Download AAPC Exam Test Bank: Questions & Answers (Verified) 2024-2025 and more Exams Management Information Systems in PDF only on Docsity!
AAPC-AMERICAN ACADEMY OF PROFESSIONAL CODERS EXAM
TEST BANK||QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) 2024- 2025
Mr. Peabody is an established client who was told by Dr. Woods to come back for an injection in his right knee if he was still getting pain due to arthritis. Mr. Peabody is in for just the injection. The physician only examines the knee (problem focused exam) before he gives the injection. Dr. Woods explains the risks associated with the procedure and the client gives consent. The doctor prepped the knee with betadine and injects the right knee with 10 mg of Depo- Medrol. How is this visit reported? A. 20610, J B. 99212 - 25, 20610, J C. 99212, 20610-25, J D. J Correct Answer: A. 20610, J A CRNA is performing a case personally without medical direction from an anesthesiologist. Which modifier is appropriately reported for the CRNA services? A. QX B. QZ
C. QK
D. QS
Correct Answer: B. QZ Client presents to her physician 10 weeks following a true posterior wall myocardial infarction. The client is still exhibiting symptoms of chronic ischemic heart disease. The physician reviews the current medications to confirm the client is compliant and discusses a heart-healthy diet and exercise. What is the correct ICD- 10 - CM code for this condition? A. I25. B. I21. C. I21. D. I25. Correct Answer: A. I25. When a nonparticipating provider files a claim for a client to BC/BS, how is the payment processed? A. The payment is sent to the client and the client must pay the provider. B. The payment is sent to the provider if the provider agrees to accept assignment. C. The payment is sent to the provider regardless if he accepts assignment. D. The claim is not paid because the provider is not participating in the plan. Correct Answer: A. The payment is sent to the client and the client must pay
In which of the following scenarios is Medicare the secondary payer? I. A 65 year-old client who is collecting her deceased spouse's Medicare benefits and has a supplemental insurance II. A 72 year-old client who participates in the group health insurance of his employer
III. A 66 year-old client is injured at work and the employer does not offer health insurance as a benefit of employment IV.A 55 year-old client who is on disability through Social Security and qualifies for Medicaid and Medicare A. I-IV B. II and III C. I and IV D. None Correct Answer: B. II and III When a client has Medicare primary and AARP as Medigap, what is entered on the CMS-1500 claim form in item 9d for the Insurance Plan Name or Program Name for Medicare to cross over the claim? A. Plan name followed by "MEDIGAP" B. Plan Payer ID followed by "MEDIGAP" C. COBA Medigap claim-based identifier (ID) D. Leave blank Correct Answer: C. COBA Medigap claim-based identifier (ID) Which guidelines must all billing personnel be knowledgeable about in order to ensure compliance with Medicaid programs? A. Federal guidelines B. State guidelines
D. None Correct Answer: C. Both A and B Which of the following services is covered by Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)? A. Family planning B. Obstetric care C. Pediatric checkups D. Emergency department visits Correct Answer: C. Pediatric checkups A female client who was involved in an auto accident presents to the emergency department (ED) for evaluation. She does not have any complaints. The provider evaluates her and determines there are no injuries. The provider informs the client to come back to the ED or see her primary care physician if she develops any symptoms. How is the claim processed for this encounter?
A. The medical insurance is billed primary and the auto insurance is billed secondary. B. The auto insurance is billed primary and the medical insurance is billed secondary. C. Bill the medical insurance first to receive a denial and then submit with the remittance advice to the auto insurance. D. Bill only the medical insurance because the auto insurance only covers damage to the vehicle, not medical expenses. Correct Answer: B. The auto insurance is billed primary and the medical insurance is billed secondary. What forms need to be submitted when billing for a work-related injury? A. Progress reports, and WC- 1500 claim form B. UB- 04 C. First Report of Injury form and an itemized statement D. First Report of Injury form, progress reports, and CMS-1500 claim form Correct Answer: D. First Report of Injury form, progress reports, and CMS- 1500 claim form A document provided to Medicare clients explaining their financial responsibility if Medicare denies a service is a(n): A. Notice of Financial Liability B. Advance Beneficiary Notice
B. IV
C. II and IV D. II, III, and V Correct Answer: C. II and IV A client covered by a PPO is scheduled for knee replacement surgery. The biller contacts the insurance carrier to verify benefits and preauthorize the procedure. The carrier verifies the client has a $500 deductible which must be met. After the deductible, the PPO will pay 80% of the claim. The contracted rate for the procedure is $2,500. What is the client's responsibility? A. $ B. $ C. $ D. $1,600 Correct Answer: C. $ A. Groups of doctors, hospitals, and other health care providers who coordinate high quality care to Medicare clients. B. An insurance carrier that provides a set fee based on the diagnosis of the client. C. A group of providers who contract with a third party administrator to pay fee for service for services. D. Hospitals who see a subset of clients for cost efficiency. Correct Answer: A. Groups of doctors, hospitals, and other health care providers who coordinate high quality care to Medicare clients.
A new client presents for her annual exam and has no complaints. She is scheduled to see the physician assistant (PA). How should services be billed? A. Bill under the PA. B. A new client can be billed incident to the physician. C. The PA cannot see new clients. D. Reschedule the client with the physician Correct Answer: A. Bill under the PA. CPT® codes 12032 and 12001 were reported together for a 2.6 cm intermediate repair of a laceration to the right arm and a 2.5 cm simple repair of a laceration to the left arm. 12001 was denied as a bundled service. What action should be taken by the biller (following the CPT® guidelines)? A. Write-off the charge for 12001 as it is a bundled procedure. B. Resubmit a corrected claim as 12032, 12001 - 59. C. Transfer the charge to client responsibility. D. Resubmit a corrected claim as 12032, 12001 - 51. Correct Answer: B. Resubmit a corrected claim as 12032, 12001-59. According to CMS, which of the following services are included in the global package for surgical procedures? I. Surgical procedure performed II. E/M visits unrelated to the diagnosis for which the surgical procedure
plans, healthcare clearinghouses and healthcare providers that participate in electronic data interchanges. Which of the following are requirements for the code sets? I. Dental services are reported with CDT codes II. Inclient procedures are reported with HCPCS Level II codes III. Diagnosis codes are reported with ICD- 10 - CM and ICD- 10 - PCS codes IV. Outclient services are reported with CPT® and HCPCS Level II codes V. Physician services are reported with ICD- 10 - PCS codes A. I and IV B. II, III, and V C. II, III, and IV D. II and IV Correct Answer: A. I and IV Which of the following indicates the frequency of care on a UB- 04 claim form? A. Revenue code B. Type of Bill C. MSDRG D. Condition code Correct Answer: B. Type of Bill Pam works for a medical practice. She discovered a claim was overpaid by Medicare. What Act requires the money to be refunded?
A. Health Insurance Portability and Accountability Act B. The Stark Act C. False Claims Act D. Consumer Credit Protection Act Correct Answer: C. False Claims Act Security involves the safekeeping of client information by: I. Setting office policies to protect PHI from alteration, destruction, tampering, or loss II. Allowing full access to all employees to the electronic medical records III. Giving employees a policy on confidentiality to read IV. Requiring employees to sign a confidentiality statement that details the consequences of not maintaining client confidentiality, including termination A. I and IV B. I, II, and IV C. II, III, and IV D. II and III Correct Answer: A. I and IV Dr. Taylor's office has a new medical assistant (MA) who is responsible for blood collection for lab specimens. Because the MA is new, she often misses when obtaining blood on the first stick. To be sure the office is billing for all services, the office now has a rule that all clients will be billed a minimum of two blood draws to demonstrate the work that is being done for lab collection. Which statement is true regarding this rule?
Which of the following is true regarding provider credentialing? A. A provider can complete an application with CAQH which handles credentialing for many payers. B. A provider is required to complete the credentialing process with private payers before an NPI application can be submitted. C. A provider can complete an application with NCQA to credential with private payers and obtain an NPI. D. Approval of the NPI number is all the provider needs to be credentialed with all payers. Correct Answer: A. A provider can complete an application with CAQH which handles credentialing for many payers. Which Act protects information collected by consumer reporting agencies? A. Equal Credit Opportunity Act B. Fair Credit Reporting Act C. Fair Debt Collection Practices Act D. Truth in Lending Act Correct Answer: B. Fair Credit Reporting Act There is a written office policy to write off clients co-insurance and copayment amounts as a professional courtesy. Is this appropriate? A. Yes, if it is a policy in writing it must be followed. B. Yes, if it is a written policy and everyone in the office adheres to it.
C. No, it is considered fraud to write off the clients' responsibility for all clients. D. No, it is a violation of Stark law to write off clients' responsibility. Correct Answer: C. No, it is considered fraud to write off the clients' responsibility for all clients. Which statement is TRUE regarding the Fair Debt Collection Practices Act (FDCPA)? A. Collectors are allowed to threaten legal action even if it will not be pursued. B. The FDPCA does not apply to medical practices. C. Collectors are allowed to contact debtors repeatedly. D. Collectors are not allowed to contact debtors at odd hours. Correct Answer: D. Collectors are not allowed to contact debtors at odd hours. Which of the following is an allowed collection policy after a client files for bankruptcy? A. Unpaid insurance claims for dates of service occurring after the date of the bankruptcy can be collected. B. Any co-payments or deductibles that are past due and owed by the client can be collected. C. Unpaid claims for dates of service occurring before the date of the bankruptcy and any co-pays or deductibles adjudicated on that same claim. D. Discuss a payment arrangement with the client to settle the past due account. Correct Answer: A. Unpaid insurance claims for dates of service occurring after the date of the bankruptcy can be collected.
claim cannot be reprocessed. A. I, II, and V B. I, IV, V and VI C. I, II, III, IV, and VI D. I-VI Correct Answer: C. I, II, III, IV, and VI What should a biller do when a claim is denied for not being submitted within the timely filing period? A. Track the transmission date of the claim. If within the timely filing period, provide the information to the payer to reprocess the claim. B. Write off the claim. The client is not responsible for claims denied for not being submitted within the timely filing period. C. Resubmit the claim with a different date of service that is within the timely filing period. D. Transfer the balance to client responsibility and try to collect from the client. Correct Answer: A. Track the transmission date of the claim. If within the timely filing period, provide the information to the payer to reprocess the claim. Incorrect entry of the client demographics can have an effect on many areas of the practice. What documents are necessary to verify demographics? I. Photo Identification
II. Insurance card III. Credit card information IV. Social Security card V. Client completed demographic form A. I and V B. II and IV C. II, IV and V D. I, II, and V Correct Answer: D. I, II, and V CMS has a standard enrollment form in which the provider agrees to: I. Submit claims to Medicare II. Have authorization from the Medicare beneficiary to file claims III. Retain all source documentation and medical records IV. Submit claims within 60 days of the date of service V. Submit all claims with a group NPI number VI. Research and correct claim discrepancies.
