AAPC CPB EXAM QUESTIONS WITH COMPLETE
SOLUTIONS GUARANTEED PASS
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? - ANSWER ->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? -
ANSWER ->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.
V. Employee can make changes to the policy.
VI. The employee's spouse and children are not eligible for coverage. -
ANSWER ->I, IV, V, and VI, Group health insurance 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 employees. 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? - ANSWER ->Dr. Wallace can keep the $2,000
profit under the terms of the capitated plan
What is the deadline for filing a Medicare claim? - ANSWER ->One year
from the date of service
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? - ANSWER ->. $60.00
What organization is responsible in evaluating the medical necessity,
appropriateness, and efficiency of the use of healthcare services and
procedures? - ANSWER ->Utilization Review Organization
Medicaid providers are forbidden by law to: - ANSWER ->Balance bill
patients
Which statement is FALSE about Local Coverage Determinations
, (LCDs)? - ANSWER ->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? - ANSWER ->10-day
global period - the day of the procedure and 10 days following the
procedure. View Rationale
Question 11
If add-on procedure code 11103 is performed twice during an office
visit, how is it indicated on the CMS-1500 claim form? - ANSWER >Code
11103 is reported once with the number 2 in box 24G
Which set of documentation guidelines can be used for E/M services
submitted to Medicare for a physician assistant (PA)? - ANSWER >Either
1995 or 1997 CMS documentation guidelines
Select the scenario that meets the incident-to requirements - ANSWER
>Care is delivered to an established patient by the physician assistant as
part of the physician's treatment plan while the physician is seeing
another patient in the same office suite in a different room.
Medicare beneficiary is having a screening colonoscopy performed.
How is the service reported to Medicare? - ANSWER ->G0121
Which providers submit the CMS-1500 claim form?
I. Independent diagnostic testing facilities (IDTFs)
II. Emergency department physicians
III. Hospice organizations
SOLUTIONS GUARANTEED PASS
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? - ANSWER ->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? -
ANSWER ->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.
V. Employee can make changes to the policy.
VI. The employee's spouse and children are not eligible for coverage. -
ANSWER ->I, IV, V, and VI, Group health insurance 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 employees. 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? - ANSWER ->Dr. Wallace can keep the $2,000
profit under the terms of the capitated plan
What is the deadline for filing a Medicare claim? - ANSWER ->One year
from the date of service
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? - ANSWER ->. $60.00
What organization is responsible in evaluating the medical necessity,
appropriateness, and efficiency of the use of healthcare services and
procedures? - ANSWER ->Utilization Review Organization
Medicaid providers are forbidden by law to: - ANSWER ->Balance bill
patients
Which statement is FALSE about Local Coverage Determinations
, (LCDs)? - ANSWER ->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? - ANSWER ->10-day
global period - the day of the procedure and 10 days following the
procedure. View Rationale
Question 11
If add-on procedure code 11103 is performed twice during an office
visit, how is it indicated on the CMS-1500 claim form? - ANSWER >Code
11103 is reported once with the number 2 in box 24G
Which set of documentation guidelines can be used for E/M services
submitted to Medicare for a physician assistant (PA)? - ANSWER >Either
1995 or 1997 CMS documentation guidelines
Select the scenario that meets the incident-to requirements - ANSWER
>Care is delivered to an established patient by the physician assistant as
part of the physician's treatment plan while the physician is seeing
another patient in the same office suite in a different room.
Medicare beneficiary is having a screening colonoscopy performed.
How is the service reported to Medicare? - ANSWER ->G0121
Which providers submit the CMS-1500 claim form?
I. Independent diagnostic testing facilities (IDTFs)
II. Emergency department physicians
III. Hospice organizations
