Mock CPB Exam Question and answers, 100% Accurate. Verified. Court decisions that establis

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Mock CPB Exam Question and answers, 100% Accurate. Verified. Court decisions that establish a standard use legal decisions to serve as authoritative rules or patterns in future similar cases. The... legal term for standard is ______. a. decision b. example c. precedent d. statute - ✔✔-precedent Which is established in advance and based on reported health care charges from which a predetermined per diem rate is determined? a. prospective cost-based rate b. retrospective reasonable cost system c. prospective price-based rate d. site-of-service differential - ✔✔-prospective cost-based rate Which is a legal action that can be used to recover a debt and is usually a last resort for a medical practice? a. litigation b. mediation c. adjudication d. subrogation - ✔✔-litigation When a child lives with both parents, and each parent subscribes to a different health insurance plan, the primary and secondary policies are determined by applying the birthday rule. The individual who holds the primary policy for dependent children is the spouse whose birth ______. a. month and day occur earlier in the calendar year b. year occurs earlier c. day occurs earlier in the month d. month, day, and year occur earlier - ✔✔-month and day occur earlier in the calendar year TRICARE deductibles are applied to the government's ______ year, which runs from October 1 of one year to September 30 of the next. a. fiscal b. calendar c. consecutive d. sequential - ✔✔-fiscal The Resource Based Relative Value Scale (RBRVS) system reimburses physicians' practice expenses using a ______. a. usual and reasonable payment basis b. prospective payment system c. guaranteed issue method d. fee schedule - ✔✔-fee schedule OSHA has special significance for those employed in health care because employers are required to obtain and retain manufacturers' Material Safety Data Sheets (MSDS), which contain information about ______ used on site. Training employees in the safe handling of these substances is also required. a. vaccinations and drugs b. possibly harmful agents only c. oral, IM, and IV medications d. chemical and hazardous substances - ✔✔-chemical and hazardous substances The BCBS PPO plan is sometimes described as a subscriber-driven program, and BCBS substitutes the term subscriber or ______ for policyholder. a. payer b. provider c. patient d. member - ✔✔-member Which type of automobile insurance pays for damage to a covered vehicle caused by hitting an object or being hit during an automobile accident? a. liability b. collision c. personal injury protection d. comprehensive - ✔✔-collision BlueShield plans were created as the result of a resolution passed by the House of Delegates at an American Medical Association meeting in 1938. This resolution supported the concept of ______ health insurance that would encourage physicians to cooperate with prepaid health care plans. a. voluntary b. mandatory c. commercial d. profit - ✔✔-voluntary Which of the following is an example of abuse? a. submitting claims for services and procedures knowingly not provided b. misrepresenting ICD-10-CM and CPT/HCPCS codes to justify payment c. billing noncovered services/procedures as covered services/procedures d. falsifying health care certificates of medical necessity plans of treatment - ✔✔-billing noncovered services/procedures as covered services/procedures Which code represents a new patient exam in which the physician documents a detailed history, detailed examination, and medical decision making of low complexity? a. 99203 b. 99204 c. 99214 d. 99213 - ✔✔-99203 Which punctuation is used in the ICD-10-CM index to identify manifestation codes and in the ICD-10-CM index and tabular list to enclose abbreviations, synonyms, alternative wording, or explanatory phrases? a. braces b. parentheses c. colons d. slanted brackets - ✔✔-slanted brackets Which code represents foot, abduction rotation bar, without shoes? a. L3170 b. L3150 c. L3140 d. L3160 - ✔✔-L3150 The Medicare durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS) fee schedule reimburses DMEPOS either ______ percent of the actual charge for the item or the fee schedule amount, whichever is lower. a. 80 b. 20 c. 50 d. 100 - ✔✔-80 Which claims are organized by year and are generated for providers who do not accept assignment? a. clean claims b. unassigned claims c. open claims d. closed claims - ✔✔-unassigned claims Which is the financial record source document used by health care providers and other personnel in a physician's office setting to record treated diagnoses and services rendered to the patient during the current visit? a. superbill b. explanation of benefits c. CMS-1500 claim d. remittance advice - ✔✔-superbill Which classification system was developed by the World Health Organization (WHO) and used to collect data for statistical purposes? a. National Drug Codes b. Current Procedural Terminology c. International Classification of Diseases d. Healthcare Common Procedure Coding System - ✔✔-International Classification of Diseases Where is the first-listed diagnosis reported on the CMS-1500 claim? a. Block 24E b. Block 24D c. Block 21A d. Block 24A - ✔✔-Block 21A What type of codes containing "emerging technology," are temporary codes assigned for data collection, and are still used by some third-party payers? a. Category II codes b. Category III codes c. Category I codes d. Category IV codes - ✔✔-Category III codes Which are the amounts owed to a business for services or goods provided? a. accounts payable b. allowed charges c. assignment of benefits d. accounts receivable - ✔✔-accounts receivable Atherosclerosis of native arteries of extremities with gangrene, bilateral legs is represented by which ICD-10-CM code? a. I70.263 b. I70.262 c. I70.268 d. I70.261 - ✔✔-I70.263 Secondary insurance is the insurance plan that is billed after the primary insurance plan has paid its contracted amount and the provider's office has received a(n) ______ from the primary payer. a. encounter form b. remittance advice c. CMS-1500 claim d. explanation of benefits - ✔✔-remittance advice The primary care provider (PCP) is responsible for ______. a. providing nonessential health care services to all patients b. supervising and coordinating health care services for enrollees c. denying all referrals to specialists and inpatient hospital admissions d. being a gatekeeper to provide services at the highest possible cost - ✔✔-supervising and coordinating health care services for enrollees Which program was implemented to find and correct improper Medicare payments paid to health care providers participating in fee-for-service Medicare? a. Hospital Inpatient Quality Reporting (Hospital IQR) b. Recovery Audit Contractor (RAC) c. Medicaid Integrity Program (MIP) d. Zone Program Integrity Contractor (ZPIC) - ✔✔-Recovery Audit Contractor (RAC) Institutional and other selected providers submit ______ claim data to payers for reimbursement of patient services. a. UB-02 b. CMS-1500 c. UB-92 d. UB-04 - ✔✔-UB-04 Which is a global concept that includes the collection of patient information documented by a number of providers at different facilities regarding one patient? a. electronic health record b. personal health record c. electronic medical record d. multidisciplinary health record - ✔✔-electronic health record Which is considered a nonphysician practitioner? a. pharmacist b. physician assistant c. provider d. nurse - ✔✔-physician assistant Which serves as a system of checks and balances for labor and management? a. preferred provider organization b. medical underwriter c. health insurance exchange d. third-party administrator - ✔✔-third-party administrator Medicare calls its remittance advice a(n) ______. a. provider remittance notice b. explanation of benefits c. Medicare summary notice d. electronic remittance advice - ✔✔-provider remittance notice The manual daily accounts receivable journal is also known as the ______, and it is a chronologic summary of all transactions posted to individual patient ledgers/accounts on a specific date. a. patient ledger b. superbill c. explanation of benefits d. day sheet - ✔✔-day sheet Chronic hepatic failure with coma is represented by which ICD-10-CM code? a. K72.91 b. K72.01 c. K72.11 d. K72.10 - ✔✔-K72.11 Medicare beneficiaries can also obtain supplemental insurance to help cover costs not reimbursed by the original Medicare plan. This type of coverage is called ______. a. Medicaid b. Medigap c. Medicare PLUS d. PACE - ✔✔-Medigap Diagnosis pointer letters A-L are preprinted in Block 21 of the CMS-1500 claim to allow for entry of ______ codes, and they are reported in Block 24E. a. ICD-10-PCS b. HCPCS level II c. ICD-10-CM d. CPT - ✔✔-ICD-10-CM ICD-10-CM codes require up to ______ characters, are entirely alphanumeric, and have unique coding conventions, such as Excludes1 and Excludes2. a. five b. seven c. eight d. six - ✔✔-seven TRICARE ______ are uniformed service personnel who are either active duty, retired, or deceased. a. patients b. sponsors c. beneficiaries d. providers - ✔✔-sponsors When an unlisted procedure or service code is reported, a ______ must accompany the claim to describe the nature, extent, and need for the procedure or service along with the time, effort, and equipment necessary to provide the service. a. remittance advice b. CMS-1500 claim c. special report d. copy of the record - ✔✔-special report Which coding system is used to report procedures and services on claims? a. CPT b. SNDO c. SNOMED d. ICD-10-CM - ✔✔-CPT Which type of HMO contracts health services that are delivered to subscribers by physicians who remain in their own office settings? a. independent practice association b. preferred provider organization c. triple-option plan d. point-of-service plan - ✔✔-independent practice association Who is required to personally sign the original and all photocopies of reports submitted to the workers' compensation board? a. patient or legal representative b. physician or other health care provider c. attorney representing the patient d. both the patient and physician - ✔✔-physician or other health care provider Which code represents pillow for decubitis care? a. E0198 b. E0190 c. E0193 d. E0196 - ✔✔-E0190 The forerunner of what is known today as the BlueCross plan began in 1929 when Baylor University Hospital in Dallas, Texas, approached teachers in the Dallas school district with a plan that would guarantee up to 21 days of hospitalization per year for subscribers and each of their dependents, in exchange for a $6 annual premium. This was considered a ______ plan. a. postpaid b. retrospective c. traditional d. prepaid - ✔✔-prepaid A Medicare medical necessity denial is a denial of otherwise covered services that were found to be not ______. a. necessary and frequent b. cost effective and necessary c. in compliance with critical pathways d. reasonable and necessary - ✔✔-reasonable and necessary An advance beneficiary notice of noncoverage (ABN) is a written document provided to a Medicare beneficiary by a supplier, physician, or provider, and the ABN must be presented to the patient ______. a. at least one month before providing the service b. prior to providing the service or treatment c. on the day the service or treatment is provided d. after Medicare has denied payment for the service - ✔✔-prior to providing the service or treatment Long-term acute care hospitals are defined by Medicare as having an average inpatient length of stay greater than ______ days. a. 30 b. 10 c. 15 d. 25 - ✔✔-25 Any information communicated by the ______ is considered privileged communication, and HIPAA provisions address the privacy and security of protected health information. a. patient to third-party payer b. provider to third-party payer c. third-party payer to provider d. patient to health care provider - ✔✔-patient to health care provider A military treatment facility (MTF) is a health care facility operated by the military that provides inpatient and ambulatory care to eligible TRICARE beneficiaries. Which is an example of ambulatory care? a. emergency department treatment b. acute care hospital stay c. overnight psychiatric evaluation d. rehabilitation requiring 30-day admission - ✔✔-emergency department treatment Hospital inpatient ______ codes are submitted for reimbursement purposes. a. ICD-9-CM, CPT, and HCPCS level II b. ICD-10-CM, ICD-10-PCS, CPT, and HCPCS level II c. ICD-10-CM, CPT, and HCPCS level II d. ICD-10-CM and ICD-10-PCS - ✔✔-ICD-10-CM and ICD-10-PCS Which code represents MRI without contrast followed with contrast, breast; unilateral? a. C8905 b. C8902 c. C8907 d. C8911 - ✔✔-C8905 Nonprofit corporations are charitable, educational, civic, or humanitarian organizations whose profits are ______. a. paid to the federal government as taxes b. returned to the nonprofit corporation c. distributed to shareholders and officers d. sent to beneficiaries who paid premiums - ✔✔-returned to the nonprofit corporation CPT defines counseling as it relates to evaluation and management coding as a(n) ______ concerning areas that involve diagnostic results, impressions, recommended diagnostic studies, and so on. a. discussion with a patient and/or family b. order for further ancillary testing c. assessment that impacts patient care d. way to guarantee quality patient care - ✔✔-discussion with a patient and/or family Which code represents incision and drainage of pilonidal cyst? a. 10060 b. 10080 c. 11770 d. 11772 - ✔✔-10080 Which act allows employees to continue health care coverage beyond the benefit termination date? a. Tax Equity and Fiscal Responsibility Act of 1982 b. Health Insurance Portability and Accountability Act of 1996 c. Omnibus Budget Reconciliation Act of 1981 d. Consolidated Omnibus Budget Reconciliation Act of 1985 - ✔✔-Consolidated Omnibus Budget Reconciliation Act of 1985 Provider services for inpatient care are billed on a fee-for-service basis, and service results in a unique and separate charge designated by a ______ or HCPCS level II service/procedure code. a. ICD-10-CM b. CPT c. ICD-9-CM d. ICD-10-PCS - ✔✔-CPT Medicare requires providers to submit the ______ claim for payment of outpatient and office services. a. UB-04 b. CMS-1500 c. UB-02 d. CMS-1450 - ✔✔-CMS-1500 Dr. Smith is a participating provider (PAR) for the ABC Health Insurance Plan. Mary Talley is treated by Dr. Smith in the office, for which a $100 fee is charged. Calculate the PAR provider write-off amount when the PAR provider fee is $100; PAR allowable charge is $80; patient copayment is $20; and insurance payment is $60. The PAR provider write-off amount is ______ a. $20 b. $10 c. $40 d. $30 - ✔✔-$20 The Health Information Technology for Economic and Clinical Health Act was included in the American Recovery and Reinvestment Act of 2009 and amended the Public Health Service Act to establish the ______. a. Health Care Financing Administration b. Office of National Coordinator for HIT c. Centers for Medicare and Medicaid Services d. State Children's Health Insurance Program - ✔✔-Office of National Coordinator for HIT The computer-to-computer transfer of data between providers and third-party payers (or providers and health care clearinghouses) in a data format agreed upon by sending and receiving parties is called electronic ______. a. flat file format b. remittance advice c. media claim d. data interchange - ✔✔-data interchange To qualify for workers' compensation benefits, an employee must be injured while working within the scope of the job description, be injured while performing a service required by the employer, or develop a disorder that can be directly linked to employment, such as asbestosis or mercury poisoning. The worker does not have to be physically on company property to qualify for workers' compensation. Which is an example of an on the job injury that would qualify the employee for workers' compensation benefits? a. Employee is injured when picking up reports for the office at [Show More]

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