CBCS Practice Exam #3
A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is
responsible for which of the following percentages? - ANS-0%
\A biller will electronically submit a claim to the carrier via which of the following? -
ANS-Direct data entry
\A billing and coding specialist is reviewing a CMS-1500 claim form. The assignment of
benefits box has been checked yes. The checked box indicates which of the following? -
ANS-The provider receives payment directly from the payer.
\A billing and coding specialist should add modifier -50 to codes when reporting which of the
following? - ANS-A bilateral procedure
\A billing and coding specialist should enter the prior authorization number on the CMS-1500
claim form in which of the following blocks? - ANS-23
\A claim is denied due to termination of coverage. Which of the following actions should the
billing and coding specialist take next? - ANS-Follow up with the patient to determine current
name, address, and insurance carrier for resubmission
\A coroner's autopsy is comprised of which of the following examinations? - ANS-Gross
examination
\A dependent child whose parents both have insurance coverage comes to the clinic. The
billing and coding specialist uses the birthday rule to determine which insurance policy is
primary. Which of the following describes the birthday rule? - ANS-The parent whose
birthdate comes first in the calendar year
\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 and applied $40
to the patient's annual deductible. BC/BS paid the balance at 80%. How much should the
patient expect to pay? - ANS-$48
\A patient has met a Medicare deductible of $150. The patient's coinsurance is 20%, and the
allowed amount is $600. Which of the following is the patient's out-of-pocket expense? -
ANS-$120
\A patient presents to the provider with chest pain and shortness of breath. After an
unexpected ECG result, the provider calls a cardiologist and summarizes the patient's
symptoms. What portion of HIPAA allows the provider to speak to the cardiologist prior to
obtaining the patient's consent? - ANS-Title II
\A physician is contracted with an insurance company to accept the allowed amount. The
insurance company allows $80 of a $120 billed amount, and $50 of the deductible has not
been met. How much should the physician write off the patient's account? - ANS-$40
\A physician ordered a comprehensive metabolic panel for a 70-year-old patient who has
Medicare as her primary insurance. Which of the following forms is required so the patient
knows she may be responsible for payment? - ANS-Advanced Beneficiary Notice
\A prospective billing account audit prevents fraud by reviewing and comparing a completed
claim form with which of the following documents? - ANS-A billing worksheet from the patient
account
\A provider performs an examination of a patient's sore throat during an office visit. Which of
the following describes the level of the examination? - ANS-Problem-focused examination
, \A provider receives a reimbursement from a third-party payer accompanied by which of the
following documents? - ANS-Explanation of benefits
\After a third-party payer validates a claim, which of the following takes place next? -
ANS-Claim adjudication
\After reading a provider's notes about a new patient, a coding specialist decides to code for
a longer length of time than the actual office visit. Which of the following describes the
specialist's action? - ANS-Fraud
\Behavior plays an important part of being a team player in a medical practice. Which of the
following is an appropriate action for the billing and coding specialist to take? -
ANS-Communicating with the front desk staff during a team meeting about missing
information in patient files
\Block 17b on the CMS-1500 claim form should list which of the following information -
ANS-Referring physician's national provider identifier (NPI) number
\For which of the following time periods should the billing and coding specialist track unpaid
claims before taking follow-up action? - ANS-30 days
\HIPAA transaction standards apply to which of the following entities? - ANS-Health care
clearinghouses
\If a patient has osteomyelitis, he has problems with which of the following areas? -
ANS-Bones and bone marrow
\In 1995 and 1997, which of the following introduced documentation guidelines to Medicare
carriers to ensure that services paid for have been provided and were medically necessary?
- ANS-CMS
\In an outpatient setting, which of the following forms is used as a financial report of all
services provided to patients? - ANS-Patient account record
\Medicare enforces mandatory submission of electronic claims for most providers. Which of
the following providers is allowed to submit paper claims to Medicare? - ANS-A provider's
office with fewer than 10 full-time employees
\On the CMS-1500 claim form, Blocks 1 through 13 include which of the following? -
ANS-The patient's demographics
\On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the
following? - ANS-The patient's condition and the provider's information
\Patient charges that have not been paid will appear in which of the following? -
ANS-Accounts receivable
\The "><" symbol is used to indicate new and revised text other than which of the following?
- ANS-Procedure descriptors
\The destruction of lesions using cryosurgery would use which of the following treatments? -
ANS-Cold treatment
\The physician bills $500 to a patient. After submitting the claim to the insurance company,
the claim is sent back with no payment. The patient still owes $500 for the year. This amount
is called which of the following? - ANS-Deductible
\The provision of health insurance policies that specifies which coverage is considered
primary or secondary is called which of the following? - ANS-Coordination of benefits
\The standard medical abbreviation "ECG" refers to a test used to assess which of the
following body systems? - ANS-Cardiovascular
\The star symbol in the CPT code book is used to indicate which of the following? -
ANS-Telemedicine
A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is
responsible for which of the following percentages? - ANS-0%
\A biller will electronically submit a claim to the carrier via which of the following? -
ANS-Direct data entry
\A billing and coding specialist is reviewing a CMS-1500 claim form. The assignment of
benefits box has been checked yes. The checked box indicates which of the following? -
ANS-The provider receives payment directly from the payer.
\A billing and coding specialist should add modifier -50 to codes when reporting which of the
following? - ANS-A bilateral procedure
\A billing and coding specialist should enter the prior authorization number on the CMS-1500
claim form in which of the following blocks? - ANS-23
\A claim is denied due to termination of coverage. Which of the following actions should the
billing and coding specialist take next? - ANS-Follow up with the patient to determine current
name, address, and insurance carrier for resubmission
\A coroner's autopsy is comprised of which of the following examinations? - ANS-Gross
examination
\A dependent child whose parents both have insurance coverage comes to the clinic. The
billing and coding specialist uses the birthday rule to determine which insurance policy is
primary. Which of the following describes the birthday rule? - ANS-The parent whose
birthdate comes first in the calendar year
\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 and applied $40
to the patient's annual deductible. BC/BS paid the balance at 80%. How much should the
patient expect to pay? - ANS-$48
\A patient has met a Medicare deductible of $150. The patient's coinsurance is 20%, and the
allowed amount is $600. Which of the following is the patient's out-of-pocket expense? -
ANS-$120
\A patient presents to the provider with chest pain and shortness of breath. After an
unexpected ECG result, the provider calls a cardiologist and summarizes the patient's
symptoms. What portion of HIPAA allows the provider to speak to the cardiologist prior to
obtaining the patient's consent? - ANS-Title II
\A physician is contracted with an insurance company to accept the allowed amount. The
insurance company allows $80 of a $120 billed amount, and $50 of the deductible has not
been met. How much should the physician write off the patient's account? - ANS-$40
\A physician ordered a comprehensive metabolic panel for a 70-year-old patient who has
Medicare as her primary insurance. Which of the following forms is required so the patient
knows she may be responsible for payment? - ANS-Advanced Beneficiary Notice
\A prospective billing account audit prevents fraud by reviewing and comparing a completed
claim form with which of the following documents? - ANS-A billing worksheet from the patient
account
\A provider performs an examination of a patient's sore throat during an office visit. Which of
the following describes the level of the examination? - ANS-Problem-focused examination
, \A provider receives a reimbursement from a third-party payer accompanied by which of the
following documents? - ANS-Explanation of benefits
\After a third-party payer validates a claim, which of the following takes place next? -
ANS-Claim adjudication
\After reading a provider's notes about a new patient, a coding specialist decides to code for
a longer length of time than the actual office visit. Which of the following describes the
specialist's action? - ANS-Fraud
\Behavior plays an important part of being a team player in a medical practice. Which of the
following is an appropriate action for the billing and coding specialist to take? -
ANS-Communicating with the front desk staff during a team meeting about missing
information in patient files
\Block 17b on the CMS-1500 claim form should list which of the following information -
ANS-Referring physician's national provider identifier (NPI) number
\For which of the following time periods should the billing and coding specialist track unpaid
claims before taking follow-up action? - ANS-30 days
\HIPAA transaction standards apply to which of the following entities? - ANS-Health care
clearinghouses
\If a patient has osteomyelitis, he has problems with which of the following areas? -
ANS-Bones and bone marrow
\In 1995 and 1997, which of the following introduced documentation guidelines to Medicare
carriers to ensure that services paid for have been provided and were medically necessary?
- ANS-CMS
\In an outpatient setting, which of the following forms is used as a financial report of all
services provided to patients? - ANS-Patient account record
\Medicare enforces mandatory submission of electronic claims for most providers. Which of
the following providers is allowed to submit paper claims to Medicare? - ANS-A provider's
office with fewer than 10 full-time employees
\On the CMS-1500 claim form, Blocks 1 through 13 include which of the following? -
ANS-The patient's demographics
\On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the
following? - ANS-The patient's condition and the provider's information
\Patient charges that have not been paid will appear in which of the following? -
ANS-Accounts receivable
\The "><" symbol is used to indicate new and revised text other than which of the following?
- ANS-Procedure descriptors
\The destruction of lesions using cryosurgery would use which of the following treatments? -
ANS-Cold treatment
\The physician bills $500 to a patient. After submitting the claim to the insurance company,
the claim is sent back with no payment. The patient still owes $500 for the year. This amount
is called which of the following? - ANS-Deductible
\The provision of health insurance policies that specifies which coverage is considered
primary or secondary is called which of the following? - ANS-Coordination of benefits
\The standard medical abbreviation "ECG" refers to a test used to assess which of the
following body systems? - ANS-Cardiovascular
\The star symbol in the CPT code book is used to indicate which of the following? -
ANS-Telemedicine
