AAPC CPB - CHAPTER 2: QUESTIONS
A family practitioner sees a Medicare patient and bills a 99213. This provider has
opted-out of Medicare. His fee for the service is $125.00. Medicare's approved amount
is $73.08, and the patient has met $0 of his deductible. What can the provider bill the
patient?
a. $125.00
b. $73.08
c. $14.62
d. $58.46 - ANS - a. $125.00
(Providers that opt-out of Medicare are not limited to any specific charge limit on their
patients. The patient is responsible for payment in full for services as Medicare will not
pay any amount to either the patient or provider in this situation.)
A Medicaid patient presents for services on the first day of the month. He has a $50
spenddown and has had no services this month. The visit for today was $100.00. If the
patient wants to be covered as long as possible from today's visit, what can he do?
a. Turn the receipt in to his caseworker and be eligible for two months of coverage
b. Turn the receipt in to his caseworker and be eligible for the month with $50 to
assessed by Medicaid for the visit that is above his spenddown
c. Coverage is automatic and the patient will be reimbursed the $100 from Medicaid
d. Turn in the receipt to his caseworker and be eligible for coverage for the current
month, plus two additional months - ANS - a. Turn the receipt in to his caseworker and
be eligible for two months of coverage
(A bill that is larger than the spenddown may be used to meet multiple month's
spenddown. If a patient wants the most coverage possible, $100 would meet two
month's coverage spenddown.)
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?
a. Bill the Homeowner's insurance only. Medicare will not pay anything
, b. Bill Medicare, then the Homeowner's insurance as secondary
c. File to both at the same time and see which pays more
d. Bill the Homeowner's first, then Medicare secondary if it is not paid within 120 days -
ANS - d. Bill the Homeowner's first, then Medicare secondary if it is not paid within
120 days
A new patient is seen for a visit with a participating commercial carrier. Code 99204 is
billed for $200. The contracted fee for this carrier is $153.35. The patient has a 20%
co-pay after a $1000 deductible, of which $500 has been met. How much will the patient
owe?
a. $200
b. $46.65
c. $153.35
d. $30.67 - ANS - c. $153.35
A patient has receipts for her dental cleaning, vision exam, and contact lenses. Her
employer has set up special accounts for each employee, there is no limit to the amount
the employer can contribute and the balances roll over from year to year. What type of
account is this?
a. Flexible Spending Account (FSA)
b. Health Savings Account (HSA)
c. Health Insurance Account (HIA)
d. Traditional Healthcare Reimbursement Arrangement (HRA) - ANS - d. Traditional
Healthcare Reimbursement Arrangement (HRA)
A patient is age 65 and Medicare eligible. The patient signs up for a Medicare Manage
Care plan. When the patient presents for care, claims are sent to:
a. The Medicare Administrative Contractor
b. The patient
c. The Managed Care Plan
d. Both the Managed Care Plan and Medicare Administrative Contractor - ANS - c.
The Managed Care Plan
A patient is scheduled in your office for Botox injections in her face for her smile lines.
She has not met her deductible and states that she is going to use money from her
Healthcare Reimbursement Account to pay for it. Is this possible?
A family practitioner sees a Medicare patient and bills a 99213. This provider has
opted-out of Medicare. His fee for the service is $125.00. Medicare's approved amount
is $73.08, and the patient has met $0 of his deductible. What can the provider bill the
patient?
a. $125.00
b. $73.08
c. $14.62
d. $58.46 - ANS - a. $125.00
(Providers that opt-out of Medicare are not limited to any specific charge limit on their
patients. The patient is responsible for payment in full for services as Medicare will not
pay any amount to either the patient or provider in this situation.)
A Medicaid patient presents for services on the first day of the month. He has a $50
spenddown and has had no services this month. The visit for today was $100.00. If the
patient wants to be covered as long as possible from today's visit, what can he do?
a. Turn the receipt in to his caseworker and be eligible for two months of coverage
b. Turn the receipt in to his caseworker and be eligible for the month with $50 to
assessed by Medicaid for the visit that is above his spenddown
c. Coverage is automatic and the patient will be reimbursed the $100 from Medicaid
d. Turn in the receipt to his caseworker and be eligible for coverage for the current
month, plus two additional months - ANS - a. Turn the receipt in to his caseworker and
be eligible for two months of coverage
(A bill that is larger than the spenddown may be used to meet multiple month's
spenddown. If a patient wants the most coverage possible, $100 would meet two
month's coverage spenddown.)
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?
a. Bill the Homeowner's insurance only. Medicare will not pay anything
, b. Bill Medicare, then the Homeowner's insurance as secondary
c. File to both at the same time and see which pays more
d. Bill the Homeowner's first, then Medicare secondary if it is not paid within 120 days -
ANS - d. Bill the Homeowner's first, then Medicare secondary if it is not paid within
120 days
A new patient is seen for a visit with a participating commercial carrier. Code 99204 is
billed for $200. The contracted fee for this carrier is $153.35. The patient has a 20%
co-pay after a $1000 deductible, of which $500 has been met. How much will the patient
owe?
a. $200
b. $46.65
c. $153.35
d. $30.67 - ANS - c. $153.35
A patient has receipts for her dental cleaning, vision exam, and contact lenses. Her
employer has set up special accounts for each employee, there is no limit to the amount
the employer can contribute and the balances roll over from year to year. What type of
account is this?
a. Flexible Spending Account (FSA)
b. Health Savings Account (HSA)
c. Health Insurance Account (HIA)
d. Traditional Healthcare Reimbursement Arrangement (HRA) - ANS - d. Traditional
Healthcare Reimbursement Arrangement (HRA)
A patient is age 65 and Medicare eligible. The patient signs up for a Medicare Manage
Care plan. When the patient presents for care, claims are sent to:
a. The Medicare Administrative Contractor
b. The patient
c. The Managed Care Plan
d. Both the Managed Care Plan and Medicare Administrative Contractor - ANS - c.
The Managed Care Plan
A patient is scheduled in your office for Botox injections in her face for her smile lines.
She has not met her deductible and states that she is going to use money from her
Healthcare Reimbursement Account to pay for it. Is this possible?
