Aapc Certified Professional Coder Exam Guaranteed Pass

AAPC Certified Professional Coder Exam Study Guide | Verified Answers A+ Rated What is medical billing? - answer - The process of translating healthcare services into billing claims and submitting them to payers for reimbursement. What does CMS-1500 form represent? - answer - The standard paper claim form used to bill Medicare, Medicaid, and some private insurers. A claim is rejected due to missing patient DOB. What type of error is this? - answer - A clerical or data entry error (preventable front-end denial). CPT codes describe diagnoses. - answer - False - CPT codes describe procedures/services; ICD-10-CM describes diagnoses. ICD-10-CM is used to report ________. - answer - Diagnoses What is medical necessity? - answer - A requirement that services must be reasonable and needed for diagnosis or treatment. A provider bills a service not supported by documentation. What happens? - answer - Claim denial due to lack of medical necessity. What is a claim scrubber? - answer - Software that checks claims for errors before submission. Clean claims require no corrections before processing. - answer - TRUE The payer's explanation of payment is called ________. - answer - EOB (Explanation of Benefits) A patient has Medicare primary and Medicaid secondary. What applies? - answer - Coordination of Benefits (COB) rules. What is COB? - answer - Process determining which insurance pays first. What is an ABN? - answer - Advance Beneficiary Notice informing patient of possible non-covered services. ABN guarantees Medicare payment. - answer - False - It only shifts financial responsibility to patient if denied. CPT stands for ________. - answer - Current Procedural Terminology A claim is denied due to "timely filing." What caused it? - answer - Claim submitted after payer deadline. What is timely filing limit? - answer - Maximum time allowed to submit a claim after service. What is a modifier? - answer - Two-character code that alters meaning of CPT/HCPCS code. Modifiers change the procedure description completely. - answer - False - they only modify information, not replace code meaning. Modifier 25 indicates ________. - answer - Significant, separately identifiable E/M service A bundled service is billed separately and denied. Why? - answer - NCCI edits prevent unbundling. What are NCCI edits? - answer - National Correct Coding Initiative rules preventing improper coding combinations. What is a deductible? - answer - Amount patient must pay before insurance begins payment. Coinsurance is a fixed dollar amount. - answer - False - it is a percentage of cost. Copayment is a ________ amount. - answer - Fixed A claim is rejected due to invalid ICD-10 code. Cause? - answer - Coding error or outdated code. What is a remittance advice? - answer - Document explaining payment or denial of claims. What does CARC stand for? - answer - Claim Adjustment Reason Code RARC codes explain financial denial reasons. - answer - False - RARC provides supplemental explanation, not financial adjustment reason. HCPCS Level II codes include ________. - answer - Medical supplies and services not in CPT Patient seen in ER but coded as office visit. Error type? - answer - Incorrect place of service coding. Place of Service (POS) indicates what? - answer - Location where healthcare service is provided. What is unbundling? - answer - Billing components separately that should be billed together. Unbundling is always allowed if codes exist separately. - answer - False - must follow coding guidelines and NCCI edits. DRG is primarily used for ________. - answer - Inpatient hospital billing Insurance denies claim as "not medically necessary." Next step? - answer - Appeal with supporting documentation. What is a claim appeal? - answer - Request for reconsideration of denied claim. What is prior authorization? - answer - Approval required before service delivery. Lack of prior authorization always guarantees denial. - answer - True in most p