AAPC CPB FINAL EXAM QUESTIONS & ANSWERS VERIFIED 100% CORRECT
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AAPC CPB
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AAPC CPB
NCDs are released by which of the following entities: - CMS
A health plan sends a request for medical records in order to adjudicate a claim. Does the office have to
notify the patient or have them sign a release to send the information? - no
____ sets standards and directives to protect workers...
AAPC CPB F INAL EXAM NCDs are released by which of the following entities: - CMS A health plan sends a request for medical records in order to adjudicate a claim. Does the office have to notify the patient or have them sign a release to send the information? - no ____ sets standards and directives to protect workers against transmission of infectious agents. - OSHA ________ is when the provider has limited access to payer and patient data elements on their patients only. - extranet "with contrast" does not include ___ contrast (for CT Scan) - oral, rectal A ___ is used to indicate an inpatient service is reported on an outpatient claim. - condition code A ______ indicates the location or type of service provided for an inpatient and is reported with _______. - revenue code 4 digit code A ____________ is a listing of every single procedure that a hospital can provide to its patients that are billed to payers. - chargemaster A 68 -year -old Medicare patient presented for an annual examination and had no complaints. Her claim, billed as 99387, was denied. Was this billed correctly? If not, how is this encounter correctly billed? - it depends on doc ___ provider with overall responsibility for the patient's medical care during hospitalization. - attending A claim is submitted for a patient on Medicare with a higher fee than a patient on Insurance ABC. What is this considered by CMS? - abuse a corporate umbrella for management of diversified healthcare delivery systems - IPO A discount given to self -pay patients when they pay at the time of service. - prompt payment discount A fee schedule can be based on - RVUs A health plan sends a request for medical records in order to adjudicate a claim. Does the office have to notify the patient or have them sign a release to send the information? - no A healthcare organization with 2 hospitals, 20 clinics, and 3 urgent care centers belongs to an ACO program. They have been in the shared savings program for two years and are now eligible to move large payments to a population -based model as they have bee n successful in keeping costs down and have met all the CMS benchmarks set for them. What type of ACO is this? - Pioneer A hospital chargemaster does NOT contain which of the following? - ICD10CM codes A hospital records transporter is moving medical records from the hospital to an off -site building. During the transport, a chart falls from the box on to the street. It is discovered when the transporter arrives at the off -site building and the number of charts is not correct. What type of violation is this? - breach A Medicare patient presents after slipping and falling in a neighbor's walkway. The cement had a large crack, which caused the pavement to raise and be unsteady. The neighbor has contacted his homeowner's insurance and they are accepting liability and have initiated a claim. How should the visit be billed? - Homeowners, then Medicare A new physician comes in to the practice that is just out of medical school. He will need to be able to see patients in the office and at the hospital. What process will he need to undergo in order to be able to participate with Medicare and other health p lans? - credentialling A new radiology company opens in town. The manager calls your practice and offers to pay $20 for every Medicare patient you send to them for radiology services. What does this offer violate? - anti kickback laws A patient is involved in an accident at work and their commercial insurance is billed. What type of denial will be received? - liability issue A patient presenting for care does not have an insurance card and is billed CPT 99213 for $100. The patient pays $100 to the provider. A week later, the patient presents verification of coverage through Medicaid for this date of service. What process shoul d be followed? - file a claim to Medicaid w EOB A person that files a claim for a Medicare beneficiary knowing that the service is not correctly reported is in violation of what statute? - False Claims Act A plan where a provider accepts a fixed, pre -established monthly payment for enrollees in a health insurance plan - capitated A practice agrees to pay $250,000 to settle a lawsuit alleging that the practice used X -rays of one patient to justify services on multiple other patients' claims. The manager of the office brought the civil suit. What type of case is this? - qui tam A practice allows patients to pay large balances over a six month time period with a finance charge applied. The patient receives a statement every month that only shows the unpaid balance. What does this violate? - TILA A practice sets up a payment plan with a patient. If more than four installments are extended to the patient, what regulation is the practice subject to that makes the practice a creditor? - Truth in Lending Act
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