AAPC CPB - CHAPTER 3: QUESTIONS
A 9-year-old is brought in by her father for a sore throat. The patient has insurance
coverage through both the mother and father. Which coverage is considered primary?
a. The father brought the patient for care, making his coverage primary
b. The primary insurance is determined by the birthday rule
c. Both are filed at the same time and the insurance companies sort it out
d. The mother's, because it was effective first - ANS - b. The primary insurance is
determined by the birthday rule
A child is brought in by the mother to be seen. The mother (DOB 02/08/83) is the
custodial parent and is remarried. She has an individual policy. The father (DOB
10/10/82) is covered by a policy from work. The step-father is also covered at work.
Which of the following is correct?
a. The mother's insurance is primary
b. The step-parent is primary
c. The father is always primary
d. Either the mother or the father can be primary - ANS - a. The mother's insurance is
primary
A claim that is sent for reimbursement that contains all the required data elements to
process the claim is referred to as a:
a. Submitted
b. Adjudicated
c. Clean Claim
d. Medically necessary - ANS - c. Clean Claim
A female patient is covered by her employer and her husband's insurance plan. His
birthday is 3/21 and hers is 6/18. Which insurance is considered primary?
a. The husband's insurance because of the birthday rule
b. The patient's insurance because she is the primary subscriber
c. The husband's insurance is primary, because he is the head of the household
, d. Either can be filed as primary - ANS - b. The patient's insurance because she is the
primary subscriber
A patient wants her results called to her home and states the physician is to talk to her
husband. What form should be completed before this is done?
a. Authorization to Disclose Health Information
b. Consent for Payment
c. Consent for Treatment
d. Patient Information Form - ANS - a. Authorization to Disclose Health Information
Child presents for care with the father. Both parents have coverage, date of birth for
mother is 3/21 and date of birth for father is 6/20. The mother is covered by a COBRA.
What is the primary coverage for the child?
a. The mother's coverage is primary based on the birthday rule.
b. The father's insurance is primary because the mother has COBRA
c. The father is primary because he is older
d. The father's is primary because he consented for care. - ANS - b. The father's
insurance is primary because the mother has COBRA
HIPAA Section 164.508 states that covered entities may not use or disclose protected
information without a valid authorization. In what circumstances can a practice NOT
release protected information?
a. Records sent to a physician asked to consult with the patient
b. Payment of claims
c. Records requested by the health department for communicable diseases
d. Records requested for life insurance - ANS - d. Records requested for life
insurance
How do most practices submit claims to the insurance company?
a. Directly from the PMS to the insurance carrier
b. Through a clearinghouse
c. Through a claims analyzer
d. By hiring a claims adjudicator - ANS - b. Through a clearinghouse
Information about deductibles, copays, eligibility dates, and benefit plans is completed
during what step?
A 9-year-old is brought in by her father for a sore throat. The patient has insurance
coverage through both the mother and father. Which coverage is considered primary?
a. The father brought the patient for care, making his coverage primary
b. The primary insurance is determined by the birthday rule
c. Both are filed at the same time and the insurance companies sort it out
d. The mother's, because it was effective first - ANS - b. The primary insurance is
determined by the birthday rule
A child is brought in by the mother to be seen. The mother (DOB 02/08/83) is the
custodial parent and is remarried. She has an individual policy. The father (DOB
10/10/82) is covered by a policy from work. The step-father is also covered at work.
Which of the following is correct?
a. The mother's insurance is primary
b. The step-parent is primary
c. The father is always primary
d. Either the mother or the father can be primary - ANS - a. The mother's insurance is
primary
A claim that is sent for reimbursement that contains all the required data elements to
process the claim is referred to as a:
a. Submitted
b. Adjudicated
c. Clean Claim
d. Medically necessary - ANS - c. Clean Claim
A female patient is covered by her employer and her husband's insurance plan. His
birthday is 3/21 and hers is 6/18. Which insurance is considered primary?
a. The husband's insurance because of the birthday rule
b. The patient's insurance because she is the primary subscriber
c. The husband's insurance is primary, because he is the head of the household
, d. Either can be filed as primary - ANS - b. The patient's insurance because she is the
primary subscriber
A patient wants her results called to her home and states the physician is to talk to her
husband. What form should be completed before this is done?
a. Authorization to Disclose Health Information
b. Consent for Payment
c. Consent for Treatment
d. Patient Information Form - ANS - a. Authorization to Disclose Health Information
Child presents for care with the father. Both parents have coverage, date of birth for
mother is 3/21 and date of birth for father is 6/20. The mother is covered by a COBRA.
What is the primary coverage for the child?
a. The mother's coverage is primary based on the birthday rule.
b. The father's insurance is primary because the mother has COBRA
c. The father is primary because he is older
d. The father's is primary because he consented for care. - ANS - b. The father's
insurance is primary because the mother has COBRA
HIPAA Section 164.508 states that covered entities may not use or disclose protected
information without a valid authorization. In what circumstances can a practice NOT
release protected information?
a. Records sent to a physician asked to consult with the patient
b. Payment of claims
c. Records requested by the health department for communicable diseases
d. Records requested for life insurance - ANS - d. Records requested for life
insurance
How do most practices submit claims to the insurance company?
a. Directly from the PMS to the insurance carrier
b. Through a clearinghouse
c. Through a claims analyzer
d. By hiring a claims adjudicator - ANS - b. Through a clearinghouse
Information about deductibles, copays, eligibility dates, and benefit plans is completed
during what step?
