CBCS Practice Test
A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is
responsible for which of the following percentages? - ANS-0%
When services are covered by both Medicare and Medicaid, the beneficiary is not
responsible for the payment.
\A biller will electronically submit a claim to the carrier via which of the following? -
ANS-Direct Data Entry
\A billing and coding specialist can ensure appropriate insurance coverage for an outpatient
procedure by first using which of the following processes? - ANS-Precertification
\A billing and coding specialist has four past-due charges: $400 that is 10 weeks past due;
$100 that is six weeks past due; $1000 that is four weeks past due; and $2000 that is eight
weeks past due. Which of the following charges should be sent to collections first? -
ANS-$2000
\A billing and coding specialist is preparing a claim form for a provider from a group practice.
The billing and coding specialist should enter the rendering providers national provider
identifier into which of the following blocks on the CMS
-1500 claim form? - ANS-Block 24j
\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 needs to know how much Medicare paid on a claim before
billing the secondary insurance. To which of the following should the specialist refer? -
ANS-remittance advice
\A billing and coding specialist should add modifier -52 codes when reporting which of the
following? - ANS-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-Block 23
\A billing and coding specialist should routinely analyze which of the following to determine
the number of outstanding claims? - ANS-Aging report
\A billing and coding specialist should understand that the financial record source that is
generated by a provider's office is called a? - ANS-Patient ledger account
\A claim can be denied or rejected for which of the following reasons? - ANS-Block 24D
contains the diagnosis code
\A claim is denied because the service was not covered by the insurance company. Upon
confirmation of no errors on the claim, which of the following describes the process that will
follow the denial? - ANS-The claim will not be re-submitted and the patient will be sent a bill
\A claim is denied due to termination of coverage. Which of the following actions should the
billing and coding specialist take next? - ANS-Following up with a 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? - ANS-invalid
\A coroner's autopsy is comprised of which of the following examinations? - ANS-Gross
examination
, \A deductible of $100 is applied to a patient's remittance advice. The provider requests the
account personnel write it off. Which of the following terms describes this scenario? -
ANS-fraud
\A dependent child whose parents both have insurance coverage come to the clinic. The
billing and coding specialist uses the birthday rule determine which insurance policy is
primary. Which of the following describes the birthday rule? - ANS-The patient whose
birthday comes first in the calendar year
\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
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? - 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 - ANS-The wife's insurance
\A medicare non-participating providers 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? - ANS-$230
\A nurse is reviewing a patients lab results prior to discharge and discovers an elevated
glucose level. Which of the fowling health care providers should be alerted before the nurse
can proceed with the discharge planning? - ANS-The attending physician
\A participating Blue Cross Blue Shield provider receives an explanation of benefits for a
patient account. The charge amount was $100. Blue Cross Blue Shield allowed $80 and
applied $40 to the patient's annual deductible. Blue Cross Blue Shield paid the balance at
80%. How much should the patient expect to pay? - ANS-$48
The patient will pay a $40 deductible and 20% of the $40 balance
\A participating Blue Cross/Blue Shield (BC/BS) provider receives an explanation of benefits
for a patient account. The charges amount was $100. BC/BS allowed $80 and applied $40 to
the patients annual deductible. BC/BS paid the balance at 80%. How much should the
patient expect to pay? - ANS-$48
The patient will pay a $40 deductible and 20% of the $40 balance
\A patient comes to the hospital for an inpatient procedure. Which of the following hospital
staff members is responsible for the initial patient interview, obtaining demographic and
insurance information, and documenting the chief complaint? - ANS-admitting clerk
\A patient had AARP as secondary insurance l. In which of the following blocks on the
CMS-1500 claim form should this information be entered? - ANS-Block 9a
\A patient has AARP a secondary insurance. In which of the following blocks on the
CMS-1500 claim form should this information be entered? - ANS-Block 9
\A patient has an emergency appendectomy While on vacation. The claim is rejected due to
the patient obtaining service out of pocket. Which of the following information should be
included in the claim appeal? - ANS-The patient was out of town during the emergency
\A patient has laboratory work done in the emergency department after an inhalation of toxic
fumes from a faulty exhaust fan at her place of Employment. Which of the following is
responsible for the charges? - ANS-Workers compensation
\A patient has met a Medicare deductible of $150. The patient coinsurance is 20% and the
allowed amount is $600. Which of the following is the patients out of pocket expense? -
ANS-$150
A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is
responsible for which of the following percentages? - ANS-0%
When services are covered by both Medicare and Medicaid, the beneficiary is not
responsible for the payment.
\A biller will electronically submit a claim to the carrier via which of the following? -
ANS-Direct Data Entry
\A billing and coding specialist can ensure appropriate insurance coverage for an outpatient
procedure by first using which of the following processes? - ANS-Precertification
\A billing and coding specialist has four past-due charges: $400 that is 10 weeks past due;
$100 that is six weeks past due; $1000 that is four weeks past due; and $2000 that is eight
weeks past due. Which of the following charges should be sent to collections first? -
ANS-$2000
\A billing and coding specialist is preparing a claim form for a provider from a group practice.
The billing and coding specialist should enter the rendering providers national provider
identifier into which of the following blocks on the CMS
-1500 claim form? - ANS-Block 24j
\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 needs to know how much Medicare paid on a claim before
billing the secondary insurance. To which of the following should the specialist refer? -
ANS-remittance advice
\A billing and coding specialist should add modifier -52 codes when reporting which of the
following? - ANS-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-Block 23
\A billing and coding specialist should routinely analyze which of the following to determine
the number of outstanding claims? - ANS-Aging report
\A billing and coding specialist should understand that the financial record source that is
generated by a provider's office is called a? - ANS-Patient ledger account
\A claim can be denied or rejected for which of the following reasons? - ANS-Block 24D
contains the diagnosis code
\A claim is denied because the service was not covered by the insurance company. Upon
confirmation of no errors on the claim, which of the following describes the process that will
follow the denial? - ANS-The claim will not be re-submitted and the patient will be sent a bill
\A claim is denied due to termination of coverage. Which of the following actions should the
billing and coding specialist take next? - ANS-Following up with a 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? - ANS-invalid
\A coroner's autopsy is comprised of which of the following examinations? - ANS-Gross
examination
, \A deductible of $100 is applied to a patient's remittance advice. The provider requests the
account personnel write it off. Which of the following terms describes this scenario? -
ANS-fraud
\A dependent child whose parents both have insurance coverage come to the clinic. The
billing and coding specialist uses the birthday rule determine which insurance policy is
primary. Which of the following describes the birthday rule? - ANS-The patient whose
birthday comes first in the calendar year
\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
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? - 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 - ANS-The wife's insurance
\A medicare non-participating providers 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? - ANS-$230
\A nurse is reviewing a patients lab results prior to discharge and discovers an elevated
glucose level. Which of the fowling health care providers should be alerted before the nurse
can proceed with the discharge planning? - ANS-The attending physician
\A participating Blue Cross Blue Shield provider receives an explanation of benefits for a
patient account. The charge amount was $100. Blue Cross Blue Shield allowed $80 and
applied $40 to the patient's annual deductible. Blue Cross Blue Shield paid the balance at
80%. How much should the patient expect to pay? - ANS-$48
The patient will pay a $40 deductible and 20% of the $40 balance
\A participating Blue Cross/Blue Shield (BC/BS) provider receives an explanation of benefits
for a patient account. The charges amount was $100. BC/BS allowed $80 and applied $40 to
the patients annual deductible. BC/BS paid the balance at 80%. How much should the
patient expect to pay? - ANS-$48
The patient will pay a $40 deductible and 20% of the $40 balance
\A patient comes to the hospital for an inpatient procedure. Which of the following hospital
staff members is responsible for the initial patient interview, obtaining demographic and
insurance information, and documenting the chief complaint? - ANS-admitting clerk
\A patient had AARP as secondary insurance l. In which of the following blocks on the
CMS-1500 claim form should this information be entered? - ANS-Block 9a
\A patient has AARP a secondary insurance. In which of the following blocks on the
CMS-1500 claim form should this information be entered? - ANS-Block 9
\A patient has an emergency appendectomy While on vacation. The claim is rejected due to
the patient obtaining service out of pocket. Which of the following information should be
included in the claim appeal? - ANS-The patient was out of town during the emergency
\A patient has laboratory work done in the emergency department after an inhalation of toxic
fumes from a faulty exhaust fan at her place of Employment. Which of the following is
responsible for the charges? - ANS-Workers compensation
\A patient has met a Medicare deductible of $150. The patient coinsurance is 20% and the
allowed amount is $600. Which of the following is the patients out of pocket expense? -
ANS-$150
