AAPC CPB - Chapter 2 Quiz-Answered

A patient presents to be seen in the office. He does not pay at the time the services are rendered as the provider is his primary care provider, or gatekeeper. The large group practice has 800 covered members under this plan as is paid on a monthly basis with a set amount that is based on the number of members covered and their ages. What type of plan is this? a. PPO b. Capitation c. Fee-for-service d. Indemnity - Answer- b. Capitation Which insurance is a healthcare benefit program for military personnel in all seven uniformed branches? a. Medicare b. Medicaid c. TRICARE d. BCBS - Answer- c. TRICARE This type of insurance is paid for by employers for employees and takes advantage of purchasing power of having large member numbers. a. Individual health plan b. Group health plan c. Medicare d. Medicaid - Answer- b. Group health plan A family practitioner sees a Medicare patient and bills a 99213. This provider has opted-out of Medicare. His fee for the service is $125.00. Medicare's approved amount is $73.08, and the patient has met $0 of his deductible. What can the provider bill the patient? a. $125.00 b. $73.08 c. $14.62 d. $58.46 - Answer- a. $125.00 Why must a provider obtain an NPI number? I. To submit claims II. To prove that he is licensed III. To be HIPAA compliant IV. To guarantee payment by a health plan a. I, II, III b. II, III, IV c. I, II, III, IV d. I, III - Answer- d. I, III An internist sees a 20-year-old patient for an office visit. The patient needs to see an endocrinologist for a consultation regarding her diabetes. The internist is a participating provider in her plan. She can choose any provider she wishes for her consultations, but she will save money if she sees a specialist that is in her network. She does not require a referral for her consultation. What type of insurance does the patient have? a. HMO b. Indemnity insurance c. Medicare Advantage d. PPO - Answer- d. PPO A Medicaid patient presents for services on the first day of the month. He has a $50 spenddown and has had no services this month. The visit for today was $100.00. If the patient wants to be covered as long as possible from today's visit, what can he do? a. Turn the receipt in to his caseworker and be eligible for two months of coverage b. Turn the receipt in to his caseworker and be eligible for the month with $50 to assessed by Medicaid for the visit that is above his spenddown c. Coverage is automatic and the patient will be reimbursed the $100 from Medicaid d. Turn in the receipt to his caseworker and be eligible for coverage for the current month, plus two additional months - Answer- a. Turn the receipt in to his caseworker and be eligible for two months of coverage Under the Patient Protection and Affordable Care Act (ACA), what is banned? a. Coverage for children under the age of 26 b. Patient appeal rights c. Expanded preventative health services d. Lifetime limits - Answer- d. Lifetime limits What are the options for a provider with regards to participation with Medicare? a. It is mandatory for every provider to participate in Medicare b. Providers may participate, may choose not to participate, or may opt-out of Medicare c. Providers are automatically opted-out d. Only participating providers must file claims - Answer- b. Providers may participate, may choose not to participate, or may opt-out of Medicare A patient has receipts for her dental cleaning, vision exam, and contact lenses. Her employer has set up special accounts for each employee and there is no limit to the amount the employer can contribute and the balances roll over from year-to-year. What type of account is this? a. Flexible Spending Account (FSA) b. Health Savings Account (HSA) c. Health Insurance Account (HIA) d. Healthcare Reimbursement Account (HRA) - Answer- d. Healthcare Reimbursement Account (HRA)