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AAPC CPB Latest Questions And Answers Rated 100% Correct
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What is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? -:- A deductible is the amount a policyholder pays for health care services before the health insurance begins to ...

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  • September 24, 2024
  • 29
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • aapc cpb latest questions and answers rated 100
  • what is the term for the total amount of covered m

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2024/ 2025 | © copyright | This work may not be copied for profit gain Excel!

AAPC CPB Latest Questions And Answers
Rated 100% Correct
What is the term for the total amount of covered medical expenses a policyholder must

pay each year out-of-pocket before the health insurance company begins to pay any

benefits?


-:- A deductible is the amount a policyholder pays for health care services

before the health insurance begins to pay.




Which type of insurance covers physicians and other healthcare professionals for liability as

to claims arising from patient treatment?


-:- Medical malpractice insurance is a type of liability insurance that covers

physicians and other healthcare professionals for liability as to claims arising

from patient treatment.




Which of the following does NOT fall under group policy insurance?


I. The premium is paid for by the employee.


II. The premium is paid for (or partially paid for) by an employer.


III. The employer selects the plan(s) to offer to employees.


IV. Physical exams and medical history questionnaires are a mandatory part of the

application process.




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,2024/ 2025 | © copyright | This work may not be copied for profit gain Excel!
V. Employee can make changes to the policy.


VI. The employee's spouse and children are not eligible for coverage.


-:- I, IV, V, and VI, Group health ins urance coverage is a type of health policy

that is purchased by an employer and is offered to eligible employees of the

company, and to eligible dependents of employees. With group health insurance,

the employer selects the plan (or plans) to offer to empl oyees. With an

individual policy, you are the only one who can make changes to your policy and

you are the only one who can cancel the coverage. You have full control over

your own policy. Applicants for individual health insurance will need to

complete a medical history questionnaire and have a physical exam when

applying for coverage.




Dr. Wallace is in a capitation contract with Belleview Managed Care Health Plan. He

received $25,000 from the health plan to provide services for the 175 enrollees on the

health plan. The services provided by Dr. Wallace to the enrollees cost $23,000. Based on

the information, what must be done?


-:- Dr. Wallace can keep the $2,000 profit under the terms of the capitated

plan




What is the deadline for filing a Medicare claim?


-:- One year from the date of service




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, 2024/ 2025 | © copyright | This work may not be copied for profit gain Excel!
A provider sees a patient who has TRICARE Select. The provider is not contracted with

TRICARE but is certified by the regional TRICARE Managed Care Support Contractor

(MCSC). The provider charges $200 for the office visit. TRICARE allows $160 and pays

$140. How much can the provider bill the patient for?


-:- . $60.00




What organization is responsible in evaluating the medical necessity, appropriateness, and

efficiency of the use of healthcare services and procedures?


-:- Utilization Review Organization




Medicaid providers are forbidden by law to:


-:- Balance bill patients




Which statement is FALSE about Local Coverage Determinations (LCDs)?


-:- CMS develops LCDs when there is no National Coverage Determination




When a minor procedure is performed on a Medicare patient, what is the global period and

what time frame is covered?


-:- 10-day global period - the day of the procedure and 10 days following the

procedure.



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