CBCS practice test
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% - ANS-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 - ANS-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) - ANS-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 - ANS-$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) - ANS-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 - ANS-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 - ANS-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 - ANS-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) - ANS-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 - ANS-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 - ANS-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) - ANS-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 - ANS-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. - ANS-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?
- Follow up with the provider to determine current procedure code, diagnostic code and
provider number for resubmission
- Follow up with the patient to determine current primary care provider for resubmission
- Follow up with the provider to determine current patient's status and include a billing history
for resubmission
- Follow up with the patient to determine current name, address, and insurance carrier for
resubmission - ANS-Follow up with the patient to determine current name, address, and
insurance carrier for resubmission
\A claim is submitted with a transposed insurance member ID number and returned to the
provider. Which of the following describes the status that should be assigned to the claim by
the carrier?
- Suspended
- Pending
- Denied
- invalid - ANS-invalid
\A coroner's autoplay is comprised of which of the following examinations?
- Suppression testing
- Gross examination
- Diagnostic endoscopy
- Mohs micrographic examination - ANS-Gross examination
\A dependent child whose parents both have insurance coverage, comes to the clinic. The
CBCS uses the birthday rule to determine which insurance policy is primary. What is the
birthday rule?
- The parent who has the birthdate closer to the child
- The parent whose birthday comes first in the calendar year
- The parent who is older
- In the case of identical birthdates, the payment whose name is first alphabetically -
ANS-the parent whose birthday comes first in the calendar year
\A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment
information is called which of the following?
- Encounter form
- Itemized bill
- Chargemaster
- Remittance advice - ANS-encounter form
, \A husband and wife each have group insurance through their employers. The wife has an
appointment with her provider. Which insurance should be used as primary for the
appointment?
- Husbands insurance
- Whoever is older
- Whoever has their birthday first in the calendar year
- Wife's insurance - ANS-wife's insurance
\A Medicare non-participating (non-PAR) provider's approved payment amount is $200 for a
lobectomy and the deductible has been met. Which of the following amounts is the limiting
charge for this procedure?
- $160
- $200
- $170
- $230 (can collect a max of 15% over the non-PAR Medicare schedule amount) - ANS-$230
= can collect a max of 15% over the non-PAR Medicare schedule mount
\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 - ANS-attending physician
\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 - ANS-$48
\A patient comes to the hospital for an inpatient procedure. Which of the following staff
members is responsible for the initial patient interview, obtaining demographic and insurance
information, and documenting the chief complaint?
- Nurse
- Insurance billing clerk
- Admitting clerk
- Ward clerk - ANS-admitting clerk
\A patient has AARP as secondary insurance, in which of the following blocks on the
CMS-1500 form should this information be entered?
- 1a ( primary insurance carrier)
- 9 (secondary insurance)
- 21 (diagnoses)
- 16 (dated patient is unable to work) - ANS-9 (secondary insurance)
- 1a ( primary insurance carrier)
- 21 (diagnoses)
- 16 (dated patient is unable to work)
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% - ANS-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 - ANS-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) - ANS-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 - ANS-$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) - ANS-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 - ANS-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 - ANS-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 - ANS-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) - ANS-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 - ANS-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 - ANS-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) - ANS-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 - ANS-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. - ANS-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?
- Follow up with the provider to determine current procedure code, diagnostic code and
provider number for resubmission
- Follow up with the patient to determine current primary care provider for resubmission
- Follow up with the provider to determine current patient's status and include a billing history
for resubmission
- Follow up with the patient to determine current name, address, and insurance carrier for
resubmission - ANS-Follow up with the patient to determine current name, address, and
insurance carrier for resubmission
\A claim is submitted with a transposed insurance member ID number and returned to the
provider. Which of the following describes the status that should be assigned to the claim by
the carrier?
- Suspended
- Pending
- Denied
- invalid - ANS-invalid
\A coroner's autoplay is comprised of which of the following examinations?
- Suppression testing
- Gross examination
- Diagnostic endoscopy
- Mohs micrographic examination - ANS-Gross examination
\A dependent child whose parents both have insurance coverage, comes to the clinic. The
CBCS uses the birthday rule to determine which insurance policy is primary. What is the
birthday rule?
- The parent who has the birthdate closer to the child
- The parent whose birthday comes first in the calendar year
- The parent who is older
- In the case of identical birthdates, the payment whose name is first alphabetically -
ANS-the parent whose birthday comes first in the calendar year
\A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment
information is called which of the following?
- Encounter form
- Itemized bill
- Chargemaster
- Remittance advice - ANS-encounter form
, \A husband and wife each have group insurance through their employers. The wife has an
appointment with her provider. Which insurance should be used as primary for the
appointment?
- Husbands insurance
- Whoever is older
- Whoever has their birthday first in the calendar year
- Wife's insurance - ANS-wife's insurance
\A Medicare non-participating (non-PAR) provider's approved payment amount is $200 for a
lobectomy and the deductible has been met. Which of the following amounts is the limiting
charge for this procedure?
- $160
- $200
- $170
- $230 (can collect a max of 15% over the non-PAR Medicare schedule amount) - ANS-$230
= can collect a max of 15% over the non-PAR Medicare schedule mount
\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 - ANS-attending physician
\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 - ANS-$48
\A patient comes to the hospital for an inpatient procedure. Which of the following staff
members is responsible for the initial patient interview, obtaining demographic and insurance
information, and documenting the chief complaint?
- Nurse
- Insurance billing clerk
- Admitting clerk
- Ward clerk - ANS-admitting clerk
\A patient has AARP as secondary insurance, in which of the following blocks on the
CMS-1500 form should this information be entered?
- 1a ( primary insurance carrier)
- 9 (secondary insurance)
- 21 (diagnoses)
- 16 (dated patient is unable to work) - ANS-9 (secondary insurance)
- 1a ( primary insurance carrier)
- 21 (diagnoses)
- 16 (dated patient is unable to work)
