AAPC CPB Chapter 9 Review Exam Questions and Answers

A patient with ABC insurance is seen on May 1st, and the claim is submitted on July 15 of the same year. Has the claim met the timely filing deadline? a. Yes. All payers have the same timely filing deadline of one year from date of service. b. No. All payers have a 30-day timely filing deadline. c. Maybe. ABC's timely filing policy should be reviewed to determine if the deadline was met. d. Maybe. Prepare an appeal letter just in case the claim is denied. - Answer- c. Maybe. ABC's timely filing policy should be reviewed to determine if the deadline was met. Each payer will have a policy stating their timely filing requirements and they may be different from one another. The payer's policy should be researched and applied accordingly. Cost-based fee schedules are developed using which of the following? a. RBRVS methodology b. total costs of every procedure or service listed in the CPT® c. total cost of all the procedures the physician will perform d. malpractice insurance and office operating costs - Answer- c. total cost of all the procedures the physician will perform. Cost based fee schedules are developed by accounting for all the costs involved with providing a procedure or service. These costs include lease or rental payments; utilities; office supplies and equipment; loan fees; maintenance fees; employee labor; malpractice and/or liability insurance; and health insurance and other benefit costs. A family has health insurance coverage from both the father and mother. The father's birthday is May 29, 1989 and the mother's birthday is May 26, 1990. Which insurance would be primary for their three children? a. The father's would be primary because he was born before the mother. b. The mother's would be secondary because she was born after the father. c. The mother would be primary based on the month and day of her birthday. d. The father would be primary based on the month and day of his birthday. - Answer- c. The mother would be primary based on the month and day of her birthday. The mother's insurance would be primary for the children because her birthday is May 26 and the father's is May 29. The birthday rule is based on month and day of birth not the year of birth. What will happen if there is failure to post a contractual adjustment to a patient's account? a. It will have no effect on the patient's account balance. b. It will have no effect on the A/R. c. It will leave a balance on the patient's account that should not be there. d. It will decrease the workload of the billing staff. - Answer- c. It will leave a balance on the patient's account that should not be there. Failure to post contractual adjustments will leave a balance on the patient's account that the patient should not be responsible for paying. When a provider agrees to accept the amount, the payer reimburses as payment in full. The provider must adjust off any remaining balances due from the patient. Given the following information: National conversion factor $33.08RVU value of 3.26What is the provider's fee schedule for 99203 New patient office visit using the above values? a. $108.00 b. $33.00 c. $38.15 d. $76.31 - Answer- a. $108.00 Rationale: The correct fee would be $108.00. Multiply $33.08 (national CF) x 3.26 (RVU value) = $107.84. This calculation is rounded to the nearest whole dollar, which would set the fee for 99203 at $108.00. What are payments due from patients, payers, or other guarantors considered to be? a. Active receivable b. Accounts receivable c. Allowed receivable d. Accounts refundable - Answer- b. Accounts receivable Payments due from patients, payers, or other guarantors are considered to be accounts receivable or A/R. Which of the following tasks is the most basic element of the billing process: a. Claims follow-up b. Status report monitoring c. Data entry d. Patient follow-up - Answer- c. Data entry Data entry is the most basic and fundamental element of the billing process. From capturing and entering patient demographic and insurance information to posting diagnosis and procedure codes, if the data is entered erroneously, untimely and incorrect billing will occur. What is the purpose of EHNAC? a. To monitor coding practices of providers. b. To develop standards for clearinghouses. c. To promote interoperability, quality service and regulatory compliance. d. To accomplish both b and c. - Answer- d. To accomplish both b and c. The purpose and mission of the Electronic Healthcare Network Accreditation Commission (EHNAC) is to promote accreditation in the healthcare industry to achieve quality and trust in healthcare information exchange through adoption and implementation of standards. A batch of claims is submitted to the clearinghouse for processing. The status report shows that twenty claims were acknowledged and forwarded on to the payer for payment and ten claims were rejected. What is the next step the medical biller should take in this situation? a. Contact the clearinghouse to determine why the ten claims were rejected. b. Contact the payer to determine the reason the claims were denied. c. Notify the billing department manager of the rejected claims. d. Review the status report to identify the reasons for rejection, make needed corrections and resubmit for payment. - Answer- d. Review the status report to identify the reasons for rejection, make needed corrections and resubmit for payment. When a claim is rejected at the clearinghouse level, the medical biller must review the reason for the rejection and verify the information in the practice management system, correct if needed and rebill the claim. In the chargemaster, what is the four digit code that reports the location or type of service is known as? a. key indicator. b. revenue code. c. diagnosis pointer. d. department/inventory number. - Answer- b. revenue code. The revenue code located in the CDM or chargemaster is identified by a 4 digit code designating the location or type of procedure a patient receives in the hospital or facility. According to this clearinghouse rejections report, what actions should be taken on the claim for David Adams, Date of Service 11/19/20XX? I. Review the medical records to verify the ICD-10-CM code is correct. II. Review the ICD-10-CM codebook to verify it is a correct diagnosis code. III. Adjust the charge as this is not a covered diagnosis by the insurance carrier. IV. Override the clearinghouse edit as this is a valid code.