CBCS Study Guide
When the term "See Also" is used in CPT, it directs the billing and coding specialist to which of the
following index entries? - Answer -Cross-reference term
A billing and coding specialist receives an explanation of benefits from an insurance carrier for an office
visit with a cost of $120 that participates in the insurance plan. The patient has a remaining deductible
of $52, and the plan pays 80%. Which of the insurance payments should the specialist expect for this
visit? - Answer -$76
What is the time limit for billing and coding specialist to file a Medicare claim? - Answer -12 months
from the date of service
Which of the following describes the amount to collect at the time of service from a patient who has a
health maintenance organization (HMO) plan? - Answer -Copay
Which of the following reports should a billing and coding specialist use to review and track balances
from an insurance company service? - Answer -Claims report
Which of the following are three types of plans covered under TRICARE program? - Answer -Standard,
Extra, and Prime
In Box 17 on the CMS-1500 form, which of the following is the qualifier for a referring physician? -
Answer -DN
, In which of the following locations should a billing and coding specialist find the contact information to
appeal a claim? - Answer -Insurance company file
Which of the following diagnosis establishes an admission? - Answer -Principal
A billing and coding specialist should verify code linkage in the charge capture process to ensure which
of the following? - Answer -Medical necessity
On an explanation of benefits form, which of the following should a billing and coding specialist use to
determine why the insurance company denied the insurance claim? - Answer -Remark Code
Which of the following is included in electronic remittance advice? - Answer -Patient's deductible
Which of the following covers the deductible of a patient's primary health insurance policy? - Answer -
The patient's primary insurance plan
When does the physician-patient implied contract begin? - Answer -At the time the appointment is
made
Largest section of the CPT book is the - Answer -Surgery
Under HIPAA, which of the following scenarios requires the patient authorization for the release of
health information? - Answer -Referring a patient to another provider
Which of the following information associated with an aging report informs the billing and coding
specialist about more than just the immediate claim pending? - Answer -Trends of nonpayment by the
insurance payer
What is the purpose of obtaining a preauthorization? - Answer -To obtain prior approval for health care
services
When the term "See Also" is used in CPT, it directs the billing and coding specialist to which of the
following index entries? - Answer -Cross-reference term
A billing and coding specialist receives an explanation of benefits from an insurance carrier for an office
visit with a cost of $120 that participates in the insurance plan. The patient has a remaining deductible
of $52, and the plan pays 80%. Which of the insurance payments should the specialist expect for this
visit? - Answer -$76
What is the time limit for billing and coding specialist to file a Medicare claim? - Answer -12 months
from the date of service
Which of the following describes the amount to collect at the time of service from a patient who has a
health maintenance organization (HMO) plan? - Answer -Copay
Which of the following reports should a billing and coding specialist use to review and track balances
from an insurance company service? - Answer -Claims report
Which of the following are three types of plans covered under TRICARE program? - Answer -Standard,
Extra, and Prime
In Box 17 on the CMS-1500 form, which of the following is the qualifier for a referring physician? -
Answer -DN
, In which of the following locations should a billing and coding specialist find the contact information to
appeal a claim? - Answer -Insurance company file
Which of the following diagnosis establishes an admission? - Answer -Principal
A billing and coding specialist should verify code linkage in the charge capture process to ensure which
of the following? - Answer -Medical necessity
On an explanation of benefits form, which of the following should a billing and coding specialist use to
determine why the insurance company denied the insurance claim? - Answer -Remark Code
Which of the following is included in electronic remittance advice? - Answer -Patient's deductible
Which of the following covers the deductible of a patient's primary health insurance policy? - Answer -
The patient's primary insurance plan
When does the physician-patient implied contract begin? - Answer -At the time the appointment is
made
Largest section of the CPT book is the - Answer -Surgery
Under HIPAA, which of the following scenarios requires the patient authorization for the release of
health information? - Answer -Referring a patient to another provider
Which of the following information associated with an aging report informs the billing and coding
specialist about more than just the immediate claim pending? - Answer -Trends of nonpayment by the
insurance payer
What is the purpose of obtaining a preauthorization? - Answer -To obtain prior approval for health care
services
