AAPC CPB - CHAPTER 3: QUESTIONS

Which of the following does NOT qualify a patient for coverage under Medicare?

a. End Stage Renal Disease (ESRD)

b. Age 65 or older

c. Under age 65 with disabilities

d. Low income individual

d. Low income individual

The insurance claim process begins with:

a. Patient information

b. Charge entry

c. Scheduling an appointment

d. Submitting a claim

c. Scheduling an appointment

Which of the following statements is TRUE regarding patient demographics?

a. Demographic information can only be provided by the patient

b. Patient demographic information can be released to a third party

c. Patient demographic information entered incorrectly can result in claim denials

d. Claim processing is not affected by patient demographic information

c. Patient demographic information entered incorrectly can result in claim denials

Patient insurance card will contain vital information that will allow a claim to be processed. Which of the following is NOT provided on the insurance card?

a. Policy holder, group number

b. Claim number, CPT code, diagnosis

c. Policy holder, copay, deductible

d. Claims address, Group number

b. Claim number, CPT code, diagnosis

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

a. The mother's insurance is primary

Listed below are examples of patient reminders for appointments. Which one is HIPAA compliant?

a. "This is the obstetrical office calling to remind you of your appointment Tuesday, April 12 at 9 am for your annual exam."

b. "This is Dr. Smith's office calling to remind you of your appointment Tuesday, April 12 at 9 am for your annual exam."

c. "This is to confirm your appointment for your first prenatal visit with Dr. Jones. Please notify us if you are not able to keep this appointment."

d. "This is the doctor's office calling to remind you of your appointment Tuesday, April 12 at 9 am."

d. "This is the doctor's office calling to remind you of your appointment Tuesday, April 12 at 9 am."

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.

b. The father's insurance is primary because the mother has COBRA

The parent with which the child resides is considered to be a:

a. Step-parent

b. Non-custodial parent

c. Custodial parent

d. Natural parent

c. Custodial parent

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

d. Records requested for life insurance

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

c. Clean Claim

What authorizes information to be sent to the insurance payer so payment of medical benefits can be processed?

a. MSP

b. Consent for payment

c. Encounter form

d. Chargemaster List

b. Consent for payment

Which of the following lists the life cycle of a claim?

a. Claims submission, claims processing, claims adjudication, payment/denial

b. Claims submission, claim denial, statement sent

c. Claims submission, claims processing, patient payment

d. Claims submission, claims processing, claims adjudication

a. Claims submission, claims processing, claims adjudication, payment/denial

Verification of insurance will allow the practice to know the amount to collect from the patient at the time of visit. Which of the following is TRUE?

a. If the coverage is not in effect the patient should NOT be seen until the coverage can be verified.

b. Money should NOT be collected from the patient at the time of the visit.

c. The insurance should be verified with the patient only; it is the patient's responsibility to know what to pay.

d. If the insurance is unable to be verified, the patient is offered an option to reschedule the appointment or proceed with the current appointment as a self-pay patient.

d. If the insurance is unable to be verified, the patient is offered an option to reschedule the appointment or proceed with the current appointment as a self-pay patient.

When a fee ticket (encounter form) is not completed, what procedure would NOT be acceptable?

a. Complete the form based on medical record documentation

b. Query the provider for the procedure/service and diagnosis

c. Post the service as a no charge

d. Return the form to the provider for completion

c. Post the service as a no charge

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

b. The patient's insurance because she is the primary subscriber

What process would NOT be performed at the check-out process?

a. Follow-up appointments

b. Collection of copays or deductibles

c. Review of charge ticket or encounter form

d. Patient registration process

d. Patient registration process

Information about deductibles, copays, eligibility dates, and benefit plans is completed during what step?

a. Patient registration

b. Verification of Benefits

c. Patient check-in

d. Consent for payment

b. Verification of Benefits

Patient types help to classify the patients based on

a. Age

b. Payer

c. Diagnosis

d. Address

b. Payer

The group number on the insurance card is used to identify:

a. The insured

b. The covered employer group

c. The insurance company

d. The policy number

b. The covered employer group

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

a. Authorization to Disclose Health Information

Patient is seen and billed for a 99213 for $75.00. She has a policy that pays 80% of the allowable amount which is $68.00. What is the patient responsibility and amount to collect for the visit?

a. $15.00

b. $61.40

c. $13.60

d. $10.00

c. $13.60

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

b. Through a clearinghouse

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

b. The primary insurance is determined by the birthday rule

Which of the following processes could result in lost charges?

a. The total of daily charge tickets and the amount posted in the PMS balance

b. Batch dates of service and post as a batch date

c. Balance the charge tickets, copays, and the amounts posted in the PMS with the daily appointment schedule

d. Posting charges and payment in different batches with no balancing

d. Posting charges and payment in different batches with no balancing