CBCS practice test Latest Update 2025-2026
Exam 255 Questions with 100% Verified Correct
Answers Guaranteed A+
A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating
provider is responsible for which of the following percentage?
40%
20%
10%
0% - CORRECT ANSWER: 0%
A biller will electronically submit a claim to the carrier via which of the following?
-Electronic remittance advice (response from insurance)
-Direct data entry
-Electronic fund transfer
-Charge data entry - CORRECT ANSWER: Direct data entry
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) - CORRECT 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 CBCS has four past-due charges: $400 that is 10 weeks past due; $800 that is 6
weeks past due; $1000 that is 4 weeks past due; and $2000 that is 8 weeks past due.
Which of one should be sent to collection first?
-$400
-$800
-$1000
- $2000 - CORRECT ANSWER: $2000 (the largest amount first)
A CBCS is preparing a claim from a provider from a group practice.. The CBCS should
enter the rendering provider's NPI into which of the following blocks on the CMS-1500?
- 17b (referring provider NPI)
- 24J
- 31 (providers signature)
- 25 (federal tax id number) - CORRECT ANSWER: 24J
- 17b (referring provider NPI)
- 31 (providers signature)
- 25 (federal tax id number)
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 - CORRECT ANSWER: The
provider receives payment directly from payer
A CBCS needs to know how much Medicare paid on a claim before billing the
secondary insurance. To which of the following should the specialist refer?
-Assignment of benefits
,-Medicare summary notice (how much the provider was billed and how much the patient
has to pay)
-Remittance advice
-Coordination of benefits - CORRECT ANSWER: remittance advice
A CBCS should add modifier -50 to codes when reporting which of the following?
- A bilateral procedure
- A unilateral procedure
- Multiple procedure
- Reduces services - CORRECT ANSWER: A bilateral procedure
A CBCS should enter the prior authorization number on the CMS-1500 claim form in
which of the following blocks?
- 21A (diagnosis code)
- 24 D (procedures and services)
- 23 (prior authorization)
- 24E (federal tax id) - CORRECT ANSWER: 23 (prior authorization)
- 21A (diagnosis code)
- 24 D (procedures and services)
- 24E (federal tax id)
A CBCS should routinely analyze which of the following to determine the number of
outstanding claims?
- Accounts payable report
- Aging report
- Remittance advice
- Explanation of benefits - CORRECT ANSWER: aging report
A CBCS should understand that the financial record source that is generated by the
provider's office is called a _______ .
, - Chargemaster
- Fee schedule
- Encounter form
- Patient ledger account - CORRECT ANSWER: Patient ledger account (history of
patient's financial record)
A CBCS submitted a claim to Medicare electronically. No errors were found by the billing
software or clearinghouse. Which of the following describes this claim?
- Pending claim
- Clean claim
- Tertiary claim (processed by both primary and secondary insurance)
- Physically clean claim (no staples, no highlighters) - CORRECT ANSWER: clean
A claim can be denied or rejected for which of the following reasons?
- All data is uppercase
- Block 25 contains the EIN of the rendering provider
- The patient's DOB is in eight digit format
- Block 24 D contains the diagnosis code - CORRECT ANSWER: Block 24 D contains
the diagnosis code (should be in 21)
A claim is denied because the service was not covered by the insurance. Upon
confirmation of no errors on the claim, which of the following describes the process that
will follow the denial?
- The claim will be submitted with a new CPT code
- The claim will not be resubmitted and the patient will be sent a bill
- The claim will be resubmitted with a modifier on the CPT code
- The claim will not be resubmitted, but the claim will be appealed. - CORRECT
ANSWER: The claim will not be resubmitted and the patient will be sent a bill
A claim is denied due to termination of coverage. Which of the following actions should
the CBCS take next?
Exam 255 Questions with 100% Verified Correct
Answers Guaranteed A+
A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating
provider is responsible for which of the following percentage?
40%
20%
10%
0% - CORRECT ANSWER: 0%
A biller will electronically submit a claim to the carrier via which of the following?
-Electronic remittance advice (response from insurance)
-Direct data entry
-Electronic fund transfer
-Charge data entry - CORRECT ANSWER: Direct data entry
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) - CORRECT 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 CBCS has four past-due charges: $400 that is 10 weeks past due; $800 that is 6
weeks past due; $1000 that is 4 weeks past due; and $2000 that is 8 weeks past due.
Which of one should be sent to collection first?
-$400
-$800
-$1000
- $2000 - CORRECT ANSWER: $2000 (the largest amount first)
A CBCS is preparing a claim from a provider from a group practice.. The CBCS should
enter the rendering provider's NPI into which of the following blocks on the CMS-1500?
- 17b (referring provider NPI)
- 24J
- 31 (providers signature)
- 25 (federal tax id number) - CORRECT ANSWER: 24J
- 17b (referring provider NPI)
- 31 (providers signature)
- 25 (federal tax id number)
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 - CORRECT ANSWER: The
provider receives payment directly from payer
A CBCS needs to know how much Medicare paid on a claim before billing the
secondary insurance. To which of the following should the specialist refer?
-Assignment of benefits
,-Medicare summary notice (how much the provider was billed and how much the patient
has to pay)
-Remittance advice
-Coordination of benefits - CORRECT ANSWER: remittance advice
A CBCS should add modifier -50 to codes when reporting which of the following?
- A bilateral procedure
- A unilateral procedure
- Multiple procedure
- Reduces services - CORRECT ANSWER: A bilateral procedure
A CBCS should enter the prior authorization number on the CMS-1500 claim form in
which of the following blocks?
- 21A (diagnosis code)
- 24 D (procedures and services)
- 23 (prior authorization)
- 24E (federal tax id) - CORRECT ANSWER: 23 (prior authorization)
- 21A (diagnosis code)
- 24 D (procedures and services)
- 24E (federal tax id)
A CBCS should routinely analyze which of the following to determine the number of
outstanding claims?
- Accounts payable report
- Aging report
- Remittance advice
- Explanation of benefits - CORRECT ANSWER: aging report
A CBCS should understand that the financial record source that is generated by the
provider's office is called a _______ .
, - Chargemaster
- Fee schedule
- Encounter form
- Patient ledger account - CORRECT ANSWER: Patient ledger account (history of
patient's financial record)
A CBCS submitted a claim to Medicare electronically. No errors were found by the billing
software or clearinghouse. Which of the following describes this claim?
- Pending claim
- Clean claim
- Tertiary claim (processed by both primary and secondary insurance)
- Physically clean claim (no staples, no highlighters) - CORRECT ANSWER: clean
A claim can be denied or rejected for which of the following reasons?
- All data is uppercase
- Block 25 contains the EIN of the rendering provider
- The patient's DOB is in eight digit format
- Block 24 D contains the diagnosis code - CORRECT ANSWER: Block 24 D contains
the diagnosis code (should be in 21)
A claim is denied because the service was not covered by the insurance. Upon
confirmation of no errors on the claim, which of the following describes the process that
will follow the denial?
- The claim will be submitted with a new CPT code
- The claim will not be resubmitted and the patient will be sent a bill
- The claim will be resubmitted with a modifier on the CPT code
- The claim will not be resubmitted, but the claim will be appealed. - CORRECT
ANSWER: The claim will not be resubmitted and the patient will be sent a bill
A claim is denied due to termination of coverage. Which of the following actions should
the CBCS take next?
