Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

Practice Exam

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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

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Practice Exam

2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Collecting Medicare Deductible

I had a recent experience where a surgery center insisted I pay my Medicare deductible to them when I presented for my surgery. I explained I had met part of the Medicare deductible for 2019 already from other medical bills. The reply was "we collect the Medicare deductible from all of our patinets". I had received a phone call from them prior to surgery which stated I had a Medicare deductible but did not say I had to pay it the day of the surgery. I
had always been told that physcian offices were not allowed to collect the Medicare deductible up front, that it was against Medicare regulations. I cannot find documentation of that regulation. Is it an actual regulation or just a suggestion?

Medical Billing and Coding Forum

deductible payment plan?

Do any other office based practices have a payment plan for the patients with high deductibles? We are an ortho office performing surgeries and seeing fracture care. Many of our patients have high deductible plans. Our providers would like a new policy to try to collect or at least sign up patients with high deductibles for payment plans with an automated credit card option.
Curious of your verbiage to patients and how well it is working? Do patients cancel their surgeries if they feel they can’t pay or feel they don’t want to?
Thank you in advance,
Jennifer Sanders, CPC, CPB, CPC-I, Fellow

Medical Billing and Coding Forum

COB- Secondary denying claims Primary already applied to deductible

I have a current OB patient who has BCBS as primary and Aetna as secondary. She has been seen for multiple office visits [99211] above her routine maternity visits due to a complication of her pregnancy. Her BCBS insurance has applied each of these visits to her deductible. When sent on to Aetna they have been denied as included in the global maternity billing and Aetna states the patient’s responsibility is zero. We are appealing this decision [as these visits should not be included in the global]. But if their decision stands, are we forced to take the write-off because we are contracted with them and eat the cost for the visits?

Medical Billing and Coding Forum

Assessing the Impact of High Deductible Health Plans on Radiology Practices

Before the days of managed care, insurance plans were “indemnity coverage” that reimbursed patients for their out-of-pocket costs. Physicians billed the patients and got paid when the patients felt like making payment, usually only after the insurance company had reimbursed them.  Often, the insurance money went elsewhere in the patient’s budget and the physician waited for payment.  The not-so-good old days!  With the advent of managed care contracting where physicians were paid directly by the insurance company, patient balance collections mostly disappeared.  Today the pendulum is swinging back in the opposite direction, requiring practices to once again face the necessity to collect significant balances from patients. 


Radiology Billing and Coding Blog

Deductible and Coinsurance Management

The best time to collect co-pays, deductible, coinsurance, and any outstanding balances from a patient is when he or she is in the office. As health insurance plans increase deductible and coinsurance amounts, defining policies on how to best collect is important to maintain cash flow and keep your accounts receivable (A/R) low. The deductible […]
AAPC Knowledge Center

Medicare deductible, coinsurance, and premium rates for 2016


The Centers for Medicare & Medicaid Services (CMS) issued the 2016 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. The 2016 deductible, coinsurance and base premium rates are:

2016 PART A – HOSPITAL INSURANCE (HI)

Deductible: $ 1,288.00

Coinsurance:
$ 322.00 a day for 61st-90th day
$ 644.00 a day for 91st-150th day (lifetime reserve days)
$ 161.00 a day for 21st-100th day (Skilled Nursing Facility coinsurance)

• Base Premium (BP): $ 411.00 a month
• BP with 10% surcharge: $ 452.10 a month
• BP with 45% reduction: $ 226.00 a month (for those who have 30-39 quarters of coverage)
• BP with 45% reduction and 10% surcharge: $ 248.60 a month 

2016 PART B – SUPPLEMENTARY MEDICAL INSURANCE (SMI)

Under Part B of the Medicare supplementary medical insurance (SMI) program, enrollees are subject to a monthly premium. Most SMI services are subject to an annual deductible and coinsurance (percent of costs that the enrollee must pay), which are set by statute.

Standard Premium: $ 121.80 a month

Deductible: $ 166.00 a year

Pro Rata Data Amount
$ 118.86 1st month 
$ 47.14 2nd month

Coinsurance: 20 percent


Coding Ahead