©BRIGHTSTARS EXAM SOLUTIONS
10/21/2024 9:24 PM
Review for CPB Exam Questions And
Answers 100% Pass.
To report co-management, Which below must be true? - answer✔A. Co-management only
applies to doctors in the same clinic.
B. Two physicians must be performing the surgical procedure.
C. Two doctors must be managing the Post-op Care.
D. Non of the answers are correct.
Answer: D None of the answers are correct. The doctors must be in separate office/clinics. Co-
management refers to another provider providing the post-operative care for a surgical
procedure. Co-management is not for two surgeons. Co-management refers to office visits and
standard aftercare. Two doctors cannot be paid for the same date's for post-op care (different
dates, yes).
What is a Certificate of Authority used for? - answer✔Certificate of Authority (COA) is issued
by the state. It licenses the operation of an HMO (Health Maintenance Organization.
What are the three components of the Medicare Allowable fee for a specific clinic? -
answer✔The total RVUs, the GPCI and the current year Malpractice RVU.
The work RVU, The Practice Expense RVU and the Malpractice RVU all add up to be the total
RVU's for a given service in either the office or hospital setting. The total RVUs, the GPCI and
the current year Medicare conversion factor are how the Medicare allowable for a given service
is calculated.
Which is true concerning professional courtesy charges? - answer✔DDHS OIG is its 1991
Special Fraud Alert, emphasized that the "routine" waiver of co-payments and/or deductibles is
equivalent to misstating the actual charge.
What is the time limit for filing notice of injury and claim for federal workers' compensation? -
answer✔Three years. A notice must be filed within three years of the date of injury. However, if
a claim is not filed within three years, compensation may still be paid if written notice of injury
, ©BRIGHTSTARS EXAM SOLUTIONS
10/21/2024 9:24 PM
was given within 30 days, or the employer had actual knowledge of the injury within 30 days
after it occurred.
What is a good example of a "Carrier-Specific" Rule or Guideline? - answer✔MOD-50 or
RT/LT on separate lines. Carrier-Specific Rules or Guidelines are unique to a specific carrier,
Medicare (10 Jurisdictions) or private carrier (Blue-Cross/Blue Shield). Examples include MOD-
50 versus RT/LT usage, billing an E & M with a minor procedure. Most all carriers will follow
the Medicare lead on NCCI edits, Bilateral Surgery Modifiers and 1997 E & M Guidelines.
These should not vary by carrier except in the most non-standard cases.
What is the difference between a rejection and a denial? - answer✔A rejection is most often from
the clearinghouse, before the claim gets to the carrier where you will get a specific denial code
on the EOB. In general, the clearinghouse will reject claims for global issues like NCCI edits
whereas the carrier denial can be by plan and is specific to each carrier.
What is Medical Necessity (for reimbursement)? - answer✔Matching of ICD-10 codes to a CPT
code that support reimbursement (not as a screening). Services are not reimbursed if medical
necessity is not supported.
How is modifier GA used? - answer✔When a patient signs an Advanced Beneficiary notice
(ABN); append the code to the service provided. MOD-GA when a service may not be covered
by Medicare. Don't use modifier GA on the 92015 refraction code.
A Medicare Participating Provider is? - answer✔A provider who accepts assignment for
Medicare Claims. Accepting Medicare Assignment means the provider will accepts what
Medicare pays and not bill the patient for the difference between what the services costs and
what Medicare pays.
PAR provider: - answer✔Signs an agreement with the Fiscal Intermediary.
OCE Edits include which of the following? What does OCE mean? - answer✔Age Edits;
Outpatient Code Editor. Both age and sex edits are correct but OCE means Outpatient Code
Editor.
Which item below is not an indication of complicance? - answer✔A. If the CPT code and
modifiers are valid codes and the carrier pays
B. Only certified coders are hired
C. Using an EMR system
D. All of the answers are correct.
Answer: D All of the answers are correct
10/21/2024 9:24 PM
Review for CPB Exam Questions And
Answers 100% Pass.
To report co-management, Which below must be true? - answer✔A. Co-management only
applies to doctors in the same clinic.
B. Two physicians must be performing the surgical procedure.
C. Two doctors must be managing the Post-op Care.
D. Non of the answers are correct.
Answer: D None of the answers are correct. The doctors must be in separate office/clinics. Co-
management refers to another provider providing the post-operative care for a surgical
procedure. Co-management is not for two surgeons. Co-management refers to office visits and
standard aftercare. Two doctors cannot be paid for the same date's for post-op care (different
dates, yes).
What is a Certificate of Authority used for? - answer✔Certificate of Authority (COA) is issued
by the state. It licenses the operation of an HMO (Health Maintenance Organization.
What are the three components of the Medicare Allowable fee for a specific clinic? -
answer✔The total RVUs, the GPCI and the current year Malpractice RVU.
The work RVU, The Practice Expense RVU and the Malpractice RVU all add up to be the total
RVU's for a given service in either the office or hospital setting. The total RVUs, the GPCI and
the current year Medicare conversion factor are how the Medicare allowable for a given service
is calculated.
Which is true concerning professional courtesy charges? - answer✔DDHS OIG is its 1991
Special Fraud Alert, emphasized that the "routine" waiver of co-payments and/or deductibles is
equivalent to misstating the actual charge.
What is the time limit for filing notice of injury and claim for federal workers' compensation? -
answer✔Three years. A notice must be filed within three years of the date of injury. However, if
a claim is not filed within three years, compensation may still be paid if written notice of injury
, ©BRIGHTSTARS EXAM SOLUTIONS
10/21/2024 9:24 PM
was given within 30 days, or the employer had actual knowledge of the injury within 30 days
after it occurred.
What is a good example of a "Carrier-Specific" Rule or Guideline? - answer✔MOD-50 or
RT/LT on separate lines. Carrier-Specific Rules or Guidelines are unique to a specific carrier,
Medicare (10 Jurisdictions) or private carrier (Blue-Cross/Blue Shield). Examples include MOD-
50 versus RT/LT usage, billing an E & M with a minor procedure. Most all carriers will follow
the Medicare lead on NCCI edits, Bilateral Surgery Modifiers and 1997 E & M Guidelines.
These should not vary by carrier except in the most non-standard cases.
What is the difference between a rejection and a denial? - answer✔A rejection is most often from
the clearinghouse, before the claim gets to the carrier where you will get a specific denial code
on the EOB. In general, the clearinghouse will reject claims for global issues like NCCI edits
whereas the carrier denial can be by plan and is specific to each carrier.
What is Medical Necessity (for reimbursement)? - answer✔Matching of ICD-10 codes to a CPT
code that support reimbursement (not as a screening). Services are not reimbursed if medical
necessity is not supported.
How is modifier GA used? - answer✔When a patient signs an Advanced Beneficiary notice
(ABN); append the code to the service provided. MOD-GA when a service may not be covered
by Medicare. Don't use modifier GA on the 92015 refraction code.
A Medicare Participating Provider is? - answer✔A provider who accepts assignment for
Medicare Claims. Accepting Medicare Assignment means the provider will accepts what
Medicare pays and not bill the patient for the difference between what the services costs and
what Medicare pays.
PAR provider: - answer✔Signs an agreement with the Fiscal Intermediary.
OCE Edits include which of the following? What does OCE mean? - answer✔Age Edits;
Outpatient Code Editor. Both age and sex edits are correct but OCE means Outpatient Code
Editor.
Which item below is not an indication of complicance? - answer✔A. If the CPT code and
modifiers are valid codes and the carrier pays
B. Only certified coders are hired
C. Using an EMR system
D. All of the answers are correct.
Answer: D All of the answers are correct
