AAPC CPB Final
___ provider with overall responsibility for the patient's medical care during
hospitalization. - ANS - attending
____ sets standards and directives to protect workers against transmission of infectious
agents. - ANS - OSHA
________ is when the provider has limited access to payer and patient data elements
on their patients only. - ANS - extranet
"with contrast" does not include ___ contrast (for CT Scan) - ANS - oral, rectal
A ___ is used to indicate an inpatient service is reported on an outpatient claim. - ANS -
condition code
A ______ indicates the location or type of service provided for an inpatient and is
reported with _______. - ANS - revenue code
4 digit code
A ____________ is a listing of every single procedure that a hospital can provide to its
patients that are billed to payers. - ANS - chargemaster
A 68-year-old Medicare patient presented for an annual examination and had no
complaints. Her claim, billed as 99387, was denied. Was this billed correctly? If not, how
is this encounter correctly billed? - ANS - it depends on doc
A claim is submitted for a patient on Medicare with a higher fee than a patient on
Insurance ABC. What is this considered by CMS? - ANS - abuse
a corporate umbrella for management of diversified healthcare delivery systems - ANS
- IPO
A discount given to self-pay patients when they pay at the time of service. - ANS -
prompt payment discount
A fee schedule can be based on - ANS - RVUs
,A health plan sends a request for medical records in order to adjudicate a claim. Does
the office have to notify the patient or have them sign a release to send the information?
- ANS - no
A healthcare organization with 2 hospitals, 20 clinics, and 3 urgent care centers belongs
to an ACO program. They have been in the shared savings program for two years and
are now eligible to move large payments to a population-based model as they have
been successful in keeping costs down and have met all the CMS benchmarks set for
them. What type of ACO is this? - ANS - Pioneer
A hospital chargemaster does NOT contain which of the following? - ANS - ICD10CM
codes
A hospital records transporter is moving medical records from the hospital to an off-site
building. During the transport, a chart falls from the box on to the street. It is discovered
when the transporter arrives at the off-site building and the number of charts is not
correct. What type of violation is this? - ANS - breach
A Medicare patient presents after slipping and falling in a neighbor's walkway. The
cement had a large crack, which caused the pavement to raise and be unsteady. The
neighbor has contacted his homeowner's insurance and they are accepting liability and
have initiated a claim. How should the visit be billed? - ANS - Homeowners, then
Medicare
A new physician comes in to the practice that is just out of medical school. He will need
to be able to see patients in the office and at the hospital. What process will he need to
undergo in order to be able to participate with Medicare and other health plans? - ANS
- credentialling
A new radiology company opens in town. The manager calls your practice and offers to
pay $20 for every Medicare patient you send to them for radiology services. What does
this offer violate? - ANS - anti kickback laws
A patient is involved in an accident at work and their commercial insurance is billed.
What type of denial will be received? - ANS - liability issue
A patient presenting for care does not have an insurance card and is billed CPT 99213
for $100. The patient pays $100 to the provider. A week later, the patient presents
, verification of coverage through Medicaid for this date of service. What process should
be followed? - ANS - file a claim to Medicaid w EOB
A person that files a claim for a Medicare beneficiary knowing that the service is not
correctly reported is in violation of what statute? - ANS - False Claims Act
A plan where a provider accepts a fixed, pre-established monthly payment for enrollees
in a health insurance plan - ANS - capitated
A practice agrees to pay $250,000 to settle a lawsuit alleging that the practice used
X-rays of one patient to justify services on multiple other patients' claims. The manager
of the office brought the civil suit. What type of case is this? - ANS - qui tam
A practice allows patients to pay large balances over a six month time period with a
finance charge applied. The patient receives a statement every month that only shows
the unpaid balance. What does this violate? - ANS - TILA
A practice sets up a payment plan with a patient. If more than four installments are
extended to the patient, what regulation is the practice subject to that makes the
practice a creditor? - ANS - Truth in Lending Act
A private practice hires a consultant to come in and audit some medical records. Under
the Privacy Rule, what is this consultant considered? - ANS - biz associate
A request for medical records is received for a specific date of service from patient's
insurance company with regards to a submitted claim. No authorization for release of
information is provided. What action should be taken? - ANS - release reqt to ins co
A savings account that allows individuals to save pre-tax dollars to reimburse for
healthcare expenses is known as a(n): - ANS - FSA, HSA
a unique 10-digit identification number required by HIPAA - ANS - NPI
According to Aetna's published guidelines, what is the timeframe for filing an appeal? -
ANS - 60 days
According to Cigna's appeals process, how many level of internal appeals are offered? -
ANS - 11
___ provider with overall responsibility for the patient's medical care during
hospitalization. - ANS - attending
____ sets standards and directives to protect workers against transmission of infectious
agents. - ANS - OSHA
________ is when the provider has limited access to payer and patient data elements
on their patients only. - ANS - extranet
"with contrast" does not include ___ contrast (for CT Scan) - ANS - oral, rectal
A ___ is used to indicate an inpatient service is reported on an outpatient claim. - ANS -
condition code
A ______ indicates the location or type of service provided for an inpatient and is
reported with _______. - ANS - revenue code
4 digit code
A ____________ is a listing of every single procedure that a hospital can provide to its
patients that are billed to payers. - ANS - chargemaster
A 68-year-old Medicare patient presented for an annual examination and had no
complaints. Her claim, billed as 99387, was denied. Was this billed correctly? If not, how
is this encounter correctly billed? - ANS - it depends on doc
A claim is submitted for a patient on Medicare with a higher fee than a patient on
Insurance ABC. What is this considered by CMS? - ANS - abuse
a corporate umbrella for management of diversified healthcare delivery systems - ANS
- IPO
A discount given to self-pay patients when they pay at the time of service. - ANS -
prompt payment discount
A fee schedule can be based on - ANS - RVUs
,A health plan sends a request for medical records in order to adjudicate a claim. Does
the office have to notify the patient or have them sign a release to send the information?
- ANS - no
A healthcare organization with 2 hospitals, 20 clinics, and 3 urgent care centers belongs
to an ACO program. They have been in the shared savings program for two years and
are now eligible to move large payments to a population-based model as they have
been successful in keeping costs down and have met all the CMS benchmarks set for
them. What type of ACO is this? - ANS - Pioneer
A hospital chargemaster does NOT contain which of the following? - ANS - ICD10CM
codes
A hospital records transporter is moving medical records from the hospital to an off-site
building. During the transport, a chart falls from the box on to the street. It is discovered
when the transporter arrives at the off-site building and the number of charts is not
correct. What type of violation is this? - ANS - breach
A Medicare patient presents after slipping and falling in a neighbor's walkway. The
cement had a large crack, which caused the pavement to raise and be unsteady. The
neighbor has contacted his homeowner's insurance and they are accepting liability and
have initiated a claim. How should the visit be billed? - ANS - Homeowners, then
Medicare
A new physician comes in to the practice that is just out of medical school. He will need
to be able to see patients in the office and at the hospital. What process will he need to
undergo in order to be able to participate with Medicare and other health plans? - ANS
- credentialling
A new radiology company opens in town. The manager calls your practice and offers to
pay $20 for every Medicare patient you send to them for radiology services. What does
this offer violate? - ANS - anti kickback laws
A patient is involved in an accident at work and their commercial insurance is billed.
What type of denial will be received? - ANS - liability issue
A patient presenting for care does not have an insurance card and is billed CPT 99213
for $100. The patient pays $100 to the provider. A week later, the patient presents
, verification of coverage through Medicaid for this date of service. What process should
be followed? - ANS - file a claim to Medicaid w EOB
A person that files a claim for a Medicare beneficiary knowing that the service is not
correctly reported is in violation of what statute? - ANS - False Claims Act
A plan where a provider accepts a fixed, pre-established monthly payment for enrollees
in a health insurance plan - ANS - capitated
A practice agrees to pay $250,000 to settle a lawsuit alleging that the practice used
X-rays of one patient to justify services on multiple other patients' claims. The manager
of the office brought the civil suit. What type of case is this? - ANS - qui tam
A practice allows patients to pay large balances over a six month time period with a
finance charge applied. The patient receives a statement every month that only shows
the unpaid balance. What does this violate? - ANS - TILA
A practice sets up a payment plan with a patient. If more than four installments are
extended to the patient, what regulation is the practice subject to that makes the
practice a creditor? - ANS - Truth in Lending Act
A private practice hires a consultant to come in and audit some medical records. Under
the Privacy Rule, what is this consultant considered? - ANS - biz associate
A request for medical records is received for a specific date of service from patient's
insurance company with regards to a submitted claim. No authorization for release of
information is provided. What action should be taken? - ANS - release reqt to ins co
A savings account that allows individuals to save pre-tax dollars to reimburse for
healthcare expenses is known as a(n): - ANS - FSA, HSA
a unique 10-digit identification number required by HIPAA - ANS - NPI
According to Aetna's published guidelines, what is the timeframe for filing an appeal? -
ANS - 60 days
According to Cigna's appeals process, how many level of internal appeals are offered? -
ANS - 11
