CPB PRACTICE EXAM QUESTIONS AND GUIDED ANSWERS 100%
PASS
WHO IS COVERED BY CHAMPVA?
A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR FAMILIES
B) ACTIVE DUTY MILITARY AND THEIR FAMILIES
C) RETIRED MILITARY AND THEIR FAMILIES
D) ACTIVE DUTY MILITARY OVER THE AGE OF 65 - A) VETERANS WITH SERVICE - CONNECTED
DISABILITIES AND THEIR FAMILIES
RATIONALE: THE CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE DEPARTMENT OF VETERANS
AFFAIRS (CHAMPVA) COVERS VETERANS WHO ARE PERMANENTLY AND TOTALLY DISABLED DUE
TO A SERVICE-RELATED DISABILITY AND THEIR SPOUSE AND CHILDREN.
PATIENT IS BROUGHT TO THE LOCAL URGENT CARE AFTER FALLING FROM A LADDER WHILE
HANGING EXTERIOR LIGHTS ON HIS HOUSE. X-RAYS REVEALED A CLOSED FRACTURE OF HIS LEFT
FEMUR. THE PATIENT IS COVERED BY HIS EMPLOYER'S GROUP HEALTH PLAN AND HE ALSO HAS A
HOMEOWNER'S LIABILITY INSURANCE POLICY. WHICH INSURANCE SHOULD BE BILLED?
A) THE HOMEOWNER'S INSURANCE FIRST, FOLLOWED BY THE GROUP HEALTH PLAN
B) THE EMPLOYER'S GROUP HEALTH PLAN
C) THE HOMEOWNER'S INSURANCE ONLY
D) FILE THE EMPLOYER'S GROUP HEALTH PLAN AS PRIMARY AND LIST THE HOMEOWNER'S
INSURANCE AS SECONDARY. - B) THE EMPLOYER'S GROUP HEALTH PLAN
RATIONALE: THE HEALTH INSURANCE PLAN IS BILLED FIRST AND THEN THROUGH THE PROCESS
OF SUBROGATION IT WILL BE DETERMINED IF A LIABILITY PAYER SHOULD BE CONSIDERED
PRIMARY.
3. PRIVATE COMPANIES CONTRACT WITH CMS TO ADMINISTER:
,A) MEDICARE PART A & B
B) MEDICARE PART B
C) MEDICARE PART C
D) MEDICARE PART A, B, & C - D) MEDICARE PART A, B, AND C
RATIONALE: MEDICARE PART A, B, AND C ARE ALL ADMINISTERED BY PRIVATE COMPANIES THAT
CONTRACT WITH CMS AS MEDICARE ADMINISTRATIVE CONTRACTORS OR MACs.
WHAT IS A CO-PAYMENT?
A) AN AMOUNT PAID EVERY MONTH BY THE POLICYHOLDER TO MAINTAIN HEALTH INSURANCE
COVERAGE
B) A PERCENTAGE OF THE ALLOWED AMOUNT THAT THE PATIENT IS RESPONSIBLE FOR.
C) A FLAT AMOUNT PAID TO THE HEALTHCARE PROVIDER WHEN THE POLICYHOLDER IS SEEN
FOR AN OFFICE VISIT.
D) THE ADJUSTED AMOUNT BASED ON THE INSURANCE POLICY REQUIREMENT. - C) A FLAT
AMOUNT PAID TO THE HEALTHCARE PROVIDER WHEN THE POLICY HOLDER IS SEEN FOR AN
OFFICE VISIT.
WHICH OF THE FOLLOWING STATEMENTS IS TRUE REGARDING THE NON-PAR MEDICARE
ALLOWED FEE SCHEDULE?
A) THE NON-PAR PROVIDER CAN BILL THE PATIENT THE DIFFERENCE BETWEEN THE CHARGE
AND THE MEDICARE ALLOWABLE.
B) THE NON-PAR LIMITING CHARGE IS 115% OF THE NON-PAR MEDICARE PHYSICIAN FEE
SCHEDULE
C) THE NON-PAR PHYSICIAN FEE SCHEDULE IS 115% OF THE PAR MEDICARE PHYSICIAN FEE
SCHEDULE
D) THE NON-PAR LIMITING CHARGE IS 95% OF THE PAR MEDICARE PHYSICIAN FEE SCHEDULE. -
B) THE NON-PAR LIMITING CHARGE IS 115% OF THE NON-PAR MEDICARE PHYSICIAN FEE
SCHEDULE.
RATIONALE: PER CMS, THE NON-PAR LIMITING CHARGE IS 115% OF THE NON-PAR MEDICARE
PHYSICIAN FEE SCHEDULE.
, WHAT IS A MEDIGAP POLICY?
A) A POLICY THAT COVERS HEALTHCARE SERVICES THAT MEDICARE DOES NOT COVER.
B) A POLICY THAT WILL NOT REIMBURSE FOR OUT-OF-POCKET COSTS NOT COVERED BY
MEDICARE
C) A SUPPLEMENTAL INSURANCE OFFERED BY CMS.
D) A POLICY REQUIRED BY MEDICARE. - A) A POLICY THAT COVERS HEALTHCARE SERVICES THAT
MEDICARE DOES NOT COVER.
MEDICARE PART A IS AVAILABLE TO INDIVIDUALS UNDER THE AGE OF 65 WHO HAVE:
A) DIABETES MELLITUS TYPE I OR II
B) CKD (CHRONIC KIDNEY DISEASE)
C) ESRD AND MEET CERTAIN REQUIREMENTS
D) ANY CHRONIC HEALTH CONDITION - C) ESRD AND MEET CERTAIN REQUIREMENTS.
RATIONALE: MEDICARE PART A COVERAGE IS AVAILABLE TO INDIVIDUALS BELOW THE AGE OF 65
WHO HAVE; 1) RECEIVED SOCIAL SECURITY OR RRB DISABILITY BENEFITS FOR 24 MONTHS, 2)
END-STAGE RENAL DISEASE AND MEET CERTAIN REQUIREMENTS
WHICH OF THE FOLLOWING STATEMENTS IS TRUE REGARDING MEDICAID?
A) MEDICAID ELIGIBILITY POLICIES ARE THE SAME FOR STATES OF SIMILAR SIZE AND
GEOGRAPHIC REGION.
B) MEDICAID ELIGIBILITY IS CLEAR AND CONSISTENT FROM STATE TO STATE
C) MEDICAID PROGRAMS RECEIVE MATCHING FFEDERAL FUNDING ONLY IF CERTAIN
HEALTHCARE SERVICES ARE PROVIDED TO ELIGIBLE INDIVIDUALS.
D) MEDICAID PROGRAMS MUST PROVIDE MEDICAL ASSISTANCE FOR ALL POOR PERSONS. - C)
MEDICAID PROGRAMS RECEIVE MATCHING FEDERAL FUNDING ONLY IF CERTAIN HEALTHCARE
SERVICES ARE PROVIDED TO ELIGBLE INDIVIDUALS.
PASS
WHO IS COVERED BY CHAMPVA?
A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR FAMILIES
B) ACTIVE DUTY MILITARY AND THEIR FAMILIES
C) RETIRED MILITARY AND THEIR FAMILIES
D) ACTIVE DUTY MILITARY OVER THE AGE OF 65 - A) VETERANS WITH SERVICE - CONNECTED
DISABILITIES AND THEIR FAMILIES
RATIONALE: THE CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE DEPARTMENT OF VETERANS
AFFAIRS (CHAMPVA) COVERS VETERANS WHO ARE PERMANENTLY AND TOTALLY DISABLED DUE
TO A SERVICE-RELATED DISABILITY AND THEIR SPOUSE AND CHILDREN.
PATIENT IS BROUGHT TO THE LOCAL URGENT CARE AFTER FALLING FROM A LADDER WHILE
HANGING EXTERIOR LIGHTS ON HIS HOUSE. X-RAYS REVEALED A CLOSED FRACTURE OF HIS LEFT
FEMUR. THE PATIENT IS COVERED BY HIS EMPLOYER'S GROUP HEALTH PLAN AND HE ALSO HAS A
HOMEOWNER'S LIABILITY INSURANCE POLICY. WHICH INSURANCE SHOULD BE BILLED?
A) THE HOMEOWNER'S INSURANCE FIRST, FOLLOWED BY THE GROUP HEALTH PLAN
B) THE EMPLOYER'S GROUP HEALTH PLAN
C) THE HOMEOWNER'S INSURANCE ONLY
D) FILE THE EMPLOYER'S GROUP HEALTH PLAN AS PRIMARY AND LIST THE HOMEOWNER'S
INSURANCE AS SECONDARY. - B) THE EMPLOYER'S GROUP HEALTH PLAN
RATIONALE: THE HEALTH INSURANCE PLAN IS BILLED FIRST AND THEN THROUGH THE PROCESS
OF SUBROGATION IT WILL BE DETERMINED IF A LIABILITY PAYER SHOULD BE CONSIDERED
PRIMARY.
3. PRIVATE COMPANIES CONTRACT WITH CMS TO ADMINISTER:
,A) MEDICARE PART A & B
B) MEDICARE PART B
C) MEDICARE PART C
D) MEDICARE PART A, B, & C - D) MEDICARE PART A, B, AND C
RATIONALE: MEDICARE PART A, B, AND C ARE ALL ADMINISTERED BY PRIVATE COMPANIES THAT
CONTRACT WITH CMS AS MEDICARE ADMINISTRATIVE CONTRACTORS OR MACs.
WHAT IS A CO-PAYMENT?
A) AN AMOUNT PAID EVERY MONTH BY THE POLICYHOLDER TO MAINTAIN HEALTH INSURANCE
COVERAGE
B) A PERCENTAGE OF THE ALLOWED AMOUNT THAT THE PATIENT IS RESPONSIBLE FOR.
C) A FLAT AMOUNT PAID TO THE HEALTHCARE PROVIDER WHEN THE POLICYHOLDER IS SEEN
FOR AN OFFICE VISIT.
D) THE ADJUSTED AMOUNT BASED ON THE INSURANCE POLICY REQUIREMENT. - C) A FLAT
AMOUNT PAID TO THE HEALTHCARE PROVIDER WHEN THE POLICY HOLDER IS SEEN FOR AN
OFFICE VISIT.
WHICH OF THE FOLLOWING STATEMENTS IS TRUE REGARDING THE NON-PAR MEDICARE
ALLOWED FEE SCHEDULE?
A) THE NON-PAR PROVIDER CAN BILL THE PATIENT THE DIFFERENCE BETWEEN THE CHARGE
AND THE MEDICARE ALLOWABLE.
B) THE NON-PAR LIMITING CHARGE IS 115% OF THE NON-PAR MEDICARE PHYSICIAN FEE
SCHEDULE
C) THE NON-PAR PHYSICIAN FEE SCHEDULE IS 115% OF THE PAR MEDICARE PHYSICIAN FEE
SCHEDULE
D) THE NON-PAR LIMITING CHARGE IS 95% OF THE PAR MEDICARE PHYSICIAN FEE SCHEDULE. -
B) THE NON-PAR LIMITING CHARGE IS 115% OF THE NON-PAR MEDICARE PHYSICIAN FEE
SCHEDULE.
RATIONALE: PER CMS, THE NON-PAR LIMITING CHARGE IS 115% OF THE NON-PAR MEDICARE
PHYSICIAN FEE SCHEDULE.
, WHAT IS A MEDIGAP POLICY?
A) A POLICY THAT COVERS HEALTHCARE SERVICES THAT MEDICARE DOES NOT COVER.
B) A POLICY THAT WILL NOT REIMBURSE FOR OUT-OF-POCKET COSTS NOT COVERED BY
MEDICARE
C) A SUPPLEMENTAL INSURANCE OFFERED BY CMS.
D) A POLICY REQUIRED BY MEDICARE. - A) A POLICY THAT COVERS HEALTHCARE SERVICES THAT
MEDICARE DOES NOT COVER.
MEDICARE PART A IS AVAILABLE TO INDIVIDUALS UNDER THE AGE OF 65 WHO HAVE:
A) DIABETES MELLITUS TYPE I OR II
B) CKD (CHRONIC KIDNEY DISEASE)
C) ESRD AND MEET CERTAIN REQUIREMENTS
D) ANY CHRONIC HEALTH CONDITION - C) ESRD AND MEET CERTAIN REQUIREMENTS.
RATIONALE: MEDICARE PART A COVERAGE IS AVAILABLE TO INDIVIDUALS BELOW THE AGE OF 65
WHO HAVE; 1) RECEIVED SOCIAL SECURITY OR RRB DISABILITY BENEFITS FOR 24 MONTHS, 2)
END-STAGE RENAL DISEASE AND MEET CERTAIN REQUIREMENTS
WHICH OF THE FOLLOWING STATEMENTS IS TRUE REGARDING MEDICAID?
A) MEDICAID ELIGIBILITY POLICIES ARE THE SAME FOR STATES OF SIMILAR SIZE AND
GEOGRAPHIC REGION.
B) MEDICAID ELIGIBILITY IS CLEAR AND CONSISTENT FROM STATE TO STATE
C) MEDICAID PROGRAMS RECEIVE MATCHING FFEDERAL FUNDING ONLY IF CERTAIN
HEALTHCARE SERVICES ARE PROVIDED TO ELIGIBLE INDIVIDUALS.
D) MEDICAID PROGRAMS MUST PROVIDE MEDICAL ASSISTANCE FOR ALL POOR PERSONS. - C)
MEDICAID PROGRAMS RECEIVE MATCHING FEDERAL FUNDING ONLY IF CERTAIN HEALTHCARE
SERVICES ARE PROVIDED TO ELIGBLE INDIVIDUALS.
