CPB Final Exam Questions With 100% Correct Answers.

EPO - ...provides benefits to subscribers who are required to receive services from network providers IDS - ...organizations of affiliated providers sites that offer joint healthcare services to subscribers HMO - ...providers comprehensive healthcare services to voluntarily enrolled members on a prepaid basis POS - ...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 - ...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? - The payment is sent to the patient and the patient must pay the provider. Birthday rule - 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) - 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? - name, medicare claim number, sex, is entitled to, effective dateWhich of the following services is covered by Early Periodic Screening Diagnostic Treatment (EPSDT)? - Pediatric check ups What forms need to be submitted when billing for a work-related injury? - First Report of Injury Form, Progress reports and CMS-1500 What is an accountable care organization (ACO)? - 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 ? - bill under the PA According to CMS, which of the following services are included in the global package for surgical procedures? - 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? - 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 - type of bill A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate? - 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? -