CPB Final Exam Questions & Answers, 100% Accurate. Graded A+
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CPB
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CPB
CPB Final Exam Questions & Answers, 100% Accurate. Graded A+
EPO - -...provides benefits to subscribers who are required to receive services from network providers
IDS - -...organizations of affiliated providers sites that offer joint healthcare services to subscribers
HMO - -...provider...
100 accurate graded a epo provides benefits to subscribers who are required to receive services from network providers ids organizations of af
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CPB Final Exam Questions & Answers,
100% Accurate. Graded A+
EPO - ✔✔-...provides benefits to subscribers who are required to receive services from network
providers
IDS - ✔✔-...organizations of affiliated providers sites that offer joint healthcare services to subscribers
HMO - ✔✔-...providers comprehensive healthcare services to voluntarily enrolled members on a
prepaid basis
POS - ✔✔-...patients can use the managed care panel of providers (paying discounted healthcare cost)
or self-refer to out-of-network providers (and pay higher cost)
PPO - ✔✔-...contracted network of healthcare providers that provide care to subscribers for a
discounted fee
When a nonparticipating provider files a claim for a patient to BC/BS, how is the payment processed? -
✔✔-The payment is sent to the patient and the patient must pay the provider.
Birthday rule - ✔✔-the policyholder whose birth month and day occurs earlier in the calendar year holds
the primary policy when each parent subscribes to a different health insurance plan
Nonparticipating Providers (nonPARs) - ✔✔-they expect to be paid the full fee charged for services
rendered
*In these cases, the patient may be asked to pay the provider in full and then be reimbursed by BCBS
the allowed fee for each service, minus the patient's deductible and copayment obligations
-even when the provider agrees to file the claim for the patient, the insurance company sends the
payment for the claim directly to the patient and not to the provider
, A patient's Medicare card contains which of the following information? - ✔✔-name, medicare claim
number, sex, is entitled to, effective date
Which of the following services is covered by Early Periodic Screening Diagnostic Treatment (EPSDT)? -
✔✔-Pediatric check ups
What forms need to be submitted when billing for a work-related injury? - ✔✔-First Report of Injury
Form, Progress reports and CMS-1500
What is an accountable care organization (ACO)? - ✔✔-Groups of doctors, hospitals, and other health
care providers who coordinate high quality care for Medicare patients.
New patient presents for annual exam and has no complaints. She is scheduled to see the physician
assistant (PA). How should services be billed ? - ✔✔-bill under the PA
According to CMS, which of the following services are included in the global package for surgical
procedures? - ✔✔-Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia
Subsequent to the decision for surgery, one related Evaluation and Management (E/M) encounter on
the date immediately prior to or on the date of procedure (including history and physical).
Immediate postoperative care, including dictating operative notes, talking with the family and other
physicians or other qualified health care professionals.
Writing orders
Evaluating the patient in the postanesthesia recovery area
Typical postoperative follow-up care
How should a claim be processed if a procedure code requires more than four modifiers? - ✔✔-Report
the first four modifiers in Block 24d and all the additional modifiers in Block 19. ?
Which of the following indicates the frequency of care on a UB-04 - ✔✔-type of bill
A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate? - ✔✔-
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