AAPC CPB FINAL EXAM TEST BANK UPDATE
GRADED A+ WITH ANSWERS
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
IV. Ambulance companies submitting under their own Medicare number
V. Physicians in a group practice
VI. Ambulatory surgery centers - ANSWER: I, II, IV, V and VI
According to CPT® Radiology Guidelines, if a patient is given oral contrast for a CT
scan of the abdomen which code is reported? - ANSWER: 74150 Computed
tomography, abdomen; without contrast material
Which of the following is NOT in the HIPAA Privacy Rule? - ANSWER: Implementing
hardware, software, and/or procedural mechanisms to record and examine access
and other activity in information systems that contains or use electronic PHI (e-PHI).
GRADED A+ WITH ANSWERS
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
IV. Ambulance companies submitting under their own Medicare number
V. Physicians in a group practice
VI. Ambulatory surgery centers - ANSWER: I, II, IV, V and VI
According to CPT® Radiology Guidelines, if a patient is given oral contrast for a CT
scan of the abdomen which code is reported? - ANSWER: 74150 Computed
tomography, abdomen; without contrast material
Which of the following is NOT in the HIPAA Privacy Rule? - ANSWER: Implementing
hardware, software, and/or procedural mechanisms to record and examine access
and other activity in information systems that contains or use electronic PHI (e-PHI).
