My AAPC CPB - Chapter 12 Review
A Blue Cross/Blue Shield insurance plan that allows members to choose any provider,
but offers higher levels of coverage when members obtain services from network
providers would be an example of:
a. Health Maintenance Organization (HMO)
b. Point of Service (POS)
c. Preferred Provider Organization (PPO)
d. Indemnity - ANS - c. Preferred Provider Organization (PPO)
A claim is submitted for a patient who suffered a fractured femur. The diagnosis code
that was submitted is S82.401A, with the CPT® fracture care code 27230. Does the
diagnosis code support medical necessity for the service provided?
a. Yes, the diagnosis code supports the CPT® code billed.
b. Yes, the procedure code is supported by the ICD-10-CM code.
c. No, the diagnosis code does not support the CPT® fracture care code.
d. A diagnosis code is not necessary when reporting CPT® codes. - ANS - c. No, the
diagnosis code does not support the CPT® fracture care code.
A participating provider of Blue Cross/Blue Shield sees a patient in the ER. The charges
equal $500.00. The patient has a $1000 deductible of which none has been met, and a
$75.00 ER copay. How much should be collected from the patient at the time of
completion of the ER visit?
a. $75.00
b. $1000.00
c. $500.00
d. Wait for the EOB as a contractual write-off will apply. - ANS - a. $75.00
A patient seeks care from a neurologist without a referral from the patient's primary care
physician, which is required by the insurance company. What is the likely outcome for
neurologist's claim?
a. The claim will be paid at a 75% of fee.
b. The claim will be paid at 50% of fee.
, c. The claim will be denied.
d. The claim will be paid at full rate. - ANS - c. The claim will be denied.
A patient's insurance member card is issued by:
a. the physician's office.
b. the employer.
c. the state.
d. the insurance company. - ANS - d. the insurance company.
A savings account that allows individuals to save pre-tax dollars to reimburse for
healthcare expenses is known as a(n):
a. Flexible Spending Account (FSA)
b. Health Savings Account (HSA)
c. Employer Savings Account (ESA)
d. Both a and b - ANS - d. Both a and b
Best practice to prevent receiving a denial due to coverage termination would be to:
a. call each payer every month to ensure that each scheduled patient is still covered.
b. verify coverage prior to the patient's scheduled appointment.
c. verify coverage after the patient is seen by provider.
d. contact each patient every month to verify insurance coverage. - ANS - b. verify
coverage prior to the patient's scheduled appointment.
Blue Cross and Blue Shield is the:
a. oldest and smallest family of health benefits companies in the United States.
b. newest and largest family of health benefits companies in the United States.
c. oldest and largest family of health benefits companies in the United States.
d. only health insurance company promoting preferred provider organizations. - ANS -
c. oldest and largest family of health benefits companies in the United States.
Blue Cross/Blue Shield identifies the individual or employee who pays for healthcare
insurance coverage as the:
a. Member
b. Group
c. Subscriber
A Blue Cross/Blue Shield insurance plan that allows members to choose any provider,
but offers higher levels of coverage when members obtain services from network
providers would be an example of:
a. Health Maintenance Organization (HMO)
b. Point of Service (POS)
c. Preferred Provider Organization (PPO)
d. Indemnity - ANS - c. Preferred Provider Organization (PPO)
A claim is submitted for a patient who suffered a fractured femur. The diagnosis code
that was submitted is S82.401A, with the CPT® fracture care code 27230. Does the
diagnosis code support medical necessity for the service provided?
a. Yes, the diagnosis code supports the CPT® code billed.
b. Yes, the procedure code is supported by the ICD-10-CM code.
c. No, the diagnosis code does not support the CPT® fracture care code.
d. A diagnosis code is not necessary when reporting CPT® codes. - ANS - c. No, the
diagnosis code does not support the CPT® fracture care code.
A participating provider of Blue Cross/Blue Shield sees a patient in the ER. The charges
equal $500.00. The patient has a $1000 deductible of which none has been met, and a
$75.00 ER copay. How much should be collected from the patient at the time of
completion of the ER visit?
a. $75.00
b. $1000.00
c. $500.00
d. Wait for the EOB as a contractual write-off will apply. - ANS - a. $75.00
A patient seeks care from a neurologist without a referral from the patient's primary care
physician, which is required by the insurance company. What is the likely outcome for
neurologist's claim?
a. The claim will be paid at a 75% of fee.
b. The claim will be paid at 50% of fee.
, c. The claim will be denied.
d. The claim will be paid at full rate. - ANS - c. The claim will be denied.
A patient's insurance member card is issued by:
a. the physician's office.
b. the employer.
c. the state.
d. the insurance company. - ANS - d. the insurance company.
A savings account that allows individuals to save pre-tax dollars to reimburse for
healthcare expenses is known as a(n):
a. Flexible Spending Account (FSA)
b. Health Savings Account (HSA)
c. Employer Savings Account (ESA)
d. Both a and b - ANS - d. Both a and b
Best practice to prevent receiving a denial due to coverage termination would be to:
a. call each payer every month to ensure that each scheduled patient is still covered.
b. verify coverage prior to the patient's scheduled appointment.
c. verify coverage after the patient is seen by provider.
d. contact each patient every month to verify insurance coverage. - ANS - b. verify
coverage prior to the patient's scheduled appointment.
Blue Cross and Blue Shield is the:
a. oldest and smallest family of health benefits companies in the United States.
b. newest and largest family of health benefits companies in the United States.
c. oldest and largest family of health benefits companies in the United States.
d. only health insurance company promoting preferred provider organizations. - ANS -
c. oldest and largest family of health benefits companies in the United States.
Blue Cross/Blue Shield identifies the individual or employee who pays for healthcare
insurance coverage as the:
a. Member
b. Group
c. Subscriber
