AAPC CPB FINAL EXAM 2023-2024 REAL
EXAM 170 QUESTIONS AND ANSWERS
(VERIFIED ANSWERS)|ARGADE
Which is a TRUE statement regarding Workers' Compensation?
A. There is no copayment for the injured worker in workers' compensation cases.
B. The filing deadline for a first report of injury form is one week from the date of
the accident.
C. Providers can balance bill a patient when compensation payment is not paid in
full.
D. There is a deductible for the injured worker in workers' compensation claims. -
ANSWER- A. There is no copayment for the injured worker in workers'
compensation cases.
Bob sees his family physician for seasonal allergies. Before leaving, Bob pays the
charge for the office visit. As a courtesy, the physician's staff submits a claim to
Bob's insurance company. If the service is covered by the insurance company, Bob
can expect to be reimbursed for the office visit. This is which type of insurance
model?
A. Healthcare Anywhere
B. Managed Care Plan
C. Fee-for-service (traditional coverage)
D. Health Maintenance Organization (HMO) - ANSWER- C. Fee-for-service
(traditional coverage)
Which of the following benefits are NOT covered by all Medigap policies?
I. Part A co-insurance and hospital costs
II. Skilled nursing facility care co-insurance
III. Parts A & B deductible
IV. Part B excess charges
V. Foreign travel exchange
,A. I, II, III
B. I, III
C. I, IV, V
D. II, III, IV, V - ANSWER- D. II, III, IV, V
Medicaid eligibility is primarily determined by?
A. Income
B. Prior insurance coverage
C. Marital status
D. Number of living relatives - ANSWER- A. Income
____________ is incorporated by CMS into the NCCI program to limit the number
of times a service or procedure can be reported by a physician on the same date of
service to a patient.
A. Outpatient Code Editor (OCE)
B. Medically Unlikely Edits (MUE)
C. Physician Fee Schedule
D. National Coverage Determination (NCD) - ANSWER- B. Medically Unlikely
Edits (MUE)
In the CPT® codebook, which of the following codes may be used for reporting
synchronous telemedicine services when appended by modifier 95?
A. 93000
B. 99441
C. 99225
D. 99253 - ANSWER- D. 99253
Which service is NOT included in the global package for surgical procedures?
A. Treatment for postoperative complications that require a return trip to the OR.
B. Writing orders
C. Evaluating the patient in the Post-Anesthesia Care Unit
D. Local infiltration, digital block, topical anesthesia - ANSWER- A. Treatment
for postoperative complications that require a return trip to the OR.
,A biller notices there is a large amount of Medigap claims where Medicare has
paid the claim but Medicaid has not processed or paid the claim. After research,
the biller discovers the IDs for the Medigap coverage is not formatted correctly on
the CMS 1500 claim form. Which of the following format is correct for the
Medigap insurer ID in Item 9a?
A. 675974608
B. AETNA675974608
C. MG675974608
D. Item 9a is left blank - ANSWER- C. MG675974608
When item 18 on a CMS-1500 claim form has dates of service for inpatient care,
what is entered in item 32?
A. Physician's name and office address who saw the patient in the hospital.
B. Patient's name and address.
C. Name and address of the facility that provided the service
D. You can leave block Item 32 blank because block Item 33 has the required
information. - ANSWER- C. Name and address of the facility that provided the
service
According to CPT® subsection guidelines for Excision-Malignant Lesions, when
there is a removal of a 3 cm malignant lesion on the arm and the defect area is
repaired with an intermediate layer closure, how is it reported?
A. 11603, 12032-51
B. 11603
C. 12032
D. 11603, 12002-51 - ANSWER- A. 11603, 12032-51
On the UB-04 claim form the type of bill (TOB) is reported with four digits.
Which digit classifies the type of care provided?
A. Digit 1
B. Digit 2
C. Digit 3
D. Digit 4 - ANSWER- C. Digit 3
The CPT® or HCPCS Level II code reported on a UB-04 is translated to what type
of code by Medicare to reimburse for outpatient facility services?
, A. Ambulatory Payment Classification (APC)
B. National Drug Code (NDC)
C. International Classification of Diseases, 10th Revision, Procedural Coding
System (ICD-10-PCS)
D. Both B and C - ANSWER- A. Ambulatory Payment Classification (APC)
Which of the following are common identifiers for protected health information
(PHI) which can be used to identify an individual?
I. Birth Date
II. Past mental health condition
III. Driving records
IV. Mailing Address
V. Medical record number
A. I-V
B. I, II, IV, V
C. III, V
D. I, IV - ANSWER- B. I, II, IV, V
Which of the following service type providers is required to accept assignment on
Medicare claims?
I. Clinical diagnostic laboratory services
II. Specialized radiology services
III. Services provided to Medicare/Medicaid patients
IV. Simplified billing roster for influenza virus vaccine and pneumococcal vaccine
V. Physical therapy services
A. I, III, and IV
B. I, II, and V
C. III, IV, and V
D. I, III, and V - ANSWER- A. I, III, and IV
A Medicare patient comes in for a consultation from the orthopedist. The patient
was referred by her primary care provider due to right hip pain. The orthopedist
documents a detailed history and an expanded problem focused exam. An X-Ray
of the hip is ordered. The medical decision making was moderately complex. The
orthopedist provides a report back to the primary care provider with
EXAM 170 QUESTIONS AND ANSWERS
(VERIFIED ANSWERS)|ARGADE
Which is a TRUE statement regarding Workers' Compensation?
A. There is no copayment for the injured worker in workers' compensation cases.
B. The filing deadline for a first report of injury form is one week from the date of
the accident.
C. Providers can balance bill a patient when compensation payment is not paid in
full.
D. There is a deductible for the injured worker in workers' compensation claims. -
ANSWER- A. There is no copayment for the injured worker in workers'
compensation cases.
Bob sees his family physician for seasonal allergies. Before leaving, Bob pays the
charge for the office visit. As a courtesy, the physician's staff submits a claim to
Bob's insurance company. If the service is covered by the insurance company, Bob
can expect to be reimbursed for the office visit. This is which type of insurance
model?
A. Healthcare Anywhere
B. Managed Care Plan
C. Fee-for-service (traditional coverage)
D. Health Maintenance Organization (HMO) - ANSWER- C. Fee-for-service
(traditional coverage)
Which of the following benefits are NOT covered by all Medigap policies?
I. Part A co-insurance and hospital costs
II. Skilled nursing facility care co-insurance
III. Parts A & B deductible
IV. Part B excess charges
V. Foreign travel exchange
,A. I, II, III
B. I, III
C. I, IV, V
D. II, III, IV, V - ANSWER- D. II, III, IV, V
Medicaid eligibility is primarily determined by?
A. Income
B. Prior insurance coverage
C. Marital status
D. Number of living relatives - ANSWER- A. Income
____________ is incorporated by CMS into the NCCI program to limit the number
of times a service or procedure can be reported by a physician on the same date of
service to a patient.
A. Outpatient Code Editor (OCE)
B. Medically Unlikely Edits (MUE)
C. Physician Fee Schedule
D. National Coverage Determination (NCD) - ANSWER- B. Medically Unlikely
Edits (MUE)
In the CPT® codebook, which of the following codes may be used for reporting
synchronous telemedicine services when appended by modifier 95?
A. 93000
B. 99441
C. 99225
D. 99253 - ANSWER- D. 99253
Which service is NOT included in the global package for surgical procedures?
A. Treatment for postoperative complications that require a return trip to the OR.
B. Writing orders
C. Evaluating the patient in the Post-Anesthesia Care Unit
D. Local infiltration, digital block, topical anesthesia - ANSWER- A. Treatment
for postoperative complications that require a return trip to the OR.
,A biller notices there is a large amount of Medigap claims where Medicare has
paid the claim but Medicaid has not processed or paid the claim. After research,
the biller discovers the IDs for the Medigap coverage is not formatted correctly on
the CMS 1500 claim form. Which of the following format is correct for the
Medigap insurer ID in Item 9a?
A. 675974608
B. AETNA675974608
C. MG675974608
D. Item 9a is left blank - ANSWER- C. MG675974608
When item 18 on a CMS-1500 claim form has dates of service for inpatient care,
what is entered in item 32?
A. Physician's name and office address who saw the patient in the hospital.
B. Patient's name and address.
C. Name and address of the facility that provided the service
D. You can leave block Item 32 blank because block Item 33 has the required
information. - ANSWER- C. Name and address of the facility that provided the
service
According to CPT® subsection guidelines for Excision-Malignant Lesions, when
there is a removal of a 3 cm malignant lesion on the arm and the defect area is
repaired with an intermediate layer closure, how is it reported?
A. 11603, 12032-51
B. 11603
C. 12032
D. 11603, 12002-51 - ANSWER- A. 11603, 12032-51
On the UB-04 claim form the type of bill (TOB) is reported with four digits.
Which digit classifies the type of care provided?
A. Digit 1
B. Digit 2
C. Digit 3
D. Digit 4 - ANSWER- C. Digit 3
The CPT® or HCPCS Level II code reported on a UB-04 is translated to what type
of code by Medicare to reimburse for outpatient facility services?
, A. Ambulatory Payment Classification (APC)
B. National Drug Code (NDC)
C. International Classification of Diseases, 10th Revision, Procedural Coding
System (ICD-10-PCS)
D. Both B and C - ANSWER- A. Ambulatory Payment Classification (APC)
Which of the following are common identifiers for protected health information
(PHI) which can be used to identify an individual?
I. Birth Date
II. Past mental health condition
III. Driving records
IV. Mailing Address
V. Medical record number
A. I-V
B. I, II, IV, V
C. III, V
D. I, IV - ANSWER- B. I, II, IV, V
Which of the following service type providers is required to accept assignment on
Medicare claims?
I. Clinical diagnostic laboratory services
II. Specialized radiology services
III. Services provided to Medicare/Medicaid patients
IV. Simplified billing roster for influenza virus vaccine and pneumococcal vaccine
V. Physical therapy services
A. I, III, and IV
B. I, II, and V
C. III, IV, and V
D. I, III, and V - ANSWER- A. I, III, and IV
A Medicare patient comes in for a consultation from the orthopedist. The patient
was referred by her primary care provider due to right hip pain. The orthopedist
documents a detailed history and an expanded problem focused exam. An X-Ray
of the hip is ordered. The medical decision making was moderately complex. The
orthopedist provides a report back to the primary care provider with
