CPB Final Exam
EPO - Answer ...provides benefits to subscribers who are required to receive services
from network providers
IDS - Answer ...organizations of affiliated providers sites that offer joint healthcare
services to subscribers
HMO - Answer ...providers comprehensive healthcare services to voluntarily enrolled
members on a prepaid basis
POS - Answer ...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 - Answer ...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? - Answer The payment is sent to the patient and the patient must
pay the provider.
Birthday rule - Answer 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) - Answer 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? - Answer name,
medicare claim number, sex, is entitled to, effective date
Which of the following services is covered by Early Periodic Screening Diagnostic
Treatment (EPSDT)? - Answer Pediatric check ups
What forms need to be submitted when billing for a work-related injury? - Answer First
Report of Injury Form, Progress reports and CMS-1500
, What is an accountable care organization (ACO)? - Answer 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 ? - Answer bill under the PA
According to CMS, which of the following services are included in the global package for
surgical procedures? - Answer 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? - Answer 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 - Answer type of bill
A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate? -
Answer
Electronic Healthcare Transactions and code sets are required to be used by health
plans, healthcare clearinghouses and healthcare providers that participate in electronic
data interchanges. Which of the following are requirements for the code sets? - Answer
Pam works for a medical practice. She receives a call from a person stating he is with
the patient's insurance company and would like some information on the patient's last
visit. What is the most compliant practice regarding releasing the information? - Answer
Pam tells him that all requests must be in writing.
Security involves the safekeeping of patient information by: - Answer Setting office
policies to protect PHI from alteration, destruction, tampering, or loss
Requiring employees to sign a confidentiality statement that details the consequences
of not maintaining patient confidentiality, including termination
Dr. Taylor's office has a new medical assistant (MA) who is responsible for blood
collection for lab specimens. Because the MA is new, she often misses when obtaining
blood at the first stick. To be sure the office is billing for all services, the office now has
a rule that all patients will be billed a minimum of two blood draws to demonstrate the
EPO - Answer ...provides benefits to subscribers who are required to receive services
from network providers
IDS - Answer ...organizations of affiliated providers sites that offer joint healthcare
services to subscribers
HMO - Answer ...providers comprehensive healthcare services to voluntarily enrolled
members on a prepaid basis
POS - Answer ...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 - Answer ...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? - Answer The payment is sent to the patient and the patient must
pay the provider.
Birthday rule - Answer 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) - Answer 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? - Answer name,
medicare claim number, sex, is entitled to, effective date
Which of the following services is covered by Early Periodic Screening Diagnostic
Treatment (EPSDT)? - Answer Pediatric check ups
What forms need to be submitted when billing for a work-related injury? - Answer First
Report of Injury Form, Progress reports and CMS-1500
, What is an accountable care organization (ACO)? - Answer 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 ? - Answer bill under the PA
According to CMS, which of the following services are included in the global package for
surgical procedures? - Answer 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? - Answer 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 - Answer type of bill
A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate? -
Answer
Electronic Healthcare Transactions and code sets are required to be used by health
plans, healthcare clearinghouses and healthcare providers that participate in electronic
data interchanges. Which of the following are requirements for the code sets? - Answer
Pam works for a medical practice. She receives a call from a person stating he is with
the patient's insurance company and would like some information on the patient's last
visit. What is the most compliant practice regarding releasing the information? - Answer
Pam tells him that all requests must be in writing.
Security involves the safekeeping of patient information by: - Answer Setting office
policies to protect PHI from alteration, destruction, tampering, or loss
Requiring employees to sign a confidentiality statement that details the consequences
of not maintaining patient confidentiality, including termination
Dr. Taylor's office has a new medical assistant (MA) who is responsible for blood
collection for lab specimens. Because the MA is new, she often misses when obtaining
blood at the first stick. To be sure the office is billing for all services, the office now has
a rule that all patients will be billed a minimum of two blood draws to demonstrate the
