AAPC CPB - Chapter 3 Review

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

When reading an insurance card what information should the receptionist or front office person look for? a. Policy holder name, ID number, benefits b. Policy holder, ID number, address for patient c. Policy holder name, copay and deductible, patient's birthdate d. Policy holder name, copay and deductible, patient's address

a. Policy holder name, ID number, benefits

In what circumstance would the checkout process be unnecessary? a. The patient made a copay during the check-in process and no follow up appointment is necessary b. The patient needs to make a follow-up appointment c. The patient had a procedure performed in addition to the E/M and need to return in a week d. The patient has services performed that are not covered by the insurance

a. The patient made a copay during the check-in process and no follow up appointment is necessary

Which statement is TRUE regarding appointment reminders? a. Appointment reminders do not help mitigate the risk of missed appointments. b. Appointment reminders can be sent via text. c. You must have a HIPAA authorization for release of information to send appointment reminders. d. The staff time required for appointment reminders makes it unnecessary to remind patients of upcoming appointments.

b. Appointment reminders can be sent via text.

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

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 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

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

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 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

When charges are entered and all required components are verified by the claims editing system, what would this be considered as? a. Completed process b. Denial resolution c. A clean claim d. Claim submission

c. A clean claim

Which of the following is NOT considered a part of the authorized process when the patient signs the consent for payment? a. Authorize payment to the provider b. Authorize submission of a claim to insurance company c. Authorization for treatment d. Accept responsibility for any balance that is not covered by the patient's insurance

c. Authorization for treatment

When insurance coverage is being verified, which of the following is NOT a method on which to rely? a. Phone b. Internet c. Patient d. Clearinghouse

c. Patient

The back of the health insurance card includes what information? a. Primary Care Provider b. Copays c. Phone or contact information for eligibility d. Group number

c. Phone or contact information for eligibility

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

Which software system is used to store appointments, scheduling, registration, and billing and receivables? a. Electronic Health Record (EHR) b. Health Information Management System c. Practice Management System (PMS) d. Electronic Medical Record (EMR)

c. Practice Management System (PMS)

A patient calls the PCP office after hours and is told to go to the ER. What copay would be applicable to the ER visit? ABC Insurance Policy Holder Name ID: 1234 Benefits Deductible: $2500 Single $4000 Family Copays: Office: $35.00 Specialist: $50.00 ER: $100.00 waived if admitted Pharmacy-Rx $10/$25/$50 a. $25.00 b. $35.00 c. $50.00 d. $100.00

d. $100.00

What information can be released based on this Disclosure form? AAPC Physician Practice are authorized to make the disclosure. The type of information to be used or disclosed is as follows: ____ Problem list ____ Medication list ____ List of allergies ____ Immunization records ____ Most recent history __X_ Most recent discharge summary __X__ Lab results (dates or types) __X__ X-Ray and imagining reports (dates or types) ____ Consultation reports from ___ Entire record a. The most recent visit b. Entire record c. Lab and X-ray d. Discharge summary, lab, and X-ray

d. Discharge summary, lab, and X-ray

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.

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

Which statement regarding patient demographic information is correct? a. The patient does not need to provide all information on the registration form. b. The patient will always be the responsible party. c. There is no need for a copy of the insurance card if the patient demographic sheet is completed in its entirety. d. Patients can provide information by completing a paper form or by completing an online registration.

d. Patients can provide information by completing a paper form or by completing an online registration.

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