AAPC CPB Chapter 12 Practical
Application
Based on the question above, what should be done to correct this claim?
A. Correct the patient's demographic information.
B. Correct the provider information.
C. Correct the coding on the claim.
D. Both B and C - ANS - D. Both B and C
Response Feedback:
The diagnosis code on the claim form is incorrect. Should reflect M25.551. Provider's
SSN is incorrect. EIN should have been marked instead of SSN in the claim form.
Based on the question above, what should the office do with errors on the claim form?
I. Correct the provider information on the claim.
II. Correct the patient's demographics.
III. Change accepting assignment to yes.
IV. There are no changes to made to this claim.
V. Correct the CPT code(s)
A. I, II and III
B. II and III
C. II and V
D. There are no errors to correct on this claim. - ANS - A. I, II and III
Response Feedback:
Rationale: Change the providers information on the claim: Change Item 25 to show EIN
instead of SSN. Change accepting assignment to yes in Item 27. The physician accepts
assignment from Blue Cross Blue Shield of Florida. Correct patient's date of birth.
Use CPB Chapter 12 Case 10.pdf to answer the following question.
, Based on the information provided, what actions should the biller take?
I. Check with the provider or coder regarding the coding on the claim.
II. Determine when the claim was originally filed.
III. Check with Blue Cross/Blue Shield for acceptable documents to prove timely filing of
a claim. If the documents are found, file an appeal.
IV. Write off the balance.
A. I and II
B. I, II, and III
C. IV Only
D. II and III - ANS - D. II and III
Response Feedback:
The denial reason is because the claim was filed after the timely filing deadline. Refer to
the BCBS provider manual for the acceptable documents to demonstrate timely filing of
a claim. Billers should have a list of timely filing deadlines for their BCBS carrier.
Use CPB Chapter 12 Case 2.pdf to answer questions 3 and 4.
After review of the information provided, are there any errors on the claim form? If so,
which elements are incorrect?
I. Federal Tax ID number
II. Code correlation conflict
III. Incorrect modifier
IV. Diagnosis pointer
V. Units of service
A. II and III
B. II and IV
C. I, and V
D. There are no errors on this claim. - ANS - C. I, and V
Response Feedback:
Application
Based on the question above, what should be done to correct this claim?
A. Correct the patient's demographic information.
B. Correct the provider information.
C. Correct the coding on the claim.
D. Both B and C - ANS - D. Both B and C
Response Feedback:
The diagnosis code on the claim form is incorrect. Should reflect M25.551. Provider's
SSN is incorrect. EIN should have been marked instead of SSN in the claim form.
Based on the question above, what should the office do with errors on the claim form?
I. Correct the provider information on the claim.
II. Correct the patient's demographics.
III. Change accepting assignment to yes.
IV. There are no changes to made to this claim.
V. Correct the CPT code(s)
A. I, II and III
B. II and III
C. II and V
D. There are no errors to correct on this claim. - ANS - A. I, II and III
Response Feedback:
Rationale: Change the providers information on the claim: Change Item 25 to show EIN
instead of SSN. Change accepting assignment to yes in Item 27. The physician accepts
assignment from Blue Cross Blue Shield of Florida. Correct patient's date of birth.
Use CPB Chapter 12 Case 10.pdf to answer the following question.
, Based on the information provided, what actions should the biller take?
I. Check with the provider or coder regarding the coding on the claim.
II. Determine when the claim was originally filed.
III. Check with Blue Cross/Blue Shield for acceptable documents to prove timely filing of
a claim. If the documents are found, file an appeal.
IV. Write off the balance.
A. I and II
B. I, II, and III
C. IV Only
D. II and III - ANS - D. II and III
Response Feedback:
The denial reason is because the claim was filed after the timely filing deadline. Refer to
the BCBS provider manual for the acceptable documents to demonstrate timely filing of
a claim. Billers should have a list of timely filing deadlines for their BCBS carrier.
Use CPB Chapter 12 Case 2.pdf to answer questions 3 and 4.
After review of the information provided, are there any errors on the claim form? If so,
which elements are incorrect?
I. Federal Tax ID number
II. Code correlation conflict
III. Incorrect modifier
IV. Diagnosis pointer
V. Units of service
A. II and III
B. II and IV
C. I, and V
D. There are no errors on this claim. - ANS - C. I, and V
Response Feedback:
