AAPC CPB - Chapter 9 Review
A ______ indicates the location or type of service provided for an inpatient and is
reported with _______.
a. Revenue code; four-digit code
b. Revenue code; three-digit code
c. CPT code; five-digit code
d. MSDRG code; three-digit code - ANS - a. Revenue code; four-digit code
A ____________ is a listing of every single procedure that a hospital can provide to its
patients that are billed to payers.
a. Charge Ticket
b. Chargemaster
c. UB-04 claim form
d. CMS-1500 claim form - ANS - b. Chargemaster
A clearinghouse is an entity that provides which of the following services?
a. Converts nonstandard data received from payers to standard transaction data to
meet HIPAA requirements.
b. Pursues payments of debts owed by individuals or businesses.
c. Assists providers in the collection of appropriate reimbursement for services
rendered.
d. Explains insurance benefits, policy requirements, and filing rules to patients. - ANS -
a. Converts nonstandard data received from payers to standard transaction data to
meet HIPAA requirements.
A hospital chargemaster does NOT contain which of the following?
a. Revenue Code
b. Service Description
c. CPT Code
d. ICD-10-CM diagnosis code - ANS - d. ICD-10-CM diagnosis code
An audit that occurs before a claim is submitted is a _____________.
, a. Internal audit
b. Payer's audit
c. Post-payment audit
d. Pre-payment audit - ANS - d. Pre-payment audit
Mr. Cooper was in outpatient surgery for a hernia repair. During the surgery a
complication occurs that requires Mr. Cooper to be admitted into the hospital. Which
payment system will be used?
a. Outpatient Prospective Payment System (OPPS)
b. Inpatient Prospective Payment System (IPPS)
c. Ambulatory Payment Classification (APC)
d. Both OPPS and IPPS - ANS - b. Inpatient Prospective Payment System (IPPS)
Mrs. Fryer takes her son to the ED for an injured arm. Her son is covered by both
parents. Mr. Fryer's birthday is 10/14/1984 and Mrs. Fryer's birthday is 6/10/1986.
Under the birthday rule whose insurance plan will be primary?
a. Mrs. Fryer
b. Mr. Fryer
c. Either one can be primary
d. The parent's birthday closest to the child's birthday - ANS - a. Mrs. Fryer
Mrs. Jones went in for a surgical procedure and the claim was denied because the
office did not obtain prior authorization. The carrier does not allow authorizations to be
obtained after the procedure has been performed. What is done to recover any
payment?
a. Bill Mrs. Jones and she is responsible for payment.
b. The provider is required to write off the balance.
c. Bill Mrs. Jones for 20% of the service and write off the balance.
d. None of the above. - ANS - b. The provider is required to write off the balance.
Payments due from patients, payers, or other guarantors that are owed to the practice
for services rendered are considered
a. Collections
b. Bad Debt
c. Accounts Receivable
A ______ indicates the location or type of service provided for an inpatient and is
reported with _______.
a. Revenue code; four-digit code
b. Revenue code; three-digit code
c. CPT code; five-digit code
d. MSDRG code; three-digit code - ANS - a. Revenue code; four-digit code
A ____________ is a listing of every single procedure that a hospital can provide to its
patients that are billed to payers.
a. Charge Ticket
b. Chargemaster
c. UB-04 claim form
d. CMS-1500 claim form - ANS - b. Chargemaster
A clearinghouse is an entity that provides which of the following services?
a. Converts nonstandard data received from payers to standard transaction data to
meet HIPAA requirements.
b. Pursues payments of debts owed by individuals or businesses.
c. Assists providers in the collection of appropriate reimbursement for services
rendered.
d. Explains insurance benefits, policy requirements, and filing rules to patients. - ANS -
a. Converts nonstandard data received from payers to standard transaction data to
meet HIPAA requirements.
A hospital chargemaster does NOT contain which of the following?
a. Revenue Code
b. Service Description
c. CPT Code
d. ICD-10-CM diagnosis code - ANS - d. ICD-10-CM diagnosis code
An audit that occurs before a claim is submitted is a _____________.
, a. Internal audit
b. Payer's audit
c. Post-payment audit
d. Pre-payment audit - ANS - d. Pre-payment audit
Mr. Cooper was in outpatient surgery for a hernia repair. During the surgery a
complication occurs that requires Mr. Cooper to be admitted into the hospital. Which
payment system will be used?
a. Outpatient Prospective Payment System (OPPS)
b. Inpatient Prospective Payment System (IPPS)
c. Ambulatory Payment Classification (APC)
d. Both OPPS and IPPS - ANS - b. Inpatient Prospective Payment System (IPPS)
Mrs. Fryer takes her son to the ED for an injured arm. Her son is covered by both
parents. Mr. Fryer's birthday is 10/14/1984 and Mrs. Fryer's birthday is 6/10/1986.
Under the birthday rule whose insurance plan will be primary?
a. Mrs. Fryer
b. Mr. Fryer
c. Either one can be primary
d. The parent's birthday closest to the child's birthday - ANS - a. Mrs. Fryer
Mrs. Jones went in for a surgical procedure and the claim was denied because the
office did not obtain prior authorization. The carrier does not allow authorizations to be
obtained after the procedure has been performed. What is done to recover any
payment?
a. Bill Mrs. Jones and she is responsible for payment.
b. The provider is required to write off the balance.
c. Bill Mrs. Jones for 20% of the service and write off the balance.
d. None of the above. - ANS - b. The provider is required to write off the balance.
Payments due from patients, payers, or other guarantors that are owed to the practice
for services rendered are considered
a. Collections
b. Bad Debt
c. Accounts Receivable
