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
...
patient is brought to the local urgent care after falling from a ladder while hanging exterior lights on his house x rays re
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CPB PRACTICE EXAM QUESTIONS AND
ANSWERS
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 - Answer 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. - Answer 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 - Answer 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. - Answer 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. - Answer 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. - Answer 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 - Answer 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. - Answer C) MEDICAID PROGRAMS RECEIVE MATCHING
FEDERAL FUNDING ONLY IF CERTAIN HEALTHCARE SERVICES ARE PROVIDED
TO ELIGBLE INDIVIDUALS.
MEDICAID PROGRAMS MUST PROVIDE CERTAIN HEALTHCARE SERVICES TO
ELIGIBLE INDIVIDUALS IN ORDER TO RECEIVE MATCHING FEDERAL FUNDS
KNOWN AS FEDERAL MEDICAL ASSISTANCE PERCENTAGE (FMAP). THE
PERCENTAGE IS DETERMINED ON A YEAR TO YEAR BASIS USING A FORMULA
THAT COMPARES THE STATE'S PER CAPITA AVERAGE INCOME WITH THE
NATIONAL AVERAGE. STATES WITH LOWER AVERAGE INCOME PER CAPITA
RECEIVE A HIGHER FMAP.
WHEN SUBMITTING A MEDIGAP POLICY, WHICH OPTION IS AN EXAMPLE OF
HOW THE PATIENT'S ID NUMBER SHOULD APPEAR IN ITEM 9A OF THE CMS-
1500 CLAIM FORM?
A) 123456789
B) 123456789A
C) MGAP 123456789
D) AETNA 123456789 MEDIGAP - Answer C) MGAP 123456789
RATIONALE: IN ITEM 9A ENTER MEDIGAP FOLLOWED BY THE POLICY NUMBER
AND GROUP NUMBER IF APPLICABLE. THESE SHOULD BE SEPARATED BY
SPACES IE. MEDIGAP 123456 222. MG OR MGAP ARE ALSO ACCEPTABLE.
MEDICAID COVERS EPSDT SERVICES. WHAT IS THE DEFINITION OF THIS
ACRONYM?
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