Who is covered by CHAMPVA? - ANSWERSVeterans 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 revealed a closed fracture of his left femur. The patient is covered by ...
Practice Examination – CPB Questions
& Answers
Who is covered by CHAMPVA? - ANSWERSVeterans 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 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? - ANSWERSThe employer's
group health plan.
Which do private companies contract with CMS to administer? - ANSWERSMedicare
Part A, B, & C
What is a co-payment? - ANSWERSA flat amount paid to the heathcare provider when
the policyholder is seen for an office vist.
Which of the following statements is true regarding the non-PAR Medicare allowed fee
schedule? - ANSWERSThe non-PAR limiting charge is 115% of the non-PAR Medicare
Physician Fee Schedule.
What is Medigap policy? - ANSWERSA policy that covers healthcare services that
Medicare does not cover.
Medicare Part A is available to individuals under the age of 65 who have which of the
following? - ANSWERSEnd-stage renal disease (ESRD) and meet certain
requirements.
Which of the following statements is true regarding Medicaid? - ANSWERSMedicaid
programs receive matching federal funding only if certain healthcare services are
provided to eligible individuals.
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? - ANSWERSMGAP
124356789
Medicaid covers EPSDT services. What is the definition of this acronym? -
ANSWERSEarly and Periodic Screening, Diagnostic, and Treatment
A Medicare patient has been treated for four (4) diagnoses during his last visit:
hypertension, type 2 diabetes, osteoarthritis, and CKD. How many diagnoses can be
, reported in Box 24E (Diagnosis Code Pointer) CMS-1500 claim form for each service
provided for this patient? - ANSWERSOne
To compare units of service with CPT and HCPCS Level II codes, CMS added which of
the following to the NCCI program? - ANSWERSMedically unlikely edits
Which of the following scenarios would support billing incident-to-services? -
ANSWERSAn established patient seen by a mid-level provider for follow-up for blood
pressure check, physician is in the office suite.
What is linked by NCD's and LCD's? - ANSWERSDiagnoses to procedures or service
that are determined to be reasonable and medically necessary for Medicare patients.
CPT codes 64418 and 19380 were reported together for the injection of the supra
capsular nerve with anesthetic agent (64418) with revision of a reconstructed breast
(19380). The injection was denied as a bundled service. What is the next step for the
biller? - ANSWERSWrite off the charge for 64418 because it is a bundled procedure.
By signing the Assignment of Benefits in item 13 of the CMS-1500 claim form, what is
the patient doing? - ANSWERSDirecting the insurance company to send the
reimbursement to the provider.
What form is revenue code that indicates the type or location of service reported on? -
ANSWERSUB-40 claim form
Which of the following statements is NOT true for the TOB codes? - ANSWERSDigit 1
identifies the type of facility.
The following types of charges would be reported on the CMS-1500 claim form
EXCEPT which? - ANSWERSRoom and board
How long do Medicare Conditions of Participation (CoP) require that medical records be
retained for? - ANSWERS5 years
The Health Insurance Portability and Accountability Act (HIPAA) defines abuse as which
of the following? - ANSWERSActions not consistent with accepted and sound medical,
business, or fiscal practices.
How often should authorization forms be updated for established patients who are seen
on a regular basis? - ANSWERSOnce a year
What is "qui tam"? - ANSWERSA provision in the False Claims Act which allows a
private citizen to file a lawsuit in the name of the US government.
Multiple CPT and HCPCS Level II codes should be listd on a CMS-1500 claims form in
what order? - ANSWERSFrom highest to lowest RVU
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