AAPC CPB - CHAPTER 2: QUESTIONS & Answers

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 - ANSWERSd. I, III A patient has receipts for her dental cleaning, vision exam, and contact lenses. Her employer has set up special accounts for each employee, 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. Traditional Healthcare Reimbursement Arrangement (HRA) - ANSWERSd. Traditional Healthcare Reimbursement Arrangement (HRA) 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 - ANSWERSb. Capitation (Capitation payments are used by managed care organizations (MCOs) to control healthcare costs by putting the physicians at financial risk for services provided to patients. Payments are based on a per-person rate, rather than a fee-for-service rate.) 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 - ANSWERSa. $125.00 (Providers that opt-out of Medicare are not limited to any specific charge limit on their patients. The patient is responsible for payment in full for services as Medicare will not pay any amount to either the patient or provider in this situation.) 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 - ANSWERSb. Providers may participate, may choose not to participate, or may opt-out of Medicare Which insurance is a healthcare benefit program for military personnel in all seven uniformed branches? a. Medicare b. Medicaid c. TRICARE d. BCBS - ANSWERSc. TRICARE 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 - ANSWERSa. Turn the receipt in to his caseworker and be eligible for two months of coverage (A bill that is larger than the spenddown may be used to meet multiple month's spenddown. If a patient wants the most coverage possible, $100 would meet two month's coverage spenddown.) 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 - ANSWERSd. PPO 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 - ANSWERSd. Lifetime limits 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 - ANSWERSb. Group health plan Health Savings Account (HSA) is ____________________ to employees. a. tax-free income b. taxed income c. a monthly contribution only made by employers d. only for medical coverage, excluding dental and vision expense - ANSWERSa. tax-free income What is the benefit of using NPI numbers for payers? I. It is a single identifier for all payers II. It contains the providers' birthdates to allow certain identification III. Each payer can make their own number IV. It has no personal identifying information in the number a. I, II b. III, IV c. I, II, IV d. I, IV - ANSWERSd. I, IV A patient is age 65 and Medicare eligible. The patient signs up for a Medicare Manage Care plan. When the patient presents for care, claims are sent to: a. The Medicare Administrative Contractor b. The patient c. The Managed Care Plan d. Both the Managed Care Plan and Medicare Administrative Contractor - ANSWERSc. The Managed Care Plan Physician-Hospital Organizations (PHO), Management Service Organization (MSO) and Integrated Provider Organization (IPO) are examples of what type of healthcare models? a. Integrated Delivery Systems b. Affiliated Healthcare Systems c. Preferred Provider Organizations d. Alliance for Healthcare Systems - ANSWERSa. Integrated Delivery Systems (Integrated Delivery Systems are a network of providers and facilities that work together to offer joint healthcare services to its members.)