AAPC CPB - Chapter 9 Practical Application Exam Practice Questions and Answers (100% Pass)

AAPC CPB - Chapter 9 Practical Application Exam Practice Questions and Answers (100% Pass) Case 1 - Clearinghouse Rejections Report Status: 11/19/20XX Contents: C4450 - Principal Diagnosis Code must be valid; REJECTED BY SYSTEM EDI; Rejected Patient Name: Adams, David Patient Number: 384594 Payer: HEALTHSPRINGMEDICARE Submission Date: 11/19/XX Date of Service: 11/09/XX Charge: $557.00 Provider: Post, Alexis According to this clearinghouse rejections report, what actions should be taken on the claim for David Adams, Date of Service 11/19/20XX? ©SOPHIABENNET@ Thursday, August 22, 2024 10:21 AM Certified Professional Biller By: American Academy of Professional Coders(AAPC) 2 I. Review the medical records to verify the ICD-10-CM code is correct. II. Review the ICD-10-CM codebook to verify it is a correct diagnosis code. III. Adjust the charge as this is not a covered diagnosis by the insurance carrier. IV. Override the clearinghouse edit as this is a valid code. a. II and III b. I and II c. I, II, and IV d. II and IV - Answer️️ -b. I and II Response Feedback: According to the Clearinghouse report, the diagnosis code is invalid. The biller should look in the ICD-10-CM codebook to determine the validity of the code. In the ICD-10-CM codebook, the code requires another character. ©SOPHIABENNET@ Thursday, August 22, 2024 10:21 AM Certified Professional Biller By: American Academy of Professional Coders(AAPC) 3 The medical record should be reviewed to determine the additional character and a correct claim refiled. Case 2 - Clearinghouse Rejections Report Status: 10/18/20XX Contents: C4655 - Not eligible (Inactive) for service; REJECTED BY SYSTEM EDI; Rejected Patient Name: Smith, John Patient Number: 584263 Payer: AAPC Health Plan Submission Date: 10/18/XX Date of Service: 10/17/XX Charge: $450.00 Provider: Post, Alexis According to this clearinghouse rejections report, what actions should be taken on the claim for John Smith, Date of Service 10/18/20XX? I. Verify the insurance card information in the patient's file. ©SOPHIABENNET@ Thursday, August 22, 2024 10:21 AM Certified Professional Biller By: American Academy of Professional Coders(AAPC) 4 II. Verify coverage dates for the insurance carrier. III. Adjust the charge as the patient is not eligible for coverage. IV. Override the clearinghouse edit. a. II and III b. IV c. I and II d. III and IV - Answer️️ -c. I and II Response Feedback: The clearinghouse rejected the service because the patie