CPB PRACTICE EXAM 79 COMPLETE TEST
PAPER WITH CORRECT ANSWERS
◉ While working in a large practice, medicare over-payments are
found in several patient accounts. The manager states that the
practice will keep the money until medicare asks for it back. What
does this action constitute?
Answer: Fraud
◉ What are the 12 national priority purposes under the privacy
rule?
Answer: 1. Required by law
2. Public health activities
3. Victims of abuse / neglect/ domestic violence
4. Health oversight activities
5. Judicial and administrative proceedings
6. Law enforcement purposes
7. decedents
8. cadaver organ / eye / tissue donation
9. Research
10. Serious threat to health or safety
11. Essential government functions
,12. Workers comp
◉ What types of entities do conditions of participation apply to for
health plans?
Answer: Hospitals, clinics, transplant centers, psychiatric hospitals,
etc
◉ What is the Prompt Payment Act?
Answer: An act that was enacted to ensure the federal government
makes timely payments.
◉ A provider removes a skin lesion in an ASC and receives the denial
from the insurance carrier that states "Lower level of care could
have been provided." What steps should the biller take?
Answer: Check with the provider and write an appeal to the
insurance carrier explaining why the service was provided in an
ASC.
◉ What is the definition of bad debt?
Answer: A debt that is likely to remain unpaid and end up sent to
collections and written off by the provider.
◉ What are some potential patient errors that can happen at patient
registration?
,Answer: Invalid address, invalid insurance info, invalid phone
number
◉ What is the number one thing you should obtain from an
insurance call?
Answer: The call reference number
◉ When given a denial, what should be done?
Answer: Review the denial to determine if additional information is
needed, if errors need to be corrected, or if the denial should be
appealed
◉ May small balances for which processing costs exceed potential
collections be automatically written off?
Answer: Yes, as long as it is allowed according to the financial policy
of the practice.
◉ What a patient files for Chapter 7 under the U.S. bankruptcy code,
what happens to the debt?
Answer: Most medical debt is discharged, the provider will write-off
amounts owed.
◉ According to the Prompt Pay Act, who must pay bills within 30
days?
, Answer: Federal Agencies
◉ What is a pre-determination?
Answer: A request from a healthcare facility to get an idea whether
or not a service may be covered. This is not a guarantee of payment
and is not required.
◉ The provider, hospital, or entity that agrees to provide healthcare
services to an insurance plans enrolees is a:
Answer: Participating provider
◉ Balance billing by participating providers is:
Answer: Not allowed under participating providers contract
◉ If a claim is denied, investigated, or found to be denied in error
what should a biller do?
Answer: Appeal that claim
◉ What may be appealed?
Answer: A denied claim
◉ What modifiers will appropriately bypass the NCCI bundling
edits?
PAPER WITH CORRECT ANSWERS
◉ While working in a large practice, medicare over-payments are
found in several patient accounts. The manager states that the
practice will keep the money until medicare asks for it back. What
does this action constitute?
Answer: Fraud
◉ What are the 12 national priority purposes under the privacy
rule?
Answer: 1. Required by law
2. Public health activities
3. Victims of abuse / neglect/ domestic violence
4. Health oversight activities
5. Judicial and administrative proceedings
6. Law enforcement purposes
7. decedents
8. cadaver organ / eye / tissue donation
9. Research
10. Serious threat to health or safety
11. Essential government functions
,12. Workers comp
◉ What types of entities do conditions of participation apply to for
health plans?
Answer: Hospitals, clinics, transplant centers, psychiatric hospitals,
etc
◉ What is the Prompt Payment Act?
Answer: An act that was enacted to ensure the federal government
makes timely payments.
◉ A provider removes a skin lesion in an ASC and receives the denial
from the insurance carrier that states "Lower level of care could
have been provided." What steps should the biller take?
Answer: Check with the provider and write an appeal to the
insurance carrier explaining why the service was provided in an
ASC.
◉ What is the definition of bad debt?
Answer: A debt that is likely to remain unpaid and end up sent to
collections and written off by the provider.
◉ What are some potential patient errors that can happen at patient
registration?
,Answer: Invalid address, invalid insurance info, invalid phone
number
◉ What is the number one thing you should obtain from an
insurance call?
Answer: The call reference number
◉ When given a denial, what should be done?
Answer: Review the denial to determine if additional information is
needed, if errors need to be corrected, or if the denial should be
appealed
◉ May small balances for which processing costs exceed potential
collections be automatically written off?
Answer: Yes, as long as it is allowed according to the financial policy
of the practice.
◉ What a patient files for Chapter 7 under the U.S. bankruptcy code,
what happens to the debt?
Answer: Most medical debt is discharged, the provider will write-off
amounts owed.
◉ According to the Prompt Pay Act, who must pay bills within 30
days?
, Answer: Federal Agencies
◉ What is a pre-determination?
Answer: A request from a healthcare facility to get an idea whether
or not a service may be covered. This is not a guarantee of payment
and is not required.
◉ The provider, hospital, or entity that agrees to provide healthcare
services to an insurance plans enrolees is a:
Answer: Participating provider
◉ Balance billing by participating providers is:
Answer: Not allowed under participating providers contract
◉ If a claim is denied, investigated, or found to be denied in error
what should a biller do?
Answer: Appeal that claim
◉ What may be appealed?
Answer: A denied claim
◉ What modifiers will appropriately bypass the NCCI bundling
edits?
