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AAPC CPB - Chapter 10 Review: Multiple Choice Questions and Answers, Exams of Nursing

Newcastle UniversityNursing

A series of multiple choice questions and answers related to chapter 10 of the aapc cpb (certified professional biller) course. It covers topics such as the prompt payment act, patient balances, denials, financial policies, patient registration, debt collection practices, and insurance verification. The questions are designed to test understanding of key concepts and best practices in medical billing.

Typology: Exams

2023/2024

Available from 11/13/2024

DOCPASS
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AAPC CPB - Chapter 10 Review
Question and answer 100% solved
Which statement is TRUE regarding the Prompt Payment Act?
a. Patients are required to pay patient balances within 30 days.
b. Patient balances are dismissed if a statement is not sent to the patient within 30
days.
c. Federal agencies are not required to respond to all clean claims within 30 days of
receipt.
d. Federal agencies are required to pay clean claims within 30 days of receipt. - correct
answers d. Federal agencies are required to pay clean claims within 30 days of receipt.
When a provider wants to give a discount on services to a patient, which option is
acceptable?
a. The provider can waive the co-paymant at his discretion.
b. The provider can accept insurance only payments and write-off all patient balances.
c. The provider must discount the charge prior to billing the insurance carrier.
d. The provider cannot discount the charge under any circumstance. - correct answers
c. The provider must discount the charge prior to billing the insurance carrier.
What does a high number of days in A/R indicate for a medical practice?
a. The practice is using their A/R for loan purposes.
b. The practice has good policies in place, which results in good collections of
outstanding balances.
c. The practice potentially has a problem in the revenue cycle.
d. The days in A/R do not indicate anything about the practice. - correct answers c. The
practice potentially has a problem in the revenue cycle.
A provider removes a skin lesion in an ASC and receives a denial from the insurance
carrier that states "Lower level of care could have been provided." What steps should
the biller take?
a. Write-off the charge.
b. Check with the provider and write an appeal to the insurance carrier explaining why
the service was provided in the ASC.
c. Check with the provider and write an appeal to the insurance carrier explaining why
the service was not an inpatient service.
d. Submit the CMS-1500 claim form with a different place of service code. - correct
answers b. Check with the provider and write an appeal to the insurance carrier
explaining why the service was provided in the ASC.
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Download AAPC CPB - Chapter 10 Review: Multiple Choice Questions and Answers and more Exams Nursing in PDF only on Docsity!

AAPC CPB - Chapter 10 Review

Question and answer 100% solved

Which statement is TRUE regarding the Prompt Payment Act? a. Patients are required to pay patient balances within 30 days. b. Patient balances are dismissed if a statement is not sent to the patient within 30 days. c. Federal agencies are not required to respond to all clean claims within 30 days of receipt. d. Federal agencies are required to pay clean claims within 30 days of receipt. - correct answers d. Federal agencies are required to pay clean claims within 30 days of receipt. When a provider wants to give a discount on services to a patient, which option is acceptable? a. The provider can waive the co-paymant at his discretion. b. The provider can accept insurance only payments and write-off all patient balances. c. The provider must discount the charge prior to billing the insurance carrier. d. The provider cannot discount the charge under any circumstance. - correct answers c. The provider must discount the charge prior to billing the insurance carrier. What does a high number of days in A/R indicate for a medical practice? a. The practice is using their A/R for loan purposes. b. The practice has good policies in place, which results in good collections of outstanding balances. c. The practice potentially has a problem in the revenue cycle. d. The days in A/R do not indicate anything about the practice. - correct answers c. The practice potentially has a problem in the revenue cycle. A provider removes a skin lesion in an ASC and receives a denial from the insurance carrier that states "Lower level of care could have been provided." What steps should the biller take? a. Write-off the charge. b. Check with the provider and write an appeal to the insurance carrier explaining why the service was provided in the ASC. c. Check with the provider and write an appeal to the insurance carrier explaining why the service was not an inpatient service. d. Submit the CMS-1500 claim form with a different place of service code. - correct answers b. Check with the provider and write an appeal to the insurance carrier explaining why the service was provided in the ASC.

When accepting debit cards in a medical practice, which act requires the office to disclose specific information before completing a transaction? a. Health Insurance Portability and Accountability Act (HIPAA) b. Electronic Funds Transfer Act c. Equal Credit Opportunity Act d. Fair Credit Billing Act - correct answers b. Electronic Funds Transfer Act Which statement is TRUE regarding patient balances? a. Small balances for which processing costs exceed potential collections may be automatically written-off according to the financial policy of the practice. b. The financial policy of the practice cannot include information about write-offs for patient balances. c. Writing off any patient balance is considered waiving co-payments and puts the practice at risk for violating state and federal regulations. d. Best practices is to write-off any patient balance under $50.00. - correct answers a. Small balances for which processing costs exceed potential collections may be automatically written-off according to the financial policy of the practice. Which statement is TRUE regarding denials? a. Denials should be reviewed to determine whether additional information is needed, if errors need to be corrected, or if the denial should be appealed. b. All denials should be written off in the practice management system. If appealed and paid, the balance can be reversed. c. Denials for lack of medical necessity cannot be appealed. d. Denials for not timely filing cannot be appealed. - correct answers a. Denials should be reviewed to determine whether additional information is needed, if errors need to be corrected, or if the denial should be appealed. Review the following financial policy: Financial Policy: You are responsible for paying all co-payments at the time of service. Co-payments, co- insurance, deductibles and non-covered services cannot be waived by our office, as it is a requirement placed on you by your insurance carrier. Failure to pay your portion of services rendered will be reported to your insurance carrier and could result in termination of your insurance plan. Non-covered Services: The following services are considered "Non-Covered Services" by most insurance carriers. The fees listed below must be paid at the time of service.

  • Forms Completion: Disability Form, Insurance Form, Travel Form, Release from Work Form, Prior Authorization, and other forms are not required by most insurance plans or employers. If you require a physician to complete one of these forms, there will be a $ charge in addition to your office visit charge.

charge on which there is an unpaid personal balance will be billed a minimum of three times. 3-Insurance balances will be referred to internal follow-up staff for follow-up at 45 days post initial claim, and personal balances will be referred at the time the patient becomes responsible for payment. The collection services department becomes responsible for all balances as soon as the charge is entered. 4-Personal balances will be eligible for referral to an outside collection agency after three statements have been sent. Based on this policy, when does follow-up of insurance balances begin? a. Within two days of charge entry. b. After three claims have been sent. c. 45 days post initial claim. d. 60 days post initial claim. - correct answers b. After three claims have been sent. A claim has been denied as not medically necessary by Medicare. The biller has checked the patient's medical record and the patient's insurance policy. No ABN was signed. What is the next action the biller should take? I. Write-off the charge II. Check with the provider to appeal the claim III. Transfer the charge to the patient's account a. I b. II or III c. III d. I or II - correct answers d. I or II Which option below is the better way to ask the patient about their current demographic information? a. Is your address 123 Highway 21? b. Are you still at 123 Highway 21? c. Has your address changed? d. What is your current address? - correct answers d. What is your current address? What documents are needed for a successful appeal? a. Copy of the RA, copy of the medical record, copy of the original claim, and a letter detailing why the claim should be paid. b. The original RA, copy of the medical record, encounter form, and a statement from the patient. c. Copy of the RA, encounter form, medical record, and a letter detailing why the claim should be paid.

d. Copy of the medical record, a letter detailing why the claim should be paid, and a statement from the patient. - correct answers a. Copy of the RA, copy of the medical record, copy of the original claim, and a letter detailing why the claim should be paid. Which act protects information collected by the consumer reporting agencies? a. Truth in Lending Act b. Fair Credit Reporting Act c. Equal Credit Opportunity Act d. Fair Debt Collection Practices Act - correct answers b. Fair Credit Reporting Act Which statement is TRUE about a patient's insurance? a. Verification of coverage should happen once per year. b. Insurance coverage can only change at the beginning of a year and it is good for the remainder of the year. c. Verification of coverage should happen at each visit. d. Once you have a patient's insurance information, it is up to the patient to let you know when it changes. - correct answers c. Verification of coverage should happen at each visit. When a patient files Chapter 7 under the U.S. Bankruptcy Code, which statement is TRUE? a. The patient's debt is reorganized and paid at a discounted rate. b. The patient's debt is adjusted. c. Most medical debt is discharged, the provider will write-off amounts owed. d. The provider is required to refund the patient any balances paid. - correct answers c. Most medical debt is discharged, the provider will write-off amounts owed. What steps should be taken when a medical office receives notice that a patient has filed bankruptcy? a. Obtain the case number, verify the case filing, verify the provider is listed as a creditor and stop all collection efforts for balances filed under the bankruptcy. b. Obtain the case number and write-off all patient and insurance balances on the patient's account. c. Stop all collection efforts and dismiss the patient from the practice. d. Dismiss the patient from the practice and send any outstanding balances to a collection agency. - correct answers a. Obtain the case number, verify the case filing, verify the provider is listed as a creditor and stop all collection efforts for balances filed under the bankruptcy. Review the following financial policy: Collections Policy:

d. Make a note in the practice management system and let the insurance carrier identify it. - correct answers a. Research to determine if it is a true overpayment, then submit a refund to the insurance carrier for the overpayment.