CPPM/AAPC EXAM QUESTIONS AND ANSWERS
LATEST UPDATE (GRADED A+)
For end-stage renal disease (ESRD) beneficiaries, Medicare is the secondary payer during the first
_____________ months of the beneficiary's entitlement to ESRD benefits.
18-30
ABNs are not required for items or services that are either
_____________________________________________ OR
______________________________________________.
the service is routinely non-covered
fails to meet benefit requirements for coverage
An ABN must: (5)
1. LAYMAN: Be written in layman's language
2. WHAT: Specify the items or services in question and the cost associated
3. WHY: Specify the reason Medicare payment will be denied
4. TIMING: Be delivered before the items or services are provided
5. SIGNED: Be received, understood, and signed
GA Modifier
Expected to be denied as not medically necessary; ABN on File
GZ Modifier
Denial Expected; No ABN on file
GX Modifier
Expected to be denied as non-covered; ABN on File
MS-DRG is an acronym for...
Medicare Severity Diagnosis Related Group
APC is an acronym for...
Ambulatory Payment Classification
Some exceptions to the routine notice ABN prohibition include: (4)
1. Experimental items and services
2. Items and services with frequency limitations for coverage
, 3. DME/supplies denied because the supplier had no supplier number
4. services that are always denied for medical necessity
You cannot issue an ABN to: (4)
1. MUE: bill the beneficiary for the services denied due to a Medically Unlikely Edit (MUE)
2. EMERGENCY: when ABN is signed in a medical emergency or under great duress (compelling or
coercive circumstances)
3. UNBUNDLING: charge a beneficiary for a component of a bundled service paid by Medicare
4. MEDICARE WOULD PAY: transfer liability to the beneficiary when Medicare would otherwise pay for
items and services
According to Medical Group Management Association (MGMA), data has shown that ___________ of
denials are preventable.
90%
Define Prospective Fee Schedules
Payments are based on physician fee schedules negotiated with the payer.
Define Discounted Fee for Service
A retrospective model of payment based on paying the provider a certain percentage of charges.
Define Capitation
Payment is determined on a per capita basis, meaning the payer will contract to pay the provider a set
amount per month for each patient, independent of the services provided.
What is the resource-based relative value scale (RBRVS) payment methodology?
Used by Medicare to calculate a rate for each CPT® code based on three factors: relative value units
(RVU), Geographic Price Cost Index (GPCI), and Conversion Factor (CF)
What are the different types of prospective payment methods? (3)
Prospective Fee Schedule, RBRVS, Capitation
Industry standard is to consider a collection agency after _______ days of direct collections efforts
from the practice.
60-90
It is not worth sending balances under $x to a collections agency.
$10
Six provisions of Fair Debt Collection Protection Act (FDCPA)
LATEST UPDATE (GRADED A+)
For end-stage renal disease (ESRD) beneficiaries, Medicare is the secondary payer during the first
_____________ months of the beneficiary's entitlement to ESRD benefits.
18-30
ABNs are not required for items or services that are either
_____________________________________________ OR
______________________________________________.
the service is routinely non-covered
fails to meet benefit requirements for coverage
An ABN must: (5)
1. LAYMAN: Be written in layman's language
2. WHAT: Specify the items or services in question and the cost associated
3. WHY: Specify the reason Medicare payment will be denied
4. TIMING: Be delivered before the items or services are provided
5. SIGNED: Be received, understood, and signed
GA Modifier
Expected to be denied as not medically necessary; ABN on File
GZ Modifier
Denial Expected; No ABN on file
GX Modifier
Expected to be denied as non-covered; ABN on File
MS-DRG is an acronym for...
Medicare Severity Diagnosis Related Group
APC is an acronym for...
Ambulatory Payment Classification
Some exceptions to the routine notice ABN prohibition include: (4)
1. Experimental items and services
2. Items and services with frequency limitations for coverage
, 3. DME/supplies denied because the supplier had no supplier number
4. services that are always denied for medical necessity
You cannot issue an ABN to: (4)
1. MUE: bill the beneficiary for the services denied due to a Medically Unlikely Edit (MUE)
2. EMERGENCY: when ABN is signed in a medical emergency or under great duress (compelling or
coercive circumstances)
3. UNBUNDLING: charge a beneficiary for a component of a bundled service paid by Medicare
4. MEDICARE WOULD PAY: transfer liability to the beneficiary when Medicare would otherwise pay for
items and services
According to Medical Group Management Association (MGMA), data has shown that ___________ of
denials are preventable.
90%
Define Prospective Fee Schedules
Payments are based on physician fee schedules negotiated with the payer.
Define Discounted Fee for Service
A retrospective model of payment based on paying the provider a certain percentage of charges.
Define Capitation
Payment is determined on a per capita basis, meaning the payer will contract to pay the provider a set
amount per month for each patient, independent of the services provided.
What is the resource-based relative value scale (RBRVS) payment methodology?
Used by Medicare to calculate a rate for each CPT® code based on three factors: relative value units
(RVU), Geographic Price Cost Index (GPCI), and Conversion Factor (CF)
What are the different types of prospective payment methods? (3)
Prospective Fee Schedule, RBRVS, Capitation
Industry standard is to consider a collection agency after _______ days of direct collections efforts
from the practice.
60-90
It is not worth sending balances under $x to a collections agency.
$10
Six provisions of Fair Debt Collection Protection Act (FDCPA)
