1
AAPC CPB FINAL EXAM REAL EXAM 170
QUESTIONS AND ANSWERS (VERIFIED
ANSWERS)|ARGADE
1.
A patient visits a physician's office for evaluation of persistent
abdominal pain. During the encounter, the provider documents the
patient's history, performs a physical examination, reviews previous
laboratory results, and develops a treatment plan. Which component of
the encounter primarily describes the physician's assessment of the
patient's condition and the plan for managing that condition?
A. Chief complaint
B. History of present illness
C. Assessment and plan
D. Review of systems
Answer: C
2.
A medical office receives an insurance claim that contains the patient's
demographic information, provider information, diagnosis codes,
procedure codes, and charges associated with the services performed.
The billing specialist reviews the claim before transmission to the payer.
Which document is most commonly used to submit professional medical
services electronically to an insurance company?
A. CMS-1500
B. UB-04
C. ABN
D. EOB
,2
Answer: A
3.
A patient receives medical services from a physician who is contracted
with the patient's insurance plan. The physician has agreed to accept the
payer's negotiated reimbursement rates for covered services. What is the
provider's status most accurately described as?
A. Nonparticipating provider
B. Participating provider
C. Out-of-network provider
D. Self-pay provider
Answer: B
4.
A patient has health insurance with an annual deductible of $1,500. At
the beginning of the year, the patient receives a covered service costing
$800. Assuming the deductible has not yet been met and no other
costsharing applies, what amount is generally the patient's
responsibility?
A. $0
B. $400
C. $800
D. $1,500 Answer: C
5.
A patient's insurance policy requires a fixed payment of $30 each time
the patient visits a primary care physician. The amount does not change
based on the total allowed charge for the visit. What type of patient
costsharing is this?
,3
A. Deductible
B. Coinsurance
C. Copayment
D. Premium
Answer: C
6.
A health insurance policy states that after the deductible is satisfied, the
insurance company pays 80% of the allowed amount and the patient is
responsible for the remaining 20%. Which term describes the patient's
20% responsibility?
A. Copayment
B. Coinsurance
C. Premium
D. Deductible
Answer: B
7.
A medical biller receives an Explanation of Benefits showing the
amount billed by the provider, the allowed amount, the amount paid by
insurance, and the remaining patient responsibility. What is the primary
purpose of an Explanation of Benefits?
A. To serve as a medical record
B. To explain how an insurance claim was processed
C. To replace the patient's insurance card
D. To authorize a surgical procedure
Answer: B
, 4
8.
A patient is covered by two health insurance plans. The billing
department must determine which plan should receive the claim first
before submitting the remaining balance to the secondary plan. Which
concept determines the order in which the plans pay?
A. Medical necessity
B. Coordination of benefits
C. Prior authorization
D. Utilization review
Answer: B
9.
A physician performs a procedure that requires the patient's insurance
company to approve coverage before the procedure is performed. The
office contacts the payer and obtains approval before scheduling the
service. What is this process called?
A. Referral
B. Prior authorization
C. Claim adjustment
D. Adjudication
Answer: B
10.
A patient receives treatment that the insurance company determines was
not reasonably necessary for diagnosing or treating the patient's
condition. The claim is denied because the payer considers the service
unnecessary under its coverage criteria. Which concept is involved?
AAPC CPB FINAL EXAM REAL EXAM 170
QUESTIONS AND ANSWERS (VERIFIED
ANSWERS)|ARGADE
1.
A patient visits a physician's office for evaluation of persistent
abdominal pain. During the encounter, the provider documents the
patient's history, performs a physical examination, reviews previous
laboratory results, and develops a treatment plan. Which component of
the encounter primarily describes the physician's assessment of the
patient's condition and the plan for managing that condition?
A. Chief complaint
B. History of present illness
C. Assessment and plan
D. Review of systems
Answer: C
2.
A medical office receives an insurance claim that contains the patient's
demographic information, provider information, diagnosis codes,
procedure codes, and charges associated with the services performed.
The billing specialist reviews the claim before transmission to the payer.
Which document is most commonly used to submit professional medical
services electronically to an insurance company?
A. CMS-1500
B. UB-04
C. ABN
D. EOB
,2
Answer: A
3.
A patient receives medical services from a physician who is contracted
with the patient's insurance plan. The physician has agreed to accept the
payer's negotiated reimbursement rates for covered services. What is the
provider's status most accurately described as?
A. Nonparticipating provider
B. Participating provider
C. Out-of-network provider
D. Self-pay provider
Answer: B
4.
A patient has health insurance with an annual deductible of $1,500. At
the beginning of the year, the patient receives a covered service costing
$800. Assuming the deductible has not yet been met and no other
costsharing applies, what amount is generally the patient's
responsibility?
A. $0
B. $400
C. $800
D. $1,500 Answer: C
5.
A patient's insurance policy requires a fixed payment of $30 each time
the patient visits a primary care physician. The amount does not change
based on the total allowed charge for the visit. What type of patient
costsharing is this?
,3
A. Deductible
B. Coinsurance
C. Copayment
D. Premium
Answer: C
6.
A health insurance policy states that after the deductible is satisfied, the
insurance company pays 80% of the allowed amount and the patient is
responsible for the remaining 20%. Which term describes the patient's
20% responsibility?
A. Copayment
B. Coinsurance
C. Premium
D. Deductible
Answer: B
7.
A medical biller receives an Explanation of Benefits showing the
amount billed by the provider, the allowed amount, the amount paid by
insurance, and the remaining patient responsibility. What is the primary
purpose of an Explanation of Benefits?
A. To serve as a medical record
B. To explain how an insurance claim was processed
C. To replace the patient's insurance card
D. To authorize a surgical procedure
Answer: B
, 4
8.
A patient is covered by two health insurance plans. The billing
department must determine which plan should receive the claim first
before submitting the remaining balance to the secondary plan. Which
concept determines the order in which the plans pay?
A. Medical necessity
B. Coordination of benefits
C. Prior authorization
D. Utilization review
Answer: B
9.
A physician performs a procedure that requires the patient's insurance
company to approve coverage before the procedure is performed. The
office contacts the payer and obtains approval before scheduling the
service. What is this process called?
A. Referral
B. Prior authorization
C. Claim adjustment
D. Adjudication
Answer: B
10.
A patient receives treatment that the insurance company determines was
not reasonably necessary for diagnosing or treating the patient's
condition. The claim is denied because the payer considers the service
unnecessary under its coverage criteria. Which concept is involved?
