AAPC CPB - Chapter 10 Review Exam

Which statement is TRUE regarding the Prompt Payment Act? a. Patients are required to pay patient balances within 30 days. b. Patient balances are dismissed if a statement is not sent to the patient within 30 days. c. Federal agencies are not required to respond to all clean claims within 30 days of receipt. d. Federal agencies are required to pay clean claims within 30 days of receipt. - Answer- d. Federal agencies are required to pay clean claims within 30 days of receipt. When a provider wants to give a discount on services to a patient, which option is acceptable? a. The provider can waive the co-paymant at his discretion. b. The provider can accept insurance only payments and write-off all patient balances. c. The provider must discount the charge prior to billing the insurance carrier. d. The provider cannot discount the charge under any circumstance. - Answer- c. The provider must discount the charge prior to billing the insurance carrier. What does a high number of days in A/R indicate for a medical practice? a. The practice is using their A/R for loan purposes. b. The practice has good policies in place, which results in good collections of outstanding balances. c. The practice potentially has a problem in the revenue cycle. d. The days in A/R do not indicate anything about the practice. - Answer- c. The practice potentially has a problem in the revenue cycle. A provider removes a skin lesion in an ASC and receives a denial from the insurance carrier that states "Lower level of care could have been provided." What steps should the biller take? a. Write-off the charge. b. Check with the provider and write an appeal to the insurance carrier explaining why the service was provided in the ASC. c. Check with the provider and write an appeal to the insurance carrier explaining why the service was not an inpatient service. d. Submit the CMS-1500 claim form with a different place of service code. - Answer- b. Check with the provider and write an appeal to the insurance carrier explaining why the service was provided in the ASC. When accepting debit cards in a medical practice, which act requires the office to disclose specific information before completing a transaction? a. Health Insurance Portability and Accountability Act (HIPAA) b. Electronic Funds Transfer Act c. Equal Credit Opportunity Act d. Fair Credit Billing Act - Answer- b. Electronic Funds Transfer Act Which statement is TRUE regarding patient balances? a. Small balances for which processing costs exceed potential collections may be automatically written-off according to the financial policy of the practice. b. The financial policy of the practice cannot include information about write-offs for patient balances. c. Writing off any patient balance is considered waiving co-payments and puts the practice at risk for violating state and federal regulations. d. Best practices is to write-off any patient balance under $50.00. - Answer- a. Small balances for which processing costs exceed potential collections may be automatically written-off according to the financial policy of the practice. Which statement is TRUE regarding denials? a. Denials should be reviewed to determine whether additional information is needed, if errors need to be corrected, or if the denial should be appealed. b. All denials should be written off in the practice management system. If appealed and paid, the balance can be reversed. c. Denials for lack of medical necessity cannot be appealed. d. Denials for not timely filing cannot be appealed. - Answer- a. Denials should be reviewed to determine whether additional information is needed, if errors need to be corrected, or if the denial should be appealed. Review the following financial policy: Financial Policy: You are responsible for paying all co-payments at the time of service. Co-payments, co-insurance, deductibles and non-covered services cannot be waived by our office, as it is a requirement placed on you by your insurance carrier. Failure to pay your portion of services rendered will be reported to your insurance carrier and could result in termination of your insurance plan. Non-covered Services: The following services a