AAPC Chapter 13 Practical Application

Based on the question above, how should the claim be corrected? A. Correct the dates on the claim. B. Correct the coding on the claim. C. Correct the dates and the coding on the claim. D. There is nothing to correct on the claim.

A. Correct the dates on the claim. Response Feedback: Correct the date of service to 8/29/20XX.

Based on the question above, what action(s) should the biller take? I. Correct the dates on the claim and refile. II. Correct the insurance information on the claim and refile. III. Correct the codes on the claim and refile. IV. Write-off the charge. A. I and II B. III C. IV D. Wait for the insurance carrier to pay the claim.

A. I and II Response Feedback: The claim shows the Insured name as different from the patient name. Review the medical record, correct the claim and resubmit for payment. The claim form shows 2 different dates of birth for the patient. Review the medical record, correct the claim and resubmit for payment.

Use CPB Chapter 13_Case 1.pdf to answer questions 1 & 2. What is incorrect on this claim? I. Birth date II. Date of service III. CPT code(s) IV. ICD-10-CM code V. HCPCS code A. II only B. I and V C. V only D. There are no errors on the claim.

A. II only Response Feedback: The date of service was 8/29/20XX. The Box 24 A line 3 for HCPCS code J7609 shows 8/30/20XX. Correct the date of service on the line and resubmit the claim for payment.

Use CPB Chapter 13_Case 3.pdf to answer the following question. What is incorrect on this claim? I. Date of service II. Date of birth III. CPT code IV. ICD-10-CM code V. Insurance ID number A. I only B. II, III and IV C. I and II D. III, IV, and V

B. II, III and IV Response Feedback: DOB is incorrect. The claim shows the procedure code is for an ED visit and not an office visit. The ICD-10-CM code is also incorrect. ICD-10-CM code Z00.121 should be reported because abnormal findings were found during the exam such as the mild thrush and diaper rash. Review the medical record, correct the claim and resubmit for payment.

Use CPB Chapter 13_Case 2.pdf to answer the following question. What is incorrect on this claim? A. The claim form is missing the FECA number. B. The claim shows the patient's condition is related to an auto accident but there no record of that in the demographics or the medical record. C. The ICD-10-CM code is reported incorrectly. D. There are no errors on this claim.

B. The claim shows the patient's condition is related to an auto accident but there no record of that in the demographics or the medical record. Response Feedback: There is no mention of the patient's pain being related to an auto accident. Correct the claim and resubmit.

Use CPB Chapter 13_Case 6.pdf to answer the following question. According to this remittance advice, why was this Aetna claim denied? A. The claim was deemed as patient responsibility. B. The patient's eligibility expired. C. The payer does not cover injections. D. The date of service is incorrect on the claim.

B. The patient's eligibility expired. Response Feedback: The reason for denial is the patient's eligibility has expired.

Use CPB Chapter 13_Case 7.pdf to answer the following question. From review of the case above, why was this claim denied? A. The patient's eligibility is invalid. B. The payer does not cover preventive or wellness visits. C. The CPT code is invalid. D. The services is not medically necessary.

B. The payer does not cover preventive or wellness visits. Response Feedback: The claim was denied because preventive services are not covered by the plan.

Based on the question above, what action should the biller take? A. The claim was incorrectly denied, resubmit the claim to the insurance carrier as is. B. Correct the date of service and refile the claim. C. Contact the patient to obtain current insurance information and resubmit the claim to the correct payer. D. Injections are not covered, write off the balance.

C. Contact the patient to obtain current insurance information and resubmit the claim to the correct payer. Response Feedback: When a claim is denied for expired insurance eligibility, the patient should be contacts to obtain the correct information.

Use CPB Chapter 13_Case 4.pdf to answer the following question. What is incorrect on this claim? I. Date of service II. Birth date III. Insured's ID number IV. Insured's name V. CPT code VI. ICD-10-CM code A. I and III B. IV and V C. II, III, and IV D. There are no errors on this claim.

C. II, III, and IV Response Feedback: The claim shows the Insured name as different from the patient name and two different ID numbers. The claim form shows 2 different dates of birth for the patient. Review the medical record, correct the claim and resubmit for payment.

Use CPB Chapter 13_Case 5.pdf to answer the following question. This claim was rejected by the clearinghouse. What information is incorrect on this claim? A. Insured's information B. CPT, ICD-1-CM, or HCPCS Level II coding C. The place of service D. There are no errors on this claim.

C. The place of service Response Feedback: The place of service is missing.

Based on the denial above, what action should the biller take? A. Write-off the balance. B. Re-file the claim. C. Transfer the balance to the patient. D. Appeal the claim.

C. Transfer the balance to the patient. Response Feedback: The remittance advice indicates the balance is the patient responsibility with PR. The balance should be transferred to the patient.

Based on the question above, what should the biller do? A. Correct the date of birth on the claim. B. Check the medical record and correct the coding on the claim. C. Correct the patient's insurance information. D. Both A and B.

D. Both A and B. Response Feedback: The claim shows the procedure code is for an ED visit and not an office visit. Review the medical record, correct the claim and resubmit for payment. Correct the date of birth.