CBCS ACTUAL FINALS ANSWERS AND QUESTIONS
SET A+
✔✔Which of the following options is considered proper supportive documentation for
reporting CPT and ICD codes for surgical procedure?
- Approval on previous claim form
- Operative report
- Encounter form
- Progress note - ✔✔Operative report
✔✔Which of the following actions should be taken first when reviewing a delinquent
claim?
- Verify the age of the account
- Query the insurance company
- Obtain claim status
- Resubmitting the claim - ✔✔Verify the age of the account
✔✔Which of the following components of an explanation of benefits expedites the
process of a phone appeal?
- NPI number
- Claim control number
- Insured's ID number
- Check number - ✔✔Claim control number
✔✔A claim can be denied or rejected for which of the following reasons?
- All data is uppercase
- Block 25 contains the EIN of the rendering provider
- The patient's DOB is in eight digit format
- Block 24 D contains the diagnosis code - ✔✔Block 24 D contains the diagnosis code
(should be in 21)
✔✔To be compliant with HIPAA, which of the following positions should be assigned in
each office?
- Gatekeeper
,- Privacy officer
- Compliance official
- Health insurance administrator - ✔✔Privacy officer
- Compliance official ( ensures that all staff comply with industry standards)
- Health insurance administrator (facilitates the payer's side)
✔✔All email correspondence to a third party payer containing a patient's PHI should be
_____ .
Encrypted
Removed
Forwarded to the patient
Accompanied with an authorization - ✔✔Encrypted
✔✔A CBCS should understand that the financial record source that is generated by the
provider's office is called a _______ .
- Chargemaster
- Fee schedule
- Encounter form
- Patient ledger account - ✔✔Patient ledger account (history of patient's financial
record)
✔✔Which of the following includes procedures and best practices for correct coding?
- Coding compliance plan
- Retrospective audit
- Prospective review
- Diagnosis related group - ✔✔Coding compliance plan (contains rules, procedures and
best practices to ensure accurate coding)
- Retrospective audit (ensure correctness of billing documents)
- Prospective review ( ensure the appropriateness and necessity of the care provided)
- Diagnosis related group (Prospective payment for acute care is based on the
Diagnosis related groups)
✔✔HIPAA transaction standards apply to which of the following entities?
- Employers who provide worker's compensation plans
- Automobile insurance agencies
- Health care clearinghouses
- Educational facilities - ✔✔healthcare clearinghouse
✔✔Which of the following actions should be taken if an insurance denies a service as
not medically necessary?
- Send the patient a copy of the remittance advice
- Appeal the decision with a provider's report
- Submit a claim to the patient's secondary insurance
- Call the patient to confirm eligibility - ✔✔Appeal the decision with a provider's report
, ✔✔A patient with a past due balance requests that his records be sent to another
provider. Which of the following actions should be taken?
- Withhold the records until the account is paid (HIPAA requires to honor the request)
- Send the patient a statement
- Accommodate the request and send the record
- Begin collection action on the balance due - ✔✔accommodate the request and send
the record
✔✔The physician bills $500 to a patient. After submitting the claim to the insurance, the
claim is sent back with no payment. The patient still owes $500 for the year. This
amount is called?
- Deductible
- Coinsurance
- Copayment
- Premium - ✔✔deductible
✔✔Which of the following is used to code diseases, injury and other health related
problems?
- ICD
- CPT
- HCPCS
- CDT - ✔✔ICD
- CDT ( Current Dental terminology)
✔✔A patient's portion of the bill should be discussed with the patient before a procedure
is performed for which of the following reasons?
- To determine the procedure
- To verify insurance coverage
- To give the patient the option to negotiate their portion of the bill
- To ensure the patient understands his portion of the bill - ✔✔To ensure the patient
understands his portion of the bill
✔✔Which of the following information is required on a patient account record?
- Name and address of guarantor
- Procedures performed
- Family history of the guarantor
- Diagnosis - ✔✔Name and address of guarantor
✔✔A claim is submitted with a transposed insurance member ID number and returned
to the provider. Which of the following describes the status that should be assigned to
the claim by the carrier?
- Suspended
- Pending
- Denied
- invalid - ✔✔invalid
SET A+
✔✔Which of the following options is considered proper supportive documentation for
reporting CPT and ICD codes for surgical procedure?
- Approval on previous claim form
- Operative report
- Encounter form
- Progress note - ✔✔Operative report
✔✔Which of the following actions should be taken first when reviewing a delinquent
claim?
- Verify the age of the account
- Query the insurance company
- Obtain claim status
- Resubmitting the claim - ✔✔Verify the age of the account
✔✔Which of the following components of an explanation of benefits expedites the
process of a phone appeal?
- NPI number
- Claim control number
- Insured's ID number
- Check number - ✔✔Claim control number
✔✔A claim can be denied or rejected for which of the following reasons?
- All data is uppercase
- Block 25 contains the EIN of the rendering provider
- The patient's DOB is in eight digit format
- Block 24 D contains the diagnosis code - ✔✔Block 24 D contains the diagnosis code
(should be in 21)
✔✔To be compliant with HIPAA, which of the following positions should be assigned in
each office?
- Gatekeeper
,- Privacy officer
- Compliance official
- Health insurance administrator - ✔✔Privacy officer
- Compliance official ( ensures that all staff comply with industry standards)
- Health insurance administrator (facilitates the payer's side)
✔✔All email correspondence to a third party payer containing a patient's PHI should be
_____ .
Encrypted
Removed
Forwarded to the patient
Accompanied with an authorization - ✔✔Encrypted
✔✔A CBCS should understand that the financial record source that is generated by the
provider's office is called a _______ .
- Chargemaster
- Fee schedule
- Encounter form
- Patient ledger account - ✔✔Patient ledger account (history of patient's financial
record)
✔✔Which of the following includes procedures and best practices for correct coding?
- Coding compliance plan
- Retrospective audit
- Prospective review
- Diagnosis related group - ✔✔Coding compliance plan (contains rules, procedures and
best practices to ensure accurate coding)
- Retrospective audit (ensure correctness of billing documents)
- Prospective review ( ensure the appropriateness and necessity of the care provided)
- Diagnosis related group (Prospective payment for acute care is based on the
Diagnosis related groups)
✔✔HIPAA transaction standards apply to which of the following entities?
- Employers who provide worker's compensation plans
- Automobile insurance agencies
- Health care clearinghouses
- Educational facilities - ✔✔healthcare clearinghouse
✔✔Which of the following actions should be taken if an insurance denies a service as
not medically necessary?
- Send the patient a copy of the remittance advice
- Appeal the decision with a provider's report
- Submit a claim to the patient's secondary insurance
- Call the patient to confirm eligibility - ✔✔Appeal the decision with a provider's report
, ✔✔A patient with a past due balance requests that his records be sent to another
provider. Which of the following actions should be taken?
- Withhold the records until the account is paid (HIPAA requires to honor the request)
- Send the patient a statement
- Accommodate the request and send the record
- Begin collection action on the balance due - ✔✔accommodate the request and send
the record
✔✔The physician bills $500 to a patient. After submitting the claim to the insurance, the
claim is sent back with no payment. The patient still owes $500 for the year. This
amount is called?
- Deductible
- Coinsurance
- Copayment
- Premium - ✔✔deductible
✔✔Which of the following is used to code diseases, injury and other health related
problems?
- ICD
- CPT
- HCPCS
- CDT - ✔✔ICD
- CDT ( Current Dental terminology)
✔✔A patient's portion of the bill should be discussed with the patient before a procedure
is performed for which of the following reasons?
- To determine the procedure
- To verify insurance coverage
- To give the patient the option to negotiate their portion of the bill
- To ensure the patient understands his portion of the bill - ✔✔To ensure the patient
understands his portion of the bill
✔✔Which of the following information is required on a patient account record?
- Name and address of guarantor
- Procedures performed
- Family history of the guarantor
- Diagnosis - ✔✔Name and address of guarantor
✔✔A claim is submitted with a transposed insurance member ID number and returned
to the provider. Which of the following describes the status that should be assigned to
the claim by the carrier?
- Suspended
- Pending
- Denied
- invalid - ✔✔invalid
