CPB Exam B Top Questions and answers. 100% Accurate, graded A+
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CPB Exam B Top Questions and answers. 100% Accurate, graded A+
What is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? - -Deductible
Which type of insurance covers physi...
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CPB Exam B Top Questions and
answers. 100% Accurate, graded A+
What is the term for the total amount of covered medical expenses a policyholder must pay each year
out-of-pocket before the health insurance company begins to pay any benefits? - ✔✔-Deductible
Which type of insurance covers physicians and other healthcare professionals for liability as to claims
arising from patient treatment? - ✔✔-Medical malpractice
Which of the following does NOT fall under group policy insurance? I. The premium is paid for by the
employee. II. The premium is paid for (or partially paid for) by an employer. III. The employer selects the
plan(s) to offer to employees. IV. Physical exams and medical history questionnaires are a mandatory
part of the application process. V. V. Employee can make changes to the policy. VI. The employee's
spouse and children are not eligible for coverage. - ✔✔-I, IV, V, VI
Dr. Wallace is in a capitation contract with Belleview Managed Care Health Plan.He received $25,000
from the health plan to provide services for the 175 enrollees on the health plan. The services provided
by Dr. Wallace to the enrollees cost $23,000. Based on the information, what must be done? - ✔✔-Dr.
Wallace can keep the $2,000 profit under the terms of the capitated plan.
What is the deadline for filing a Medicare claim? - ✔✔-One year from the date of service
A provider sees a patient who has TRICARE Standard. The provider is not contracted with TRICARE but is
certified by the regional TRICARE Managed Care Support Contractor (MCSC). The provider charges $200
for the office visit. TRICARE allows $160 and pays $140. How much can the provider bill the patient for? -
✔✔-$60.00
What organization is responsible in evaluating the medical necessity, appropriateness, and efficiency of
the use of healthcare services and procedures? - ✔✔-Utilization Review Organization
Medicaid providers are forbidden by law to: - ✔✔-Balance bill patients
, Which statement is FALSE about Local Coverage Determinations (LCDs)? - ✔✔-CMS develops LCDs when
there is no National Coverage Determination
When a minor procedure is performed on a Medicare patient, what is the global period and what
timeframe is covered? - ✔✔-10-day global period - the day of the procedure and 10 days following the
procedure
If add-on procedure code 11101 is performed twice during an office visit, how is it indicated on the CMS-
1500 claim form? - ✔✔-Code 11101 is reported once with the number 2 in box 24G
Which set of documentation guidelines can be used for E/M services submitted to Medicare for a
physician assistant (PA)? - ✔✔-Either 1995 or 1997 CMS documentation guidelines
Select the scenario that meets the incident-to requirements - ✔✔-Care is delivered to an established
patient by the physician assistant as part of the physician's treatment plan while the physician is seeing
another patient in the same office suite in a different room.
Medicare beneficiary is having a screening colonoscopy performed. How is the service reported to
Medicare? - ✔✔-G0121
Which providers submit the CMS-1500 claim form? I. Independent diagnostic testing facilities (IDTFs) II.
Emergency department physicians III. Hospice organizations IV. Ambulance companies submitting under
their own Medicare number V. Physicians in a group practice VI. Ambulatory surgery centers - ✔✔-I, II,
IV, V and VI
According to CPT® Radiology Guidelines if a patient is given oral contrast for a CT scan of the abdomen
which code is reported? - ✔✔-74150 Computed tomography, abdomen; without contrast material
Which of the following is NOT in the HIPAA Privacy Rule? - ✔✔-Implementing hardware, software,
and/or procedural mechanisms to record and examine access and other activity in information systems
that contains or use electronic PHI (e-PHI).
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