PE), and malpractice insurance (MP) Medicare Supplement Insurance policies or Medigap is sold by: a. Medicare b. Medicaid c. Private insurance companies d. Healthcare providers - Answer- c. Private insurance companies Medicare statutorily excluded services are: a. Non-covered items and services b. Not reimbursed by Medicare c. Reimbursed on a case-by-case basis. d. Both A & B - Answer- d. Both A & B Albert has purchased a Medigap policy to supplement his Medicare benefits. To which entity will Albert pay his monthly premium for this policy? a. Medicare b. MAC c. Medicaid d. Medigap insurance company - Answer- d. Medigap insurance company The term for a supplemental policy for Medicare is: a. Medifill b. Medicare Plus c. Medigap d. Medicare Secondary - Answer- c. Medigap Dr. Allen who is a non-PAR provider performs an appendectomy on a 67 year-old Medicare patient. The physician's UCR for the surgery is $1500. Medicare's approved fee for this procedure is $1100. What is the limiting charge that this non-PAR provider can charge to this Medicare patient? a. $1265