CPB PRACTICE EXAM 79 QUESTIONS AND
SOLUTIONS
◉ A patient with an acute myocardial infarction is brought by
ambulance to the emergency department. The patient is taken into
the cardiac catheterization lab. Angioplasty and a stent was placed
in the LAD. The patient's insurance requires preauthorization for all
surgical procedures. Which of the following statements is true for
most payers?
A. If the biller did not obtain authorization prior to the procedure
being performed, the surgical services will not be paid.
B. Because this was an emergency, it is acceptable to obtain
authorization following the surgery.
C. Because this was an emergency, a preauthorization is not
required.
D. If the biller did not obtain authorization prior to the procedure
being performed, the entire claim will not be paid.
Answer: B. Because this was an emergency, it is acceptable to obtain
authorization following the surgery.
◉ Which of the following steps should be completed when filling an
appeal?
,I. Submit in the format required by the payer.
II. Review the reason for the denial and determine if the payer made
an error.
III. Provide supporting documentation from an official source to
support your reason for appeal.
IV. Keep a copy of the information submitted to the payer for the
appeal.
V. Appeal the claim as soon as a denial is received.
VI. Appeal the claim as soon as you are certain the payer denied in
error and the claim cannot be reprocessed.
A. I, II, and V
B. I, IV, V and VI
C. I, II, III, IV, and VI
D. I-VI
Answer: C. I, II, III, IV, and VI
◉ What should a biller do when a claim is denied for not being
submitted within the timely filing period?
A. Track the transmission date of the claim. If within the timely filing
period, provide the information to the payer to reprocess the claim.
B. Write off the claim. The patient is not responsible for claims
denied for not being submitted within the timely filing period.
,C. Resubmit the claim with a different date of service that is within
the timely filing period.
D. Transfer the balance to patient responsibility and try to collect
from the patient.
Answer: A. Track the transmission date of the claim. If within the
timely filing period, provide the information to the payer to
reprocess the claim.
◉ Incorrect entry of the patient demographics can have an effect on
many areas of the practice. What documents are necessary to verify
demographics?
I. Photo Identification
II. Insurance card
III. Credit card information
IV. Social Security card
V. Patient completed demographic form
A. I and V
B. II and IV
C. II, IV and V
D. I, II, and V
Answer: D. I, II, and V
, ◉ CMS has a standard enrollment form in which the provider agrees
to:
I. Submit claims to Medicare
II. Have authorization from the Medicare beneficiary to file claims
III. Retain all source documentation and medical records
IV. Submit claims within 60 days of the date of service
V. Submit all claims with a group NPI number
VI. Research and correct claim discrepancies.
A. I, II, and IV
B. II, IV, and V
C. I, III, IV, and VI
D. I, II, III, and VI
Answer: D. I, II, III, and VI
◉ Ms. Turner had surgery one month ago for hernia repair. She is
still in the post-operative period and comes in today to the see the
same physician that performed the hernia repair surgery about a
lump that she noticed on her tailbone. The physician performs an
examination and the diagnosis is that she has a pilonidal cyst which
is unrelated to the surgery. Can the physician bill an E/M service for
today's visit during the post-operative period?
SOLUTIONS
◉ A patient with an acute myocardial infarction is brought by
ambulance to the emergency department. The patient is taken into
the cardiac catheterization lab. Angioplasty and a stent was placed
in the LAD. The patient's insurance requires preauthorization for all
surgical procedures. Which of the following statements is true for
most payers?
A. If the biller did not obtain authorization prior to the procedure
being performed, the surgical services will not be paid.
B. Because this was an emergency, it is acceptable to obtain
authorization following the surgery.
C. Because this was an emergency, a preauthorization is not
required.
D. If the biller did not obtain authorization prior to the procedure
being performed, the entire claim will not be paid.
Answer: B. Because this was an emergency, it is acceptable to obtain
authorization following the surgery.
◉ Which of the following steps should be completed when filling an
appeal?
,I. Submit in the format required by the payer.
II. Review the reason for the denial and determine if the payer made
an error.
III. Provide supporting documentation from an official source to
support your reason for appeal.
IV. Keep a copy of the information submitted to the payer for the
appeal.
V. Appeal the claim as soon as a denial is received.
VI. Appeal the claim as soon as you are certain the payer denied in
error and the claim cannot be reprocessed.
A. I, II, and V
B. I, IV, V and VI
C. I, II, III, IV, and VI
D. I-VI
Answer: C. I, II, III, IV, and VI
◉ What should a biller do when a claim is denied for not being
submitted within the timely filing period?
A. Track the transmission date of the claim. If within the timely filing
period, provide the information to the payer to reprocess the claim.
B. Write off the claim. The patient is not responsible for claims
denied for not being submitted within the timely filing period.
,C. Resubmit the claim with a different date of service that is within
the timely filing period.
D. Transfer the balance to patient responsibility and try to collect
from the patient.
Answer: A. Track the transmission date of the claim. If within the
timely filing period, provide the information to the payer to
reprocess the claim.
◉ Incorrect entry of the patient demographics can have an effect on
many areas of the practice. What documents are necessary to verify
demographics?
I. Photo Identification
II. Insurance card
III. Credit card information
IV. Social Security card
V. Patient completed demographic form
A. I and V
B. II and IV
C. II, IV and V
D. I, II, and V
Answer: D. I, II, and V
, ◉ CMS has a standard enrollment form in which the provider agrees
to:
I. Submit claims to Medicare
II. Have authorization from the Medicare beneficiary to file claims
III. Retain all source documentation and medical records
IV. Submit claims within 60 days of the date of service
V. Submit all claims with a group NPI number
VI. Research and correct claim discrepancies.
A. I, II, and IV
B. II, IV, and V
C. I, III, IV, and VI
D. I, II, III, and VI
Answer: D. I, II, III, and VI
◉ Ms. Turner had surgery one month ago for hernia repair. She is
still in the post-operative period and comes in today to the see the
same physician that performed the hernia repair surgery about a
lump that she noticed on her tailbone. The physician performs an
examination and the diagnosis is that she has a pilonidal cyst which
is unrelated to the surgery. Can the physician bill an E/M service for
today's visit during the post-operative period?
