AAPC CPB – CHAPTER 13 REVIEW ALREADY GRADED A+

What are some ways to avoid missing/invalid code denials on submitted claims? I. QA coding staff II. Code the same way all the time III. Offer education to coding staff IV. Use current year coding books I, II, III I, IV I, III, IV I, III 1 of 27 Term Which regulations require a health insurer offering group or individual coverage to implementan effective appeals process for appeals of coverage determinations and claims? Health Insurance Portability and Accountability Act False Claims Act Prompt Payment Act Patient Protection and Affordable Care Act 2 of 27 Term On 05/02/19, a claim for a fine needle aspiration biopsy with ultrasound guidance was reportedwith CPT code 10022, ICD-10-CM code D49.2 for DOS 05/01/2019. Why would the claim bedenied? Not medically necessary Invalid CPT code for DOS Invalid ICD-10-CM code for DOS Timely filing 3 of 27 Term Which of the following is a coordination of benefits issue? Submitting a secondary claim without a primary insurance EOB Submitting a claim for a known non-covered service Submitting a claim to commercial insurance for a work injury Submitting a claim without medical records 4 of 27 Term Which type of denial is more likely to happen when the patient is insured through an HMO? Patient not eligible No referral Timely filing Not medically necessary 5 of 27 Term What rejections/denials are the easiest to prevent with good front office policy? I. Incorrect patient information II. Eligibility expiration III. Medical necessity IV. Liability denials I, II I, II, IV I, III, IV I, IV 6 of 27 Term According to Aetna's published guidelines, what is the timeframe for filing an appeal? Within 60 calendar days of the initial claim decision Within 180 calenda