CBCS PRACTICE EXAMINATION 2026
QUESTIONS WITH ANSWERS GRADED A+
◍ A patient is pre authorized to receive vitamin B12 injections from January 1
to May 31. On June 2, the provider orders an additional 6 month of
injections. In order for the patient to continue with coverage of care, which
of the following should occur?- The patient should stop receiving the
injection because the authorization has lapsed- The patient should stop
receiving the injection and find a new provider- The provider should go
ahead with the injections due to medical necessity- The provider should
contact the insurance carrier to obtain a new authorization.
Answer: The provider should contact the insurance carrier to obtain a new
authorization- The patient should stop receiving the injection because the
authorization has lapsed- The patient should stop receiving the injection and
find a new provider- The provider should go ahead with the injections due to
medical necessity
◍ Which of the following is an example of Medicare abuse?- Billing for
services not furnished - Charging excessive fees- Falsifying medical
necessity - Upcoding charges.
Answer: charging excessive fees (all others are fraud)
◍ A provider performs an examination of a patient's sore throat. Which of the
following describes the level of the examination?- Expanded problem
focused examination - Detailed examination - Problem focused
examination- Comprehensive examination.
Answer: Problem focused examination- Expanded problem focused
examination ( specific examination of an affected organ system and related
organ systems)- Detailed examination (extended examination of an affected
organ system, and other related organ systems- Comprehensive examination
(general multi system examination)
,◍ A patient's health plan is referred to as the payer of last resort. The patient is
covered by which of the following health
plans?MedicaidCHAMPAMedicareTRICARE.
Answer: Medicaid
◍ A CBCS is reviewing a CMS-1500 claim form. The assignment of the
benefits box has been checked "yes". The check box indicates which of the
following?- The provider receives payment directly from payer- The payer
sends reimbursement for service to the patient- The payer pays the provider
a set amount for each enrolled person assignment of benefit box- The
provider can collect full payment from the patient.
Answer: The provider receives payment directly from payer
◍ Which of the following documents is required to disclose an adult patient's
information- A signed released for the patient's family member- The
patient's driver's license- A signed release from the patient- The patient's
social security card.
Answer: A signed release from the patient
◍ Which of the following is an example of electronic claim
submission?-Claim submitted via a secure network-Claims submitted via
fax-Claims that are computer generated paper claims-Claims that are
completed using the CMS-1500 claim form.
Answer: claim submitted via a secure network
◍ Which of the following shows outstanding balances?- Bad debt report- Fee
schedule- Aging report- Remittance advice.
Answer: aging report
◍ Which of the following is used to code diseases, injury and other health
related problems?- ICD - CPT- HCPCS- CDT.
Answer: ICD- CDT ( Current Dental terminology)
◍ A CBCS can ensure appropriate insurance coverage for an outpatient
procedure by first using which of the following processes?-
Predetermination (finals step to determine insurance reimbursement and
, patient responsibility)- Precertification (first step to determine if the patient
has coverage)- Preaudit (review of claim before adjudication)-
Preauthorization ( insurance approval for the procedure).
Answer: Precertification (first step to determine if the patient has coverage)-
Predetermination (finals step to determine insurance reimbursement and
patient responsibility- Preaudit (review of claim before adjudication)-
Preauthorization ( insurance approval for the procedure)
◍ A nurse is reviewing a patient's lab results prior to discharge and discovers
an elevated glucose level. Which of the following health care providers
should be alerted before the nurse can proceed with discharge planning?-
The attending physician- The admitting physician- The nursing supervisor-
The physician assistant.
Answer: attending physician
◍ Which of the following includes procedures and best practices for correct
coding?- Coding compliance plan - Retrospective audit - Prospective review
- Diagnosis related group.
Answer: Coding compliance plan (contains rules, procedures and best
practices to ensure accurate coding)- Retrospective audit (ensure correctness
of billing documents)- Prospective review ( ensure the appropriateness and
necessity of the care provided)- Diagnosis related group (Prospective
payment for acute care is based on the Diagnosis related groups)
◍ A provider charged $500 to a claim that had an allowable amount of $400.
In which of the following columns should the CBCS apply the non allowed
charge?-Reference column (For notations)-Description column-Payment
column-Adjustment column of the credits.
Answer: Adjustment column of the credits
◍ When submitting claims, which of the following is the outcome if block 13
is left blank?-The provider accepts assignment and payment as payment in
full-The provider cannot collect deductible, copayment, and coinsurance
amounts-This has no effect on the claim processing and reimbursement-The
third party payer reimburses the patient, and the patient is responsible for
, reimbursing the provider.
Answer: The third party payer reimburses the patient, and the patient is
responsible for reimbursing the provider
◍ Which of the following acts applies to the administrative simplification
guideline?-HIPAA-Deficit reduction act of 2005-The patient protection and
affordable care act 2009-National correct coding initiative of 1995.
Answer: HIPAA
◍ Threatening a catheter with a balloon into a coronary artery and expanding it
to repair arteries describes which of the following procedures?-
Valvuloplasty - Atherectomy - Angioplasty- Ablation.
Answer: Angioplasty- Valvuloplasty (open a stenotic heart valve)-
Atherectomy (Non surgical procedure to open blocked coronary arteries or
vein grafts by using a device on the end of a catheter to cut or shave away
atherosclerotic plaque. It does not us a balloon.- Ablation (radio frequency
waves of the heart is used to cure a variety of cardiac arrhythmia.)
◍ A participating blue cross/blue shield provider receives an explanation of
benefits for a patient account. The charged amount was $100. Blue shield
allowed $80 and applied $40 to the patient's annual deduction. Blue shield
paid the balance at 80%. How much should the patient expect to
pay?-$80-$56-$40-$48.
Answer: $48
◍ Which of the following forms must the patient or representative sign to
allow the release of PHI?- An authorization- An affidavit- A copy of the
HIPAA security rule- A copy of the HIPAA privacy rule.
Answer: an authorization
◍ Which of the following is fraud?- submitting a bill for claims not medically
necessary- Submitting a bill for services that are not covered- Submitting a
bill for duplicate charges on a claim- Unbundling a code for higher
reimbursement.
Answer: Unbundling a code for higher reimbursement
QUESTIONS WITH ANSWERS GRADED A+
◍ A patient is pre authorized to receive vitamin B12 injections from January 1
to May 31. On June 2, the provider orders an additional 6 month of
injections. In order for the patient to continue with coverage of care, which
of the following should occur?- The patient should stop receiving the
injection because the authorization has lapsed- The patient should stop
receiving the injection and find a new provider- The provider should go
ahead with the injections due to medical necessity- The provider should
contact the insurance carrier to obtain a new authorization.
Answer: The provider should contact the insurance carrier to obtain a new
authorization- The patient should stop receiving the injection because the
authorization has lapsed- The patient should stop receiving the injection and
find a new provider- The provider should go ahead with the injections due to
medical necessity
◍ Which of the following is an example of Medicare abuse?- Billing for
services not furnished - Charging excessive fees- Falsifying medical
necessity - Upcoding charges.
Answer: charging excessive fees (all others are fraud)
◍ A provider performs an examination of a patient's sore throat. Which of the
following describes the level of the examination?- Expanded problem
focused examination - Detailed examination - Problem focused
examination- Comprehensive examination.
Answer: Problem focused examination- Expanded problem focused
examination ( specific examination of an affected organ system and related
organ systems)- Detailed examination (extended examination of an affected
organ system, and other related organ systems- Comprehensive examination
(general multi system examination)
,◍ A patient's health plan is referred to as the payer of last resort. The patient is
covered by which of the following health
plans?MedicaidCHAMPAMedicareTRICARE.
Answer: Medicaid
◍ A CBCS is reviewing a CMS-1500 claim form. The assignment of the
benefits box has been checked "yes". The check box indicates which of the
following?- The provider receives payment directly from payer- The payer
sends reimbursement for service to the patient- The payer pays the provider
a set amount for each enrolled person assignment of benefit box- The
provider can collect full payment from the patient.
Answer: The provider receives payment directly from payer
◍ Which of the following documents is required to disclose an adult patient's
information- A signed released for the patient's family member- The
patient's driver's license- A signed release from the patient- The patient's
social security card.
Answer: A signed release from the patient
◍ Which of the following is an example of electronic claim
submission?-Claim submitted via a secure network-Claims submitted via
fax-Claims that are computer generated paper claims-Claims that are
completed using the CMS-1500 claim form.
Answer: claim submitted via a secure network
◍ Which of the following shows outstanding balances?- Bad debt report- Fee
schedule- Aging report- Remittance advice.
Answer: aging report
◍ Which of the following is used to code diseases, injury and other health
related problems?- ICD - CPT- HCPCS- CDT.
Answer: ICD- CDT ( Current Dental terminology)
◍ A CBCS can ensure appropriate insurance coverage for an outpatient
procedure by first using which of the following processes?-
Predetermination (finals step to determine insurance reimbursement and
, patient responsibility)- Precertification (first step to determine if the patient
has coverage)- Preaudit (review of claim before adjudication)-
Preauthorization ( insurance approval for the procedure).
Answer: Precertification (first step to determine if the patient has coverage)-
Predetermination (finals step to determine insurance reimbursement and
patient responsibility- Preaudit (review of claim before adjudication)-
Preauthorization ( insurance approval for the procedure)
◍ A nurse is reviewing a patient's lab results prior to discharge and discovers
an elevated glucose level. Which of the following health care providers
should be alerted before the nurse can proceed with discharge planning?-
The attending physician- The admitting physician- The nursing supervisor-
The physician assistant.
Answer: attending physician
◍ Which of the following includes procedures and best practices for correct
coding?- Coding compliance plan - Retrospective audit - Prospective review
- Diagnosis related group.
Answer: Coding compliance plan (contains rules, procedures and best
practices to ensure accurate coding)- Retrospective audit (ensure correctness
of billing documents)- Prospective review ( ensure the appropriateness and
necessity of the care provided)- Diagnosis related group (Prospective
payment for acute care is based on the Diagnosis related groups)
◍ A provider charged $500 to a claim that had an allowable amount of $400.
In which of the following columns should the CBCS apply the non allowed
charge?-Reference column (For notations)-Description column-Payment
column-Adjustment column of the credits.
Answer: Adjustment column of the credits
◍ When submitting claims, which of the following is the outcome if block 13
is left blank?-The provider accepts assignment and payment as payment in
full-The provider cannot collect deductible, copayment, and coinsurance
amounts-This has no effect on the claim processing and reimbursement-The
third party payer reimburses the patient, and the patient is responsible for
, reimbursing the provider.
Answer: The third party payer reimburses the patient, and the patient is
responsible for reimbursing the provider
◍ Which of the following acts applies to the administrative simplification
guideline?-HIPAA-Deficit reduction act of 2005-The patient protection and
affordable care act 2009-National correct coding initiative of 1995.
Answer: HIPAA
◍ Threatening a catheter with a balloon into a coronary artery and expanding it
to repair arteries describes which of the following procedures?-
Valvuloplasty - Atherectomy - Angioplasty- Ablation.
Answer: Angioplasty- Valvuloplasty (open a stenotic heart valve)-
Atherectomy (Non surgical procedure to open blocked coronary arteries or
vein grafts by using a device on the end of a catheter to cut or shave away
atherosclerotic plaque. It does not us a balloon.- Ablation (radio frequency
waves of the heart is used to cure a variety of cardiac arrhythmia.)
◍ A participating blue cross/blue shield provider receives an explanation of
benefits for a patient account. The charged amount was $100. Blue shield
allowed $80 and applied $40 to the patient's annual deduction. Blue shield
paid the balance at 80%. How much should the patient expect to
pay?-$80-$56-$40-$48.
Answer: $48
◍ Which of the following forms must the patient or representative sign to
allow the release of PHI?- An authorization- An affidavit- A copy of the
HIPAA security rule- A copy of the HIPAA privacy rule.
Answer: an authorization
◍ Which of the following is fraud?- submitting a bill for claims not medically
necessary- Submitting a bill for services that are not covered- Submitting a
bill for duplicate charges on a claim- Unbundling a code for higher
reimbursement.
Answer: Unbundling a code for higher reimbursement
