AAPC Final Exam UPDATED QUESTIONS
AND CORRECT ANSWERS
Fraud and Abuse penalties do NOT include: - CORRECT ANSWER Ability to refile
claims in question
Fraud and abuse penalties include: - CORRECT ANSWER $ penalties
exclusion
Imprisonment
Individual have the right to review and obtain copies of their PHI. What is excluded from
this? - CORRECT ANSWER Psychiatrics' reports
While working in a large practice, medicare overpayments are found in several patients
accounts. the manager states that the practice will keep the money until medicare ask for it
back. what does this action constitute? - CORRECT ANSWER Reverse False claims,
failure to return money owed . or Fraud
Medical records are requested for a patient for a specific date of service. when records are
copied multiple dates are copied and sent in reply. what standards does this violate? -
CORRECT ANSWER Minimum necessary
What is an IPO ? - CORRECT ANSWER Integrated provider org.
a health care provider organization that is completely integrated operationally and clinically
and that offers a full range of health care services, including physician, hospital, and adjunct
services.
A patient presents for an immunization. When the patient pays his bill, he asks for a receipt
so that he may turn it in to meet hi spend down. what type of coverage does he have? -
CORRECT ANSWER Medicaid
,A patient presents to his internist for a visit. the pat. has a medicare HMO . To which part of
the medicare program does the patient belong? - CORRECT ANSWER Part B
What are the 2021 Medicare deductible and Co-insurance amount for out patients services on
part B? - CORRECT ANSWER $203.00 and 20% annually
NPI numbers have 2 types of entities, what are the 2 types? - CORRECT ANSWER 1.
Individual
2. Organization
a medicare patient is seen in the internist office for a check up. The office bills Medicare, but
the patient receives the payment and the office must collect their fee form the patient.
The office can charge the patient a limiting charge that is 10% above the medicare fee
schedule amount. What type of medicare provider is the physician? - CORRECT
ANSWER NON - participating provider
When does the processing of an insurance claim for a patient begin? - CORRECT
ANSWER the processing of a claim starts when the patient contact the provider to
schedule an appointment
Which software system is used to store appointments . scheduling, registration and billing
and receivables? - CORRECT ANSWER PMS - practice management system
How do most practices submit claims to insurance companies? - CORRECT
ANSWER Clearing houses
A female patient is covered by her employer and her husbands insurance. His birthday is 3/21
and hers is 6/18. which insurance is primary and why? - CORRECT ANSWER Hers ,
because she is the subscriber
a 16 yr old go to the ED with a possible heads injury from falling off a skateboard. The
patient was wearing
, a helmet. Exam reveals no outward head injuries. what codes are used to report this? -
CORRECT ANSWER report the fall off skate board, since head injury is not definitive/
What is the ICD-10-Cm code for a COUGH ? - CORRECT ANSWER R05
a 30 year old female suffers from Menstrual Migraines. She is in the ED because her
medication has not relived the Migraine. What ICD-10-CM code is reported? - CORRECT
ANSWER G43.839 is a billable diagnosis code used to specify a medical diagnosis of
menstrual migraine, intractable, without status migrainosus.
The patient is being seen to treat acute- on - chronic pansinusitis, what ICD-10-CM is used? -
CORRECT ANSWER If the same condition is described as both acute (subacute) and
chronic, and separate subentries exist in the Alphabetic Index at the same indentation level,
code both and sequence the acute (subacute) code first.
Both Jo1, J32 are coded
A patient present with a sore throat and fever. After and expanded problem focused history
and exam, a positive Strep test, the physician diagnosed. what diagnosis codes are used? -
CORRECT ANSWER Pharyngitis- J02
What is the ICD-10-CM code for the first encounter for a left wrist fracture from a fall. Code
Injury only - CORRECT ANSWER S62.92xA
If a patient has Medicare primary and secondary insurance how is the secondary filed? -
CORRECT ANSWER Medicare will cross over to the second insurance company after
adjudication has been done.
Item 4 on the CMS 1500 box, what is entered on a medicare claim when the patient has an
insurance primary to medicare and the patient is the insured? - CORRECT
ANSWER When covered by 2 insurance and medicare is not primary write the name of
the insured in the box, IF IT IS THE SAME PERSON, WRITE "SAME" IN BOX
AND CORRECT ANSWERS
Fraud and Abuse penalties do NOT include: - CORRECT ANSWER Ability to refile
claims in question
Fraud and abuse penalties include: - CORRECT ANSWER $ penalties
exclusion
Imprisonment
Individual have the right to review and obtain copies of their PHI. What is excluded from
this? - CORRECT ANSWER Psychiatrics' reports
While working in a large practice, medicare overpayments are found in several patients
accounts. the manager states that the practice will keep the money until medicare ask for it
back. what does this action constitute? - CORRECT ANSWER Reverse False claims,
failure to return money owed . or Fraud
Medical records are requested for a patient for a specific date of service. when records are
copied multiple dates are copied and sent in reply. what standards does this violate? -
CORRECT ANSWER Minimum necessary
What is an IPO ? - CORRECT ANSWER Integrated provider org.
a health care provider organization that is completely integrated operationally and clinically
and that offers a full range of health care services, including physician, hospital, and adjunct
services.
A patient presents for an immunization. When the patient pays his bill, he asks for a receipt
so that he may turn it in to meet hi spend down. what type of coverage does he have? -
CORRECT ANSWER Medicaid
,A patient presents to his internist for a visit. the pat. has a medicare HMO . To which part of
the medicare program does the patient belong? - CORRECT ANSWER Part B
What are the 2021 Medicare deductible and Co-insurance amount for out patients services on
part B? - CORRECT ANSWER $203.00 and 20% annually
NPI numbers have 2 types of entities, what are the 2 types? - CORRECT ANSWER 1.
Individual
2. Organization
a medicare patient is seen in the internist office for a check up. The office bills Medicare, but
the patient receives the payment and the office must collect their fee form the patient.
The office can charge the patient a limiting charge that is 10% above the medicare fee
schedule amount. What type of medicare provider is the physician? - CORRECT
ANSWER NON - participating provider
When does the processing of an insurance claim for a patient begin? - CORRECT
ANSWER the processing of a claim starts when the patient contact the provider to
schedule an appointment
Which software system is used to store appointments . scheduling, registration and billing
and receivables? - CORRECT ANSWER PMS - practice management system
How do most practices submit claims to insurance companies? - CORRECT
ANSWER Clearing houses
A female patient is covered by her employer and her husbands insurance. His birthday is 3/21
and hers is 6/18. which insurance is primary and why? - CORRECT ANSWER Hers ,
because she is the subscriber
a 16 yr old go to the ED with a possible heads injury from falling off a skateboard. The
patient was wearing
, a helmet. Exam reveals no outward head injuries. what codes are used to report this? -
CORRECT ANSWER report the fall off skate board, since head injury is not definitive/
What is the ICD-10-Cm code for a COUGH ? - CORRECT ANSWER R05
a 30 year old female suffers from Menstrual Migraines. She is in the ED because her
medication has not relived the Migraine. What ICD-10-CM code is reported? - CORRECT
ANSWER G43.839 is a billable diagnosis code used to specify a medical diagnosis of
menstrual migraine, intractable, without status migrainosus.
The patient is being seen to treat acute- on - chronic pansinusitis, what ICD-10-CM is used? -
CORRECT ANSWER If the same condition is described as both acute (subacute) and
chronic, and separate subentries exist in the Alphabetic Index at the same indentation level,
code both and sequence the acute (subacute) code first.
Both Jo1, J32 are coded
A patient present with a sore throat and fever. After and expanded problem focused history
and exam, a positive Strep test, the physician diagnosed. what diagnosis codes are used? -
CORRECT ANSWER Pharyngitis- J02
What is the ICD-10-CM code for the first encounter for a left wrist fracture from a fall. Code
Injury only - CORRECT ANSWER S62.92xA
If a patient has Medicare primary and secondary insurance how is the secondary filed? -
CORRECT ANSWER Medicare will cross over to the second insurance company after
adjudication has been done.
Item 4 on the CMS 1500 box, what is entered on a medicare claim when the patient has an
insurance primary to medicare and the patient is the insured? - CORRECT
ANSWER When covered by 2 insurance and medicare is not primary write the name of
the insured in the box, IF IT IS THE SAME PERSON, WRITE "SAME" IN BOX
