CBCS PRACTICE TEST| 187 questions| WITH
COMPLETE SOLUTIONS
2. A claim is submitted with a transposed insurance member ID number & returned to the
provider. This describes the status that should be assigned to the claim by the carrier? Correct
Answer: INVALID
3. Medigap coverage is offered to Medicare beneficiaries by? Correct Answer: PRIVATE
THIRD-PARTY PAYER
4. This provision ensures that an insured's benefits from all insurance companies does not exceed
100% of allowable medical Correct Answer: Coordination of benefits
5. A coroner's autopsy is comprised of which examination? Correct Answer: Gross examination.
6. This statement is true regarding the release of patient records? Correct Answer: Patient access
to psychotherapy notes may be restricted.
7. Actions by a billing & coding specialist would be considered fraud? Correct Answer: Billing
for services not provided.
8. The components of an explanation of benefits expedites the process of a phone appeal?
Correct Answer: Claim control number.
9. On the CMS-1500 claim form, blocks 14 through 33 contain information of?. Correct Answer:
The patient's condition & the provider's information
10. A billing & coding specialist should understand that the financial record source that is
generated by a provider's office is called a? Correct Answer: Patient Ledger Account.
11. The medical terms refer to the sac that endoses the heart? Correct Answer: Pericardium.
12. HIPAA transaction standards apply to? Correct Answer: Health care clearinghouse.
13. All dependents 10 years of age or older are required to have which of the following for
TRICARE? Correct Answer: Military identification.
14. The standard medical abbreviation "ECG" refers to a test used to assess? Correct Answer:
Cardiovascular system.
15. An example of a violation of an adult patient's confidentiality? Correct Answer: Patient
information was disclosed to the patient's parent without consent.
16. Claims that are submitted without an NPI number will delay payment to the provider
because? Correct Answer: the number is needed to identify the provider
, 17. Sections of the medical record is used to determine the correct Evaluation & Management
code used for billing & coding? Correct Answer: History & physical
18. Actions should be taken if an insurance company denies a service as not medically
necessary? Correct Answer: Appeal the decision with a provider's report.
19. Missing #19 Correct Answer: misssing
20. The function of the respiratory system? Correct Answer: Oxygenating blood cells
21. This describes a delinquent claim? Correct Answer: The claim is overdue for payment.
22. What actions should the billing & coding specialist take if he observes a colleague in an
unethical situation? Correct Answer: Report the incident to a supervisor.
23. A participating Blue Cross/Blue Shield (BC/BS) provider receives an explanation of benefits
for a patient account. The charged amount was $100. BC/BS allowed $80 & applied $40 to the
patient's annual deductible. BC/BS paid the balance at 80%. How much should the patient expect
to pay? Correct Answer: $48.
24. This statement is correct regarding a deductible? Correct Answer: The deductible is the
patient's responsibility.
25. A physician ordered a comprehensive metabolic panel for a 70-year-old patient who has
Medicare as her primary insurance. This form is required so the patient knows she may be
responsible for payment? Correct Answer: Advance Beneficiary Notice.
26. What is the purpose of precertification? Correct Answer: Verification of coverage.
27. What claims is submitted & then optically scanned by the insurance carrier & converted to an
electronic form? Correct Answer: Paper claim
28. What information is required on a patient account record? Correct Answer: Name & address
of guarantor.
29. This includes procedures & best practices for correct coding? Correct Answer: Coding
Compliance Plan.
30. A patient who has a primary malignant neoplasm of the lung should be referred to ? Correct
Answer: Pulmonary oncologist
31. ICD-9-CM codes describes the circumstances of a patient who sustained an accidental
fracture of the proximal tibia? Correct Answer: E887 Fracture, cause unspecified.
COMPLETE SOLUTIONS
2. A claim is submitted with a transposed insurance member ID number & returned to the
provider. This describes the status that should be assigned to the claim by the carrier? Correct
Answer: INVALID
3. Medigap coverage is offered to Medicare beneficiaries by? Correct Answer: PRIVATE
THIRD-PARTY PAYER
4. This provision ensures that an insured's benefits from all insurance companies does not exceed
100% of allowable medical Correct Answer: Coordination of benefits
5. A coroner's autopsy is comprised of which examination? Correct Answer: Gross examination.
6. This statement is true regarding the release of patient records? Correct Answer: Patient access
to psychotherapy notes may be restricted.
7. Actions by a billing & coding specialist would be considered fraud? Correct Answer: Billing
for services not provided.
8. The components of an explanation of benefits expedites the process of a phone appeal?
Correct Answer: Claim control number.
9. On the CMS-1500 claim form, blocks 14 through 33 contain information of?. Correct Answer:
The patient's condition & the provider's information
10. A billing & coding specialist should understand that the financial record source that is
generated by a provider's office is called a? Correct Answer: Patient Ledger Account.
11. The medical terms refer to the sac that endoses the heart? Correct Answer: Pericardium.
12. HIPAA transaction standards apply to? Correct Answer: Health care clearinghouse.
13. All dependents 10 years of age or older are required to have which of the following for
TRICARE? Correct Answer: Military identification.
14. The standard medical abbreviation "ECG" refers to a test used to assess? Correct Answer:
Cardiovascular system.
15. An example of a violation of an adult patient's confidentiality? Correct Answer: Patient
information was disclosed to the patient's parent without consent.
16. Claims that are submitted without an NPI number will delay payment to the provider
because? Correct Answer: the number is needed to identify the provider
, 17. Sections of the medical record is used to determine the correct Evaluation & Management
code used for billing & coding? Correct Answer: History & physical
18. Actions should be taken if an insurance company denies a service as not medically
necessary? Correct Answer: Appeal the decision with a provider's report.
19. Missing #19 Correct Answer: misssing
20. The function of the respiratory system? Correct Answer: Oxygenating blood cells
21. This describes a delinquent claim? Correct Answer: The claim is overdue for payment.
22. What actions should the billing & coding specialist take if he observes a colleague in an
unethical situation? Correct Answer: Report the incident to a supervisor.
23. A participating Blue Cross/Blue Shield (BC/BS) provider receives an explanation of benefits
for a patient account. The charged amount was $100. BC/BS allowed $80 & applied $40 to the
patient's annual deductible. BC/BS paid the balance at 80%. How much should the patient expect
to pay? Correct Answer: $48.
24. This statement is correct regarding a deductible? Correct Answer: The deductible is the
patient's responsibility.
25. A physician ordered a comprehensive metabolic panel for a 70-year-old patient who has
Medicare as her primary insurance. This form is required so the patient knows she may be
responsible for payment? Correct Answer: Advance Beneficiary Notice.
26. What is the purpose of precertification? Correct Answer: Verification of coverage.
27. What claims is submitted & then optically scanned by the insurance carrier & converted to an
electronic form? Correct Answer: Paper claim
28. What information is required on a patient account record? Correct Answer: Name & address
of guarantor.
29. This includes procedures & best practices for correct coding? Correct Answer: Coding
Compliance Plan.
30. A patient who has a primary malignant neoplasm of the lung should be referred to ? Correct
Answer: Pulmonary oncologist
31. ICD-9-CM codes describes the circumstances of a patient who sustained an accidental
fracture of the proximal tibia? Correct Answer: E887 Fracture, cause unspecified.
