(CBCS)Certified Billing and Coding Specialist Exam
Questions and Verified Answers JUST RELEASED
Question 1
What is the purpose for using modifiers?
Correct Answer
Modifiers provide the means to report or indicate a service or procedure that has been altered
by some specific circumstance but not changed in its definition or code
Question 2
Auditing refers to which of the following?
A) Writing claims
B) Signing off on claims
C) Sending claims to third-party payers
D) Reviewing claims for accuracy and completeness
Correct Answer
D) Reviewing claims for accuracy and completeness
Many facilities have internal auditing systems to review claims for accuracy and completeness.
One of the main things an audit looks for is nonspecific or inaccurate use of diagnosis and
procedure codes.
Question 3
Describe when Medicare is the secondary insurance for a patient
Correct Answer
Medicare is the secondary insurance for a patient when she has a group health insurance plan,
is covered by workers' compensation, or is on disability
Question 4
,What are the four types of nonmedical codes used by Medicare to explain claims?
Correct Answer
Group codes, claims adjustments reason codes (CARCs), Remittance advice remark codes
(RARCs), and provider-level adjustment reason codes are not related to a specific claim. These
adjustments are made by the provider's office.
Question 5
Which of the following describes a clean claim?
A) All of the data elements are completed
B) All of the data elements are written on a white piece of paper
C) Almost all the data elements are right
D) All the necessary data elements are completed
Correct Answer
D) All the necessary data elements are completed
Clean claims are accurate and complete. They have all the information needed for processing.
Question 6
CPT codes are used to describe which of the following?
A) Supplies used during surgery
B) Type of insurance a patient has
C) Services rendered by the provider
D) Payments received from third-party payers
Correct Answer
C) Services rendered by the provider
Physicians use CPT codes for hospital inpatient and outpatient services and for those performed
in other facilities
Question 7
,The allowable charge is which of the following?
A) Amount the provider charges for a service
B) Amount the patient agrees to pay
C) Amount the health insurance company will pay providers
D) Amount set by hospitals
Correct Answer
C) Amount the health insurance company will pay providers
The allowable charge, also called allowable fee, maximum fee, maximum allowable, usual -
reasonable-customary, UCR charge, or prevailing rate, is the amount the insurer will actually pay
Question 8
The Stark Law states that:
A) Debt collection agencies can't use abusive or unfair practices to collect payment
B) The government can't be charged for substandard goods or services
C) Physicians can't refer patients to practitioners with whom they have a financial relationship
D) Private health information must be kept secure
Correct Answer
C) Physicians can't refer patients to practitioners with whom they have a financial relationship
Also referred to as the Physician Self-Referral Law, the Stark Law also prohibits the referred
practitioner from presenting claims to Medicare
Question 9
What is documentation?
Correct Answer
Documentation is a complete, accurate, up-to-date record of care a patient receives at a health
care facility.
Question 10
, The Office of the Inspector General is responsible for
A) Protecting health information
B) Fighting fraud
C) Helping health care professionals stay compliant with the laws
D) Disclosing health information
Correct Answer
B) Fighting fraud
HIPAA established a comprehensive programs to combat fraud called the Health Care Fraud and
Abuse Control (HCFAC) program, which is run by the OIG
Question 11
True or False: A copay is the patient's share of the insurance premium
Correct Answer
False
Insurance premium is a weekly, monthly, or annual cost for the plan or insurance coverage.
Copayment is the out-of-pocket cost
Question 12
Name one advantage and one disadvantage of a PPO
Correct Answer
PPOs generally provide greater choice in health care professionals patients can choose to see.
Patients do not need a referral from the provider to see a specialist. A disadvantage is that cost-
control measures, such as coinsurance and copayments, are usually in place
Question 13
What is the difference between consent and authorization?
Correct Answer
Questions and Verified Answers JUST RELEASED
Question 1
What is the purpose for using modifiers?
Correct Answer
Modifiers provide the means to report or indicate a service or procedure that has been altered
by some specific circumstance but not changed in its definition or code
Question 2
Auditing refers to which of the following?
A) Writing claims
B) Signing off on claims
C) Sending claims to third-party payers
D) Reviewing claims for accuracy and completeness
Correct Answer
D) Reviewing claims for accuracy and completeness
Many facilities have internal auditing systems to review claims for accuracy and completeness.
One of the main things an audit looks for is nonspecific or inaccurate use of diagnosis and
procedure codes.
Question 3
Describe when Medicare is the secondary insurance for a patient
Correct Answer
Medicare is the secondary insurance for a patient when she has a group health insurance plan,
is covered by workers' compensation, or is on disability
Question 4
,What are the four types of nonmedical codes used by Medicare to explain claims?
Correct Answer
Group codes, claims adjustments reason codes (CARCs), Remittance advice remark codes
(RARCs), and provider-level adjustment reason codes are not related to a specific claim. These
adjustments are made by the provider's office.
Question 5
Which of the following describes a clean claim?
A) All of the data elements are completed
B) All of the data elements are written on a white piece of paper
C) Almost all the data elements are right
D) All the necessary data elements are completed
Correct Answer
D) All the necessary data elements are completed
Clean claims are accurate and complete. They have all the information needed for processing.
Question 6
CPT codes are used to describe which of the following?
A) Supplies used during surgery
B) Type of insurance a patient has
C) Services rendered by the provider
D) Payments received from third-party payers
Correct Answer
C) Services rendered by the provider
Physicians use CPT codes for hospital inpatient and outpatient services and for those performed
in other facilities
Question 7
,The allowable charge is which of the following?
A) Amount the provider charges for a service
B) Amount the patient agrees to pay
C) Amount the health insurance company will pay providers
D) Amount set by hospitals
Correct Answer
C) Amount the health insurance company will pay providers
The allowable charge, also called allowable fee, maximum fee, maximum allowable, usual -
reasonable-customary, UCR charge, or prevailing rate, is the amount the insurer will actually pay
Question 8
The Stark Law states that:
A) Debt collection agencies can't use abusive or unfair practices to collect payment
B) The government can't be charged for substandard goods or services
C) Physicians can't refer patients to practitioners with whom they have a financial relationship
D) Private health information must be kept secure
Correct Answer
C) Physicians can't refer patients to practitioners with whom they have a financial relationship
Also referred to as the Physician Self-Referral Law, the Stark Law also prohibits the referred
practitioner from presenting claims to Medicare
Question 9
What is documentation?
Correct Answer
Documentation is a complete, accurate, up-to-date record of care a patient receives at a health
care facility.
Question 10
, The Office of the Inspector General is responsible for
A) Protecting health information
B) Fighting fraud
C) Helping health care professionals stay compliant with the laws
D) Disclosing health information
Correct Answer
B) Fighting fraud
HIPAA established a comprehensive programs to combat fraud called the Health Care Fraud and
Abuse Control (HCFAC) program, which is run by the OIG
Question 11
True or False: A copay is the patient's share of the insurance premium
Correct Answer
False
Insurance premium is a weekly, monthly, or annual cost for the plan or insurance coverage.
Copayment is the out-of-pocket cost
Question 12
Name one advantage and one disadvantage of a PPO
Correct Answer
PPOs generally provide greater choice in health care professionals patients can choose to see.
Patients do not need a referral from the provider to see a specialist. A disadvantage is that cost-
control measures, such as coinsurance and copayments, are usually in place
Question 13
What is the difference between consent and authorization?
Correct Answer
