AAPC CPB FINAL EXAM REAL EXAM 170 QUESTIONS AND
ANSWERS (VERIFIED ANSWERS) |A+GRADE ASSURED
Question 1
Which of the following is the primary purpose of the ICD-10-CM coding
system in medical billing?
A) To describe medical procedures and services.
B) To classify and report diagnoses and reasons for encounters.
C) To identify medical equipment and supplies.
D) To categorize drugs and biologicals.
E) To track facility charges for inpatient stays.
Correct Answer: B) To classify and report diagnoses and reasons for
encounters.
Rationale: ICD-10-CM (International Classification of Diseases, Tenth
Revision, Clinical Modification) is the standard system used to code
diagnoses, symptoms, and causes of injury or disease, providing the
medical necessity for the services rendered.
Question 2
What is the function of a Modifier when appended to a CPT code?
A) To change the basic definition of the CPT code.
B) To provide additional information about the procedure or service
performed without changing its meaning.
C) To indicate the primary diagnosis for the encounter.
D) To identify the specific physician who performed the service.
E) To specify the location where the service was rendered.
Correct Answer: B) To provide additional information about the
procedure or service performed without changing its meaning.
Rationale: Modifiers provide additional relevant information about a
procedure or service, such as that the service was performed on an
unusual anatomical site, by more than one physician, or under
unusual circumstances, without altering the CPT code's basic
description.
Question 3
Which of the following forms is typically used by physicians and suppliers to
submit claims for outpatient services?
A) UB-04 (CMS-1450)
B) CMS-1500
C) HIPAA 837I
D) HIPAA 837P
E) CMS-1000
,Correct Answer: B) CMS-1500
Rationale: The CMS-1500 claim form is the standard paper form used
by physicians, suppliers, and other non-institutional providers to bill
for professional services. The UB-04 is used by institutions like
hospitals.
Question 4
Which component of the Revenue Cycle Management (RCM) process
occurs before a service is rendered?
A) Claims submission
B) Patient collections
C) Charge capture
D) Eligibility verification and pre-authorization
E) Denial management
Correct Answer: D) Eligibility verification and pre-authorization
Rationale: Eligibility verification and pre-authorization (also known as
"front-end" RCM activities) occur before the service is rendered to
confirm the patient's insurance coverage and obtain necessary
approvals, which helps prevent denials.
Question 5
What does the acronym "HIPAA" stand for?
A) Health Insurance Portability and Accountability Act
B) Healthcare Information Privacy and Accessibility Act
C) Health Information Protection and Administration Act
D) Hospital Insurance and Patient Access Act
E) Health Industry Professional Accreditation Act
Correct Answer: A) Health Insurance Portability and Accountability Act
Rationale: HIPAA is a U.S. federal law enacted in 1996 that primarily
sets standards for the protection of patient health information (PHI)
and impacts how electronic health information is exchanged.
Question 6
Which level of HCPCS codes are used to report services, procedures, and
supplies not covered by CPT codes (e.g., ambulance services, durable
medical equipment, prosthetic devices)?
A) CPT Level I
B) HCPCS Level II
C) ICD-10-CM
D) ICD-10-PCS
E) CDT codes
, Correct Answer: B) HCPCS Level II
Rationale: HCPCS Level II codes are alphanumeric codes used to
report products, supplies, and services not included in the CPT
(Level I) code set. Examples include ambulance services, DME,
orthotics, prosthetics, and certain drugs.
Question 7
A client has a health insurance plan with a $1,000 deductible, 80/20
coinsurance, and a $20 copayment for office visits. If the client has met their
deductible and has an approved charge of $100 for a service (not an office
visit), how much will the insurance pay?
A) $20
B) $80
C) $100
D) $0
E)
75CorrectAnswer:B)∗∗75CorrectAnswer:B)∗∗
80**
Rationale: Since the deductible has been met, coinsurance applies.
The insurance company pays 80% of the approved charge. 80% of
$100 is
80.Theclientwouldberesponsiblefortheremaining2080.Theclientwoul
dberesponsiblefortheremaining20
20). The copayment is for office visits only, not this service.
Question 8
What is the purpose of an Advance Beneficiary Notice of Noncoverage (ABN)?
A) To inform a patient that a service is covered by their insurance.
B) To notify a patient that Medicare may not pay for a service.
C) To request pre-authorization for a procedure.
D) To document a patient's medical history.
E) To collect a patient's copayment at the time of service.
Correct Answer: B) To notify a patient that Medicare may not pay for a
service.
Rationale: An ABN is a written notice given to Medicare beneficiaries
when a provider believes that Medicare may not pay for a service or
item. It informs the patient that they will be financially responsible
if Medicare denies payment.
ANSWERS (VERIFIED ANSWERS) |A+GRADE ASSURED
Question 1
Which of the following is the primary purpose of the ICD-10-CM coding
system in medical billing?
A) To describe medical procedures and services.
B) To classify and report diagnoses and reasons for encounters.
C) To identify medical equipment and supplies.
D) To categorize drugs and biologicals.
E) To track facility charges for inpatient stays.
Correct Answer: B) To classify and report diagnoses and reasons for
encounters.
Rationale: ICD-10-CM (International Classification of Diseases, Tenth
Revision, Clinical Modification) is the standard system used to code
diagnoses, symptoms, and causes of injury or disease, providing the
medical necessity for the services rendered.
Question 2
What is the function of a Modifier when appended to a CPT code?
A) To change the basic definition of the CPT code.
B) To provide additional information about the procedure or service
performed without changing its meaning.
C) To indicate the primary diagnosis for the encounter.
D) To identify the specific physician who performed the service.
E) To specify the location where the service was rendered.
Correct Answer: B) To provide additional information about the
procedure or service performed without changing its meaning.
Rationale: Modifiers provide additional relevant information about a
procedure or service, such as that the service was performed on an
unusual anatomical site, by more than one physician, or under
unusual circumstances, without altering the CPT code's basic
description.
Question 3
Which of the following forms is typically used by physicians and suppliers to
submit claims for outpatient services?
A) UB-04 (CMS-1450)
B) CMS-1500
C) HIPAA 837I
D) HIPAA 837P
E) CMS-1000
,Correct Answer: B) CMS-1500
Rationale: The CMS-1500 claim form is the standard paper form used
by physicians, suppliers, and other non-institutional providers to bill
for professional services. The UB-04 is used by institutions like
hospitals.
Question 4
Which component of the Revenue Cycle Management (RCM) process
occurs before a service is rendered?
A) Claims submission
B) Patient collections
C) Charge capture
D) Eligibility verification and pre-authorization
E) Denial management
Correct Answer: D) Eligibility verification and pre-authorization
Rationale: Eligibility verification and pre-authorization (also known as
"front-end" RCM activities) occur before the service is rendered to
confirm the patient's insurance coverage and obtain necessary
approvals, which helps prevent denials.
Question 5
What does the acronym "HIPAA" stand for?
A) Health Insurance Portability and Accountability Act
B) Healthcare Information Privacy and Accessibility Act
C) Health Information Protection and Administration Act
D) Hospital Insurance and Patient Access Act
E) Health Industry Professional Accreditation Act
Correct Answer: A) Health Insurance Portability and Accountability Act
Rationale: HIPAA is a U.S. federal law enacted in 1996 that primarily
sets standards for the protection of patient health information (PHI)
and impacts how electronic health information is exchanged.
Question 6
Which level of HCPCS codes are used to report services, procedures, and
supplies not covered by CPT codes (e.g., ambulance services, durable
medical equipment, prosthetic devices)?
A) CPT Level I
B) HCPCS Level II
C) ICD-10-CM
D) ICD-10-PCS
E) CDT codes
, Correct Answer: B) HCPCS Level II
Rationale: HCPCS Level II codes are alphanumeric codes used to
report products, supplies, and services not included in the CPT
(Level I) code set. Examples include ambulance services, DME,
orthotics, prosthetics, and certain drugs.
Question 7
A client has a health insurance plan with a $1,000 deductible, 80/20
coinsurance, and a $20 copayment for office visits. If the client has met their
deductible and has an approved charge of $100 for a service (not an office
visit), how much will the insurance pay?
A) $20
B) $80
C) $100
D) $0
E)
75CorrectAnswer:B)∗∗75CorrectAnswer:B)∗∗
80**
Rationale: Since the deductible has been met, coinsurance applies.
The insurance company pays 80% of the approved charge. 80% of
$100 is
80.Theclientwouldberesponsiblefortheremaining2080.Theclientwoul
dberesponsiblefortheremaining20
20). The copayment is for office visits only, not this service.
Question 8
What is the purpose of an Advance Beneficiary Notice of Noncoverage (ABN)?
A) To inform a patient that a service is covered by their insurance.
B) To notify a patient that Medicare may not pay for a service.
C) To request pre-authorization for a procedure.
D) To document a patient's medical history.
E) To collect a patient's copayment at the time of service.
Correct Answer: B) To notify a patient that Medicare may not pay for a
service.
Rationale: An ABN is a written notice given to Medicare beneficiaries
when a provider believes that Medicare may not pay for a service or
item. It informs the patient that they will be financially responsible
if Medicare denies payment.
