AAPC CPB Chapter 11-14(100% Correct)
Which coverage under TRICARE is a Medicare wrap around plan?
a. TRICARE for Life
b. TRICARE Reserve Select
c. TRICARE Prime
d. CHAMPVA - ANSWERSa. TRICARE for Life
A patient has Medicare and a Medigap policy. Box 13, signature on file, is checked off
on the electronic claim submission. An EOMB is received with remittance notice MA19.
What does the office need to do?
a. Nothing. This means the claim has been crossed over to the Medigap plan.
b. The biller must file the secondary insurance as the cross-over claim is not going to be
sent due to missing information.
c. The biller must check the claim filed for missing information, add the missing
information, and send back to Medicare for processing.
d. Nothing. The notice means that the patient is responsible for the bill. - ANSWERSb.
The biller must file the secondary insurance as the cross-over claim is not going to be
sent due to missing information.
A Medicare patient receives services from a participating provider on January 6, 2016,
but the charges are missed and don't get entered in to the computer. How long does the
office have to bill Medicare for the services?
a. 3 months
b. 12 months
c. 6 months
d. 1 month - ANSWERSb. 12 months
What is true regarding Medigap policies?
a. They cover everything that Medicare does not.
b. They cover deductibles, copayments, and coinsurances usually.
c. All Medigap policies are the same and offer the same coverage.
d. Medigap policies must cover patients if they injured outside the United States. -
ANSWERSb. They cover deductibles, copayments, and coinsurances usually.
A 21 year-old patient presents for fillings for two if his teeth. Are these services covered
under EPSDT?
a. No, because these types of services are not covered.
b. Yes, if the patient lives in a state that covers dental services.
,c. No, because the patient is not under the age of 21.
d. Yes, all services are covered under Medicaid. - ANSWERSc. No, because the patient
is not under the age of 21.
A Medicare patient has prescription drug coverage, but does not have Medicare
Advantage. What Medicare coverage does the patient have for his medications?
a. Part A
b. Part B
c. Part C
d. Part D - ANSWERSd. Part D
A Medicare patient presents for her pelvic, pap, and breast examination (PPB). The
patient is not sure when she had her last PPB. As she is checking out, the front desk
rep has her sign an ABN. The service is billed and denied for frequency. Can the patient
be balance billed? Why?
a. Yes. It does not matter when you get an ABN signed.
b. No. The ABN must be signed before the service is performed.
c. Yes, as long as the patient has met her deductible.
d. No. An ABN is not required, but the patient is required to pay at time of service or the
bill has to be written off. - ANSWERSb. No. The ABN must be signed before the service
is performed.
A Medicare patient presents with an injury sustained at his part-time job. His injury
status is verified by his company. After services are rendered, in what order are the
claims submitted?
a. The worker's compensation is primary, and Medicare is secondary
b. Either may be filed first, whichever pays better
c. Medicare is primary, and Worker's compensation is secondary
d. The patient must pay for services and files claims himself - ANSWERSa. The
worker's compensation is primary, and Medicare is secondary
A Medicare patient is seen by her physician. The physician has opted out of the
Medicare program. The patient and physician have a private contract. The charges for
the services rendered are $300.00. Medicare's approved amount would be $200.00.
What can the office charge this patient?
a. $160.00 (80 percent of the approved amount)
b. $218.50 (115 percent of the approved amount for non-Par providers)
c. $300.00
d. $250.00 - ANSWERSc. $300.00
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 -
ANSWERSb. 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. -
ANSWERSb. 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 - ANSWERSc. 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 - ANSWERSd. 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 - ANSWERSd. Medigap insurance company
The term for a supplemental policy for Medicare is:
a. Medifill
b. Medicare Plus
c. Medigap
d. Medicare Secondary - ANSWERSc. Medigap
Which coverage under TRICARE is a Medicare wrap around plan?
a. TRICARE for Life
b. TRICARE Reserve Select
c. TRICARE Prime
d. CHAMPVA - ANSWERSa. TRICARE for Life
A patient has Medicare and a Medigap policy. Box 13, signature on file, is checked off
on the electronic claim submission. An EOMB is received with remittance notice MA19.
What does the office need to do?
a. Nothing. This means the claim has been crossed over to the Medigap plan.
b. The biller must file the secondary insurance as the cross-over claim is not going to be
sent due to missing information.
c. The biller must check the claim filed for missing information, add the missing
information, and send back to Medicare for processing.
d. Nothing. The notice means that the patient is responsible for the bill. - ANSWERSb.
The biller must file the secondary insurance as the cross-over claim is not going to be
sent due to missing information.
A Medicare patient receives services from a participating provider on January 6, 2016,
but the charges are missed and don't get entered in to the computer. How long does the
office have to bill Medicare for the services?
a. 3 months
b. 12 months
c. 6 months
d. 1 month - ANSWERSb. 12 months
What is true regarding Medigap policies?
a. They cover everything that Medicare does not.
b. They cover deductibles, copayments, and coinsurances usually.
c. All Medigap policies are the same and offer the same coverage.
d. Medigap policies must cover patients if they injured outside the United States. -
ANSWERSb. They cover deductibles, copayments, and coinsurances usually.
A 21 year-old patient presents for fillings for two if his teeth. Are these services covered
under EPSDT?
a. No, because these types of services are not covered.
b. Yes, if the patient lives in a state that covers dental services.
,c. No, because the patient is not under the age of 21.
d. Yes, all services are covered under Medicaid. - ANSWERSc. No, because the patient
is not under the age of 21.
A Medicare patient has prescription drug coverage, but does not have Medicare
Advantage. What Medicare coverage does the patient have for his medications?
a. Part A
b. Part B
c. Part C
d. Part D - ANSWERSd. Part D
A Medicare patient presents for her pelvic, pap, and breast examination (PPB). The
patient is not sure when she had her last PPB. As she is checking out, the front desk
rep has her sign an ABN. The service is billed and denied for frequency. Can the patient
be balance billed? Why?
a. Yes. It does not matter when you get an ABN signed.
b. No. The ABN must be signed before the service is performed.
c. Yes, as long as the patient has met her deductible.
d. No. An ABN is not required, but the patient is required to pay at time of service or the
bill has to be written off. - ANSWERSb. No. The ABN must be signed before the service
is performed.
A Medicare patient presents with an injury sustained at his part-time job. His injury
status is verified by his company. After services are rendered, in what order are the
claims submitted?
a. The worker's compensation is primary, and Medicare is secondary
b. Either may be filed first, whichever pays better
c. Medicare is primary, and Worker's compensation is secondary
d. The patient must pay for services and files claims himself - ANSWERSa. The
worker's compensation is primary, and Medicare is secondary
A Medicare patient is seen by her physician. The physician has opted out of the
Medicare program. The patient and physician have a private contract. The charges for
the services rendered are $300.00. Medicare's approved amount would be $200.00.
What can the office charge this patient?
a. $160.00 (80 percent of the approved amount)
b. $218.50 (115 percent of the approved amount for non-Par providers)
c. $300.00
d. $250.00 - ANSWERSc. $300.00
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 -
ANSWERSb. 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. -
ANSWERSb. 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 - ANSWERSc. 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 - ANSWERSd. 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 - ANSWERSd. Medigap insurance company
The term for a supplemental policy for Medicare is:
a. Medifill
b. Medicare Plus
c. Medigap
d. Medicare Secondary - ANSWERSc. Medigap
