Exam (elaborations)
CPB PRACTICE EXAM QUESTIONS AND ANSWERS ,GRADED A+
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CPB PRACTICE EXAM QUESTIONS AND ANSWERS ,GRADED A+
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CPB PRACTICE EXAM QUESTIONS ANDANSWERS ,GRADED A+
WHO ffIS ffCOVERED ffBY ffCHAMPVA?
A) ffVETERANS ffWITH ffSERVICE ff- ffCONNECTED ffDISABILITIES ffAND ffTHEIR
ffFAMILIES ff
B) ffACTIVE ffDUTY ffMILITARY ffAND ffTHEIR ffFAMILIES
C) ffRETIRED ffMILITARY ffAND ffTHEIR ffFAMILIES
D) ffACTIVE ffDUTY ffMILITARY ffOVER ffTHE ffAGE ffOF ff65 ff- ffAnswer ffA) ffVETERANS
ffWITH ffSERVICE ff- ffCONNECTED ffDISABILITIES ffAND ffTHEIR ffFAMILIES
RATIONALE: ffTHE ffCIVILIAN ffHEALTH ffAND ffMEDICAL ffPROGRAM ffOF ffTHE
ffDEPARTMENT ffOF ffVETERANS ffAFFAIRS ff(CHAMPVA) ffCOVERS ffVETERANS
ffWHO ffARE ffPERMANENTLY ffAND ffTOTALLY ffDISABLED ffDUE ffTO ffA ffSERVICE-
RELATED ffDISABILITY ffAND ffTHEIR ffSPOUSE ffAND ffCHILDREN.
PATIENT ffIS ffBROUGHT ffTO ffTHE ffLOCAL ffURGENT ffCARE ffAFTER ffFALLING
ffFROM ffA ffLADDER ffWHILE ffHANGING ffEXTERIOR ffLIGHTS ffON ffHIS ffHOUSE. ffX-
RAYS ffREVEALED ffA ffCLOSED ffFRACTURE ffOF ffHIS ffLEFT ffFEMUR. ffTHE
ffPATIENT ffIS ffCOVERED ffBY ffHIS ffEMPLOYER'S ffGROUP ffHEALTH ffPLAN ffAND
ffHE ffALSO ffHAS ffA ffHOMEOWNER'S ffLIABILITY ffINSURANCE ffPOLICY. ffWHICH
ffINSURANCE ffSHOULD ffBE ffBILLED?
A) ffTHE ffHOMEOWNER'S ffINSURANCE ffFIRST, ffFOLLOWED ffBY ffTHE ffGROUP
ffHEALTH ffPLAN
B) ffTHE ffEMPLOYER'S ffGROUP ffHEALTH ffPLAN
C) ffTHE ffHOMEOWNER'S ffINSURANCE ffONLY
D) ffFILE ffTHE ffEMPLOYER'S ffGROUP ffHEALTH ffPLAN ffAS ffPRIMARY ffAND ffLIST
ffTHE ffHOMEOWNER'S ffINSURANCE ffAS ffSECONDARY. ff- ffAnswer ffB) ffTHE
ffEMPLOYER'S ffGROUP ffHEALTH ffPLAN
RATIONALE: ffTHE ffHEALTH ffINSURANCE ffPLAN ffIS ffBILLED ffFIRST ffAND ffTHEN
ffTHROUGH ffTHE ffPROCESS ffOF ffSUBROGATION ffIT ffWILL ffBE ffDETERMINED ffIF
ffA ffLIABILITY ffPAYER ffSHOULD ffBE ffCONSIDERED ffPRIMARY.
,3. ffPRIVATE ffCOMPANIES ffCONTRACT ffWITH ffCMS ffTO ffADMINISTER:
A) ffMEDICARE ffPART ffA ff& ffB
B) ffMEDICARE ffPART ffB
C) ffMEDICARE ffPART ffC
D) ffMEDICARE ffPART ffA, ffB, ff& ffC ff- ffAnswer ffD) ffMEDICARE ffPART ffA, ffB, ffAND ffC
RATIONALE: ffMEDICARE ffPART ffA, ffB, ffAND ffC ffARE ffALL ffADMINISTERED ffBY
ffPRIVATE ffCOMPANIES ffTHAT ffCONTRACT ffWITH ffCMS ffAS ffMEDICARE
ffADMINISTRATIVE ffCONTRACTORS ffOR ffMACs.
WHAT ffIS ffA ffCO-PAYMENT? ff
A) ffAN ffAMOUNT ffPAID ffEVERY ffMONTH ffBY ffTHE ffPOLICYHOLDER ffTO
ffMAINTAIN ffHEALTH ffINSURANCE ffCOVERAGE
B) ffA ffPERCENTAGE ffOF ffTHE ffALLOWED ffAMOUNT ffTHAT ffTHE ffPATIENT ffIS
ffRESPONSIBLE ffFOR.
C) ffA ffFLAT ffAMOUNT ffPAID ffTO ffTHE ffHEALTHCARE ffPROVIDER ffWHEN ffTHE
ffPOLICYHOLDER ffIS ffSEEN ffFOR ffAN ffOFFICE ffVISIT.
D) ffTHE ffADJUSTED ffAMOUNT ffBASED ffON ffTHE ffINSURANCE ffPOLICY
ffREQUIREMENT. ff- ffAnswer ffC) ffA ffFLAT ffAMOUNT ffPAID ffTO ffTHE ffHEALTHCARE
ffPROVIDER ffWHEN ffTHE ffPOLICY ffHOLDER ffIS ffSEEN ffFOR ffAN ffOFFICE ffVISIT.
WHICH ffOF ffTHE ffFOLLOWING ffSTATEMENTS ffIS ffTRUE ffREGARDING ffTHE ffNON-
PAR ffMEDICARE ffALLOWED ffFEE ffSCHEDULE?
A) ffTHE ffNON-PAR ffPROVIDER ffCAN ffBILL ffTHE ffPATIENT ffTHE ffDIFFERENCE
ffBETWEEN ffTHE ffCHARGE ffAND ffTHE ffMEDICARE ffALLOWABLE.
B) ffTHE ffNON-PAR ffLIMITING ffCHARGE ffIS ff115% ffOF ffTHE ffNON-PAR ffMEDICARE
ffPHYSICIAN ffFEE ffSCHEDULE
C) ffTHE ffNON-PAR ffPHYSICIAN ffFEE ffSCHEDULE ffIS ff115% ffOF ffTHE ffPAR
ffMEDICARE ffPHYSICIAN ffFEE ffSCHEDULE
D) ffTHE ffNON-PAR ffLIMITING ffCHARGE ffIS ff95% ffOF ffTHE ffPAR ffMEDICARE
ffPHYSICIAN ffFEE ffSCHEDULE. ff- ffAnswer ffB) ffTHE ffNON-PAR ffLIMITING ffCHARGE
ffIS ff115% ffOF ffTHE ffNON-PAR ffMEDICARE ffPHYSICIAN ffFEE ffSCHEDULE. ff
RATIONALE: ffPER ffCMS, ffTHE ffNON-PAR ffLIMITING ffCHARGE ffIS ff115% ffOF ffTHE
ffNON-PAR ffMEDICARE ffPHYSICIAN ffFEE ffSCHEDULE.
WHAT ffIS ffA ffMEDIGAP ffPOLICY?
A) ffA ffPOLICY ffTHAT ffCOVERS ffHEALTHCARE ffSERVICES ffTHAT ffMEDICARE
ffDOES ffNOT ffCOVER.
B) ffA ffPOLICY ffTHAT ffWILL ffNOT ffREIMBURSE ffFOR ffOUT-OF-POCKET ffCOSTS
ffNOT ffCOVERED ffBY ffMEDICARE
C) ffA ffSUPPLEMENTAL ffINSURANCE ffOFFERED ffBY ffCMS.
, D) ffA ffPOLICY ffREQUIRED ffBY ffMEDICARE. ff- ffAnswer ffA) ffA ffPOLICY ffTHAT
ffCOVERS ffHEALTHCARE ffSERVICES ffTHAT ffMEDICARE ffDOES ffNOT ffCOVER.
MEDICARE ffPART ffA ffIS ffAVAILABLE ffTO ffINDIVIDUALS ffUNDER ffTHE ffAGE ffOF ff65
ffWHO ffHAVE:
A) ffDIABETES ffMELLITUS ffTYPE ffI ffOR ffII
B) ffCKD ff(CHRONIC ffKIDNEY ffDISEASE)
C) ffESRD ffAND ffMEET ffCERTAIN ffREQUIREMENTS
D) ffANY ffCHRONIC ffHEALTH ffCONDITION ff- ffAnswer ffC) ffESRD ffAND ffMEET
ffCERTAIN ffREQUIREMENTS.
RATIONALE: ffMEDICARE ffPART ffA ffCOVERAGE ffIS ffAVAILABLE ffTO ffINDIVIDUALS
ffBELOW ffTHE ffAGE ffOF ff65 ffWHO ffHAVE; ff1) ffRECEIVED ffSOCIAL ffSECURITY ffOR
ffRRB ffDISABILITY ffBENEFITS ffFOR ff24 ffMONTHS, ff2) ffEND-STAGE ffRENAL
ffDISEASE ffAND ffMEET ffCERTAIN ffREQUIREMENTS
WHICH ffOF ffTHE ffFOLLOWING ffSTATEMENTS ffIS ffTRUE ffREGARDING
ffMEDICAID?
A) ffMEDICAID ffELIGIBILITY ffPOLICIES ffARE ffTHE ffSAME ffFOR ffSTATES ffOF
ffSIMILAR ffSIZE ffAND ffGEOGRAPHIC ffREGION.
B) ffMEDICAID ffELIGIBILITY ffIS ffCLEAR ffAND ffCONSISTENT ffFROM ffSTATE ffTO
ffSTATE
C) ffMEDICAID ffPROGRAMS ffRECEIVE ffMATCHING ffFFEDERAL ffFUNDING ffONLY
ffIF ffCERTAIN ffHEALTHCARE ffSERVICES ffARE ffPROVIDED ffTO ffELIGIBLE
ffINDIVIDUALS.
D) ffMEDICAID ffPROGRAMS ffMUST ffPROVIDE ffMEDICAL ffASSISTANCE ffFOR ffALL
ffPOOR ffPERSONS. ff- ffAnswer ffC) ffMEDICAID ffPROGRAMS ffRECEIVE ffMATCHING
ffFEDERAL ffFUNDING ffONLY ffIF ffCERTAIN ffHEALTHCARE ffSERVICES ffARE
ffPROVIDED ffTO ffELIGBLE ffINDIVIDUALS.
MEDICAID ffPROGRAMS ffMUST ffPROVIDE ffCERTAIN ffHEALTHCARE ffSERVICES
ffTO ffELIGIBLE ffINDIVIDUALS ffIN ffORDER ffTO ffRECEIVE ffMATCHING ffFEDERAL
ffFUNDS ffKNOWN ffAS ffFEDERAL ffMEDICAL ffASSISTANCE ffPERCENTAGE ff(FMAP).
ffTHE ffPERCENTAGE ffIS ffDETERMINED ffON ffA ffYEAR ffTO ffYEAR ffBASIS ffUSING ffA
ffFORMULA ffTHAT ffCOMPARES ffTHE ffSTATE'S ffPER ffCAPITA ffAVERAGE ffINCOME
ffWITH ffTHE ffNATIONAL ffAVERAGE. ffSTATES ffWITH ffLOWER ffAVERAGE ffINCOME
ffPER ffCAPITA ffRECEIVE ffA ffHIGHER ffFMAP.
WHEN ffSUBMITTING ffA ffMEDIGAP ffPOLICY, ffWHICH ffOPTION ffIS ffAN ffEXAMPLE
ffOF ffHOW ffTHE ffPATIENT'S ffID ffNUMBER ffSHOULD ffAPPEAR ffIN ffITEM ff9A ffOF
ffTHE ffCMS-1500 ffCLAIM ffFORM?
A) ff123456789
B) ff123456789A
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