- Study guides, Class notes & Summaries

AAPC CPB - Chapter 11 Review Practice Test 2024. Medicare's payment amount for services are determined by which of the following formulas? a. Sustainable growth rate (SGR) X Geographic Practice Cost Index (GPCI) = Medicare payment b. Total RVU X Conversion factor = Medicare payment c. Total Practice Expense (PE) X Conversion factor = Medicare payment d. Total Malpractice insurance (MP) X Conversion factor (CF) = Medicare payment - correct answer b. Total RVU X Conversion factor = Medic...

-

7 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB - Chapter 12 Quiz with Complete Answers 2024. Which type of insurance plan is a federal and state program that provides coverage to the low-income population? a. Medicare b. HMO c. Medicaid d. PPO - correct answer c. Medicaid What is the correct action when a claim has been submitted to BCBS but the provider has not received a response? a. Automatically refile the claim. b. Check claim status with the local BCBS carrier. c. Write-off the balance. d. Transfer the charges ...

-

3 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB - Chapter 12 Review Study Guide 2024.The term for the set payment that the member pays to the healthcare provider on the day of service is the: a. office visit fee. b. co-insurance. c. copay. d. co-signer. - correct answer c. copay. Blue Cross/Blue Shield identifies the individual or employee who pays for healthcare insurance coverage as the: a. Member b. Group c. Subscriber d. Payer - correct answer c. Subscriber What information can be found on the Blue Cross/Blue Sh...

-

7 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB - Chapter 13 Quiz Correctly Answered 2024.Which of the following denials is one of the leading reasons a claim is denied and can be prevented by accurate intake information being collected every time? a. Medical necessity b. Coordination of Benefits c. Request for medical records not received d. Incorrect patient information - correct answer d. Incorrect patient information Which modifier is used to indicate that an E&M service is unrelated to the global service? a. 24 b. 2...

-

3 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB - Chapter 13 Review Test Questions 2024.On 05/02/19, a claim for a fine needle aspiration biopsy with ultrasound guidance was reported with CPT code 10022, ICD-10-CM code D49.2 for DOS 05/01/2019. Why would the claim be denied? a. Not medically necessary b. Invalid CPT code for DOS c. Invalid ICD-10-CM code for DOS d. Timely filing - correct answer b. Invalid CPT code for DOS Response Feedback: Rationale: CPT™ code 10022 was deleted in 2019. CPT® codes should only be repo...

5.0

(1)

13 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB - Chapter 14 Advanced Questions 2024. What type of state worker's compensation coverage allows an employer to set aside money to cover medical expenses and other related benefits for its employees? a. State insurance fund b. Self-insurance plans c. Commercial workers' compensation insurance d. Combination program - correct answer b. Self-insurance plans Under Workers' Compensation, when is a worker covered for an injury that occurred on-the-job? a. Only if the empl...

-

3 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB - Chapter 14 Review Study Guide Questions 2024.__________ sets standards and directives to protect workers against transmission of infectious agents. a. HIPAA b. JCAHO c. NCHS d. OSHA - correct answer d. OSHA For OSHA, which employees are included as healthcare workers? I. medical staff II. maintenance staff III . housekeeping IV. food service staff V. administrative staff a. I only b. I and V c. I, III, and V d. I-V - correct answer d. I-V Which entity governs wo...

-

8 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB Chapter 1 Review Practice Test 2024.FCA - correct answer False Claims Act (FCA): {"knowing" and "knowingly"}-Federal statue setting civil and criminal penalties to protect the government from being overcharged or sold substandard goods or services: -falsely billing the government -over-representing the amount of a delivered product ....or.... -under-stating an obligation to the government Minimum Necessary Standard. What should be sent if records are being requested?...

-

13 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB Chapter 1-5 Complete Questions With Answers 2024. Eight standard transactions were adopted for Electronic Data Interchange (EDI) under HIPAA. Which of the following is NOT included as a standard transaction? a. Payment and remittance advice b. Eligibility in a health plan c. Coordination of benefits d. Physician unique identifier number - correct answer d. Physician unique identifier number A physician received office space at a reduced rate for referring patients to the hosp...

-

91 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB Chapter 4 Review Questions 2024.How many chapters does ICD-10-CM contain? a. 17 b. 19 c. 22 d. 20 - correct answer c. 22 What is/are the correct code(s) for a patient with type 1 diabetic neuropathy? a. E11.40 b. E90.40 c. E10.9, G62.9 d. E10.40 - correct answer d. E10.40 What are the correct codes for benign hypertensive heart disease and stage 3a chronic kidney disease? a. I10, I11.9, I12.9, N18.31 b. I13.10, N18.31 c. N18.31, I13.10 d. I13.0, N18.31 - correct ...

-

19 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB Chapter 4 Study Questions 2024.Acute - correct answer A condition with a rapid and short course. Anatomical - correct answer Body site. And - correct answer Can mean either "and" or "or" when it is in the code description. Brackets [ ] - correct answer Symbol to enclose synonyms, alternate wording, or explanatory phrases. Chronic - correct answer A condition that develops slowly and lasts a long time. Combination Code - correct answer Single code used to class...

-

3 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB Chapter 6 Review Exam Questions 2024. Patient is given 15 mg of methotrexate sodium IM for rheumatoid arthritis given from 5 mg vials. What HCPCS Level II code and unit(s) is reported? a. J8610 x 6 b. J9260 c. J9250 x 5 d. J9250 x 3 - correct answer d. J9250 x 3 Look in the HCPCS Level II Table of Drugs for Methotrexate Sodium, one of the routes is IM (intramuscular) directing you to code J9250. This drug is reported for 5mg. The patient received 15 mg of methotrexate. The cor...

-

18 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB Chapter 7 Review Study Exam Test 2024. Who were the NCCI edits originally developed to be used by? a. Commercial Carriers b. Medicare Administrative Contractors c. Self-pay patients d. Medicare beneficiaries - correct answer b. Medicare Administrative Contractors The NCCI edits have column 1 and Column 2 codes and provide an indicator to determine whether a modifier is allowed to be used. Which indicator is used to tell the biller a modifier is never allowed? a. 0 b. 1 c....

-

19 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB Chapter 9 Review Practice Questions 2024.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 c...

-

24 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB Chapter 10 Review Study Questions 2024. What is the first step in working a denied claim? a. Resubmit the claim b. Contact the carrier c. Appeal the claim d. Determine and understand why the claim was denied - correct answer d. Determine and understand why the claim was denied The first step in working a denied claim is to understand why the claim has denied. Insurance carriers will use different denial codes on the remittance advice. Which of the following is a statement s...

-

26 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB Chapter 11 Practical Question Guide 2024.Use CPB Chapter 11_Case to answer questions 1 & 2. After review of the information provided, are there any errors on the claim form? If so, which elements are incorrect? I. The provider must accept assignment II. Provider name conflict III. Medicare ID number is missing information IV. Medicaid ID number is missing information V. Medicare ID number in the wrong field VI. Medicaid ID number in the wrong field VII. Ordering provider na...

-

7 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB Chapter 11 Review Practice Questions 2024. A Medicare patient presents with an injury sustained at his part-time job. His injury status is verified by his company. After services are rendered, in what order are the claims submitted? a. The worker's compensation is primary, and Medicare is secondary b. Either may be filed first, whichever pays better c. Medicare is primary, and Worker's compensation is secondary d. The patient must pay for services and files claims him...

-

20 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB Chapter 11-14 Exam Correctly Answered 2024. Which coverage under TRICARE is a Medicare wrap around plan? a. TRICARE for Life b. TRICARE Reserve Select c. TRICARE Prime d. CHAMPVA - correct answer a. TRICARE for Life A patient has Medicare and a Medigap policy. Box 13, signature on file, is checked off on the electronic claim submission. An EOMB is received with remittance notice MA19. What does the office need to do? a. Nothing. This means the claim has been crossed over t...

-

43 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB Chapter 12 Practical Application Questions 2024. Use CPB Chapter 12_Case to answer questions 1 and 2. After review of the information provided, are there any errors on the claim form? If so, which elements are incorrect? I. Type of Insurance II. Primary insurance policy number III. Primary group number IV. Federal Tax ID number V. Billing provider and NPI A. I and II B. II and IV C. III and V D. There are no errors on this claim. - correct answer A. I and II Respons...

-

11 pages

Written in 2023/2024

Grade A+

ROSEGRADES

AAPC CPB Chapter 13 Review Questions 2024. Which denial occurs when the claim is a liability case and was submitted to the health insurance? a. Coordination of Benefits b. Request for medical records c. Claim not covered by insurer d. Claim covered by other insurer - correct answer d. Claim covered by other insurer Similar to a coordination of benefits denial, a claim covered by other insurer denial occurs when the claim is a liability case such as auto or work-related accident. Wha...

-

21 pages

Written in 2023/2024

Grade A+

ROSEGRADES