AAPC CPB STANDARD EXAMS ALL ANSWERS AND
QUESTIONS SET A+
✔✔A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate?
A. Code pairs cannot be reported together.
B. Codes can be reported together if documented. Append modifier 59.
C. The code can only be reported for one unit of service on a single date of service.
D. Medically unlikely the code pair is performed together. - ✔✔C. The code can only be
reported for one unit of service on a single date of service.
✔✔Electronic Healthcare Transactions and code sets are required to be used by health
plans, healthcare clearinghouses and healthcare providers that participate in electronic
data interchanges. Which of the following are requirements for the code sets?
I. Dental services are reported with CDT codes
II. Inpatient procedures are reported with HCPCS Level II codes
III. Diagnosis codes are reported with ICD-10-CM and ICD-10-PCS codes
IV. Outpatient services are reported with CPT® and HCPCS Level II codes
V. Physician services are reported with ICD-10-PCS codes
A. I and IV
B. II, III, and V
C. II, III, and IV
D. II and IV - ✔✔A. I and IV
✔✔Which of the following indicates the frequency of care on a UB-04 claim form?
A. Revenue code
B. Type of Bill
C. MSDRG
D. Condition code - ✔✔B. Type of Bill
,✔✔Pam works for a medical practice. She discovered a claim was overpaid by
Medicare. What Act requires the money to be refunded?
A. Health Insurance Portability and Accountability Act
B. The Stark Act
C. False Claims Act
D. Consumer Credit Protection Act - ✔✔C. False Claims Act
✔✔Security involves the safekeeping of patient information by:
I. Setting office policies to protect PHI from alteration, destruction, tampering, or loss
II. Allowing full access to all employees to the electronic medical records
III. Giving employees a policy on confidentiality to read
IV. Requiring employees to sign a confidentiality statement that details the
consequences of not maintaining patient confidentiality, including termination
A. I and IV
B. I, II, and IV
C. II, III, and IV
D. II and III - ✔✔A. I and IV
✔✔Dr. Taylor's office has a new medical assistant (MA) who is responsible for blood
collection for lab specimens. Because the MA is new, she often misses when obtaining
blood on the first stick. To be sure the office is billing for all services, the office now has
a rule that all patients will be billed a minimum of two blood draws to demonstrate the
work that is being done for lab collection. Which statement is true regarding this rule?
A. The rule covers the office and allows them to get paid for all services performed.
B. The rule is fraudulent because the office is billing for services not performed and
services that are a result of provider error.
C. The rule would be legal if changed to only bill for two blood draws on the patients the
MA misses on the first stick.
D. The rule is only legal if the clinic is in a hospital-based office. - ✔✔B. The rule is
fraudulent because the office is billing for services not performed and services that are a
result of provider error.
✔✔An example of an overpayment that must be refunded is _____________?
A. Payment based on a reasonable charge.
B. An unprocessed voided claim.
C. Incorrect posting of an EOB.
D. Duplicate processing of a claim - ✔✔D. Duplicate processing of a claim
✔✔Which of the following is true regarding provider credentialing?
,A. A provider can complete an application with CAQH which handles credentialing for
many payers.
B. A provider is required to complete the credentialing process with private payers
before an NPI application can be submitted.
C. A provider can complete an application with NCQA to credential with private payers
and obtain an NPI.
D. Approval of the NPI number is all the provider needs to be credentialed with all
payers. - ✔✔A. A provider can complete an application with CAQH which handles
credentialing for many payers.
✔✔Which Act protects information collected by consumer reporting agencies?
A. Equal Credit Opportunity Act
B. Fair Credit Reporting Act
C. Fair Debt Collection Practices Act
D. Truth in Lending Act - ✔✔B. Fair Credit Reporting Act
✔✔There is a written office policy to write off patients co-insurance and copayment
amounts as a professional courtesy. Is this appropriate?
A. Yes, if it is a policy in writing it must be followed.
B. Yes, if it is a written policy and everyone in the office adheres to it.
C. No, it is considered fraud to write off the patients' responsibility for all patients.
D. No, it is a violation of Stark law to write off patients' responsibility. - ✔✔C. No, it is
considered fraud to write off the patients' responsibility for all patients.
✔✔Which statement is TRUE regarding the Fair Debt Collection Practices Act
(FDCPA)?
A. Collectors are allowed to threaten legal action even if it will not be pursued.
B. The FDPCA does not apply to medical practices.
C. Collectors are allowed to contact debtors repeatedly.
D. Collectors are not allowed to contact debtors at odd hours. - ✔✔D. Collectors are not
allowed to contact debtors at odd hours.
✔✔Which of the following is an allowed collection policy after a patient files for
bankruptcy?
A. Unpaid insurance claims for dates of service occurring after the date of the
bankruptcy can be collected.
B. Any co-payments or deductibles that are past due and owed by the patient can be
collected.
C. Unpaid claims for dates of service occurring before the date of the bankruptcy and
any co-pays or deductibles adjudicated on that same claim.
, D. Discuss a payment arrangement with the patient to settle the past due account. -
✔✔A. Unpaid insurance claims for dates of service occurring after the date of the
bankruptcy can be collected.
✔✔A patient with an acute myocardial infarction is brought by ambulance to the
emergency department. The patient is taken into the cardiac catheterization lab.
Angioplasty and a stent was placed in the LAD. The patient's insurance requires
preauthorization for all surgical procedures. Which of the following statements is true for
most payers?
A. If the biller did not obtain authorization prior to the procedure being performed, the
surgical services will not be paid.
B. Because this was an emergency, it is acceptable to obtain authorization following the
surgery.
C. Because this was an emergency, a preauthorization is not required.
D. If the biller did not obtain authorization prior to the procedure being performed, the
entire claim will not be paid. - ✔✔B. Because this was an emergency, it is acceptable to
obtain authorization following the surgery.
✔✔Which of the following steps should be completed when filling an appeal?
I. Submit in the format required by the payer.
II. Review the reason for the denial and determine if the payer made an error.
III. Provide supporting documentation from an official source to support your reason for
appeal.
IV. Keep a copy of the information submitted to the payer for the appeal.
V. Appeal the claim as soon as a denial is received.
VI. Appeal the claim as soon as you are certain the payer denied in error and the claim
cannot be reprocessed.
A. I, II, and V
B. I, IV, V and VI
C. I, II, III, IV, and VI
D. I-VI - ✔✔C. I, II, III, IV, and VI
✔✔What should a biller do when a claim is denied for not being submitted within the
timely filing period?
A. Track the transmission date of the claim. If within the timely filing period, provide the
information to the payer to reprocess the claim.
B. Write off the claim. The patient is not responsible for claims denied for not being
submitted within the timely filing period.
C. Resubmit the claim with a different date of service that is within the timely filing
period.
QUESTIONS SET A+
✔✔A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate?
A. Code pairs cannot be reported together.
B. Codes can be reported together if documented. Append modifier 59.
C. The code can only be reported for one unit of service on a single date of service.
D. Medically unlikely the code pair is performed together. - ✔✔C. The code can only be
reported for one unit of service on a single date of service.
✔✔Electronic Healthcare Transactions and code sets are required to be used by health
plans, healthcare clearinghouses and healthcare providers that participate in electronic
data interchanges. Which of the following are requirements for the code sets?
I. Dental services are reported with CDT codes
II. Inpatient procedures are reported with HCPCS Level II codes
III. Diagnosis codes are reported with ICD-10-CM and ICD-10-PCS codes
IV. Outpatient services are reported with CPT® and HCPCS Level II codes
V. Physician services are reported with ICD-10-PCS codes
A. I and IV
B. II, III, and V
C. II, III, and IV
D. II and IV - ✔✔A. I and IV
✔✔Which of the following indicates the frequency of care on a UB-04 claim form?
A. Revenue code
B. Type of Bill
C. MSDRG
D. Condition code - ✔✔B. Type of Bill
,✔✔Pam works for a medical practice. She discovered a claim was overpaid by
Medicare. What Act requires the money to be refunded?
A. Health Insurance Portability and Accountability Act
B. The Stark Act
C. False Claims Act
D. Consumer Credit Protection Act - ✔✔C. False Claims Act
✔✔Security involves the safekeeping of patient information by:
I. Setting office policies to protect PHI from alteration, destruction, tampering, or loss
II. Allowing full access to all employees to the electronic medical records
III. Giving employees a policy on confidentiality to read
IV. Requiring employees to sign a confidentiality statement that details the
consequences of not maintaining patient confidentiality, including termination
A. I and IV
B. I, II, and IV
C. II, III, and IV
D. II and III - ✔✔A. I and IV
✔✔Dr. Taylor's office has a new medical assistant (MA) who is responsible for blood
collection for lab specimens. Because the MA is new, she often misses when obtaining
blood on the first stick. To be sure the office is billing for all services, the office now has
a rule that all patients will be billed a minimum of two blood draws to demonstrate the
work that is being done for lab collection. Which statement is true regarding this rule?
A. The rule covers the office and allows them to get paid for all services performed.
B. The rule is fraudulent because the office is billing for services not performed and
services that are a result of provider error.
C. The rule would be legal if changed to only bill for two blood draws on the patients the
MA misses on the first stick.
D. The rule is only legal if the clinic is in a hospital-based office. - ✔✔B. The rule is
fraudulent because the office is billing for services not performed and services that are a
result of provider error.
✔✔An example of an overpayment that must be refunded is _____________?
A. Payment based on a reasonable charge.
B. An unprocessed voided claim.
C. Incorrect posting of an EOB.
D. Duplicate processing of a claim - ✔✔D. Duplicate processing of a claim
✔✔Which of the following is true regarding provider credentialing?
,A. A provider can complete an application with CAQH which handles credentialing for
many payers.
B. A provider is required to complete the credentialing process with private payers
before an NPI application can be submitted.
C. A provider can complete an application with NCQA to credential with private payers
and obtain an NPI.
D. Approval of the NPI number is all the provider needs to be credentialed with all
payers. - ✔✔A. A provider can complete an application with CAQH which handles
credentialing for many payers.
✔✔Which Act protects information collected by consumer reporting agencies?
A. Equal Credit Opportunity Act
B. Fair Credit Reporting Act
C. Fair Debt Collection Practices Act
D. Truth in Lending Act - ✔✔B. Fair Credit Reporting Act
✔✔There is a written office policy to write off patients co-insurance and copayment
amounts as a professional courtesy. Is this appropriate?
A. Yes, if it is a policy in writing it must be followed.
B. Yes, if it is a written policy and everyone in the office adheres to it.
C. No, it is considered fraud to write off the patients' responsibility for all patients.
D. No, it is a violation of Stark law to write off patients' responsibility. - ✔✔C. No, it is
considered fraud to write off the patients' responsibility for all patients.
✔✔Which statement is TRUE regarding the Fair Debt Collection Practices Act
(FDCPA)?
A. Collectors are allowed to threaten legal action even if it will not be pursued.
B. The FDPCA does not apply to medical practices.
C. Collectors are allowed to contact debtors repeatedly.
D. Collectors are not allowed to contact debtors at odd hours. - ✔✔D. Collectors are not
allowed to contact debtors at odd hours.
✔✔Which of the following is an allowed collection policy after a patient files for
bankruptcy?
A. Unpaid insurance claims for dates of service occurring after the date of the
bankruptcy can be collected.
B. Any co-payments or deductibles that are past due and owed by the patient can be
collected.
C. Unpaid claims for dates of service occurring before the date of the bankruptcy and
any co-pays or deductibles adjudicated on that same claim.
, D. Discuss a payment arrangement with the patient to settle the past due account. -
✔✔A. Unpaid insurance claims for dates of service occurring after the date of the
bankruptcy can be collected.
✔✔A patient with an acute myocardial infarction is brought by ambulance to the
emergency department. The patient is taken into the cardiac catheterization lab.
Angioplasty and a stent was placed in the LAD. The patient's insurance requires
preauthorization for all surgical procedures. Which of the following statements is true for
most payers?
A. If the biller did not obtain authorization prior to the procedure being performed, the
surgical services will not be paid.
B. Because this was an emergency, it is acceptable to obtain authorization following the
surgery.
C. Because this was an emergency, a preauthorization is not required.
D. If the biller did not obtain authorization prior to the procedure being performed, the
entire claim will not be paid. - ✔✔B. Because this was an emergency, it is acceptable to
obtain authorization following the surgery.
✔✔Which of the following steps should be completed when filling an appeal?
I. Submit in the format required by the payer.
II. Review the reason for the denial and determine if the payer made an error.
III. Provide supporting documentation from an official source to support your reason for
appeal.
IV. Keep a copy of the information submitted to the payer for the appeal.
V. Appeal the claim as soon as a denial is received.
VI. Appeal the claim as soon as you are certain the payer denied in error and the claim
cannot be reprocessed.
A. I, II, and V
B. I, IV, V and VI
C. I, II, III, IV, and VI
D. I-VI - ✔✔C. I, II, III, IV, and VI
✔✔What should a biller do when a claim is denied for not being submitted within the
timely filing period?
A. Track the transmission date of the claim. If within the timely filing period, provide the
information to the payer to reprocess the claim.
B. Write off the claim. The patient is not responsible for claims denied for not being
submitted within the timely filing period.
C. Resubmit the claim with a different date of service that is within the timely filing
period.
