CPB Final Exam Questions & Answers, 100% Accurate. Graded A+

CPB Final Exam Questions & Answers, 100% Accurate. Graded A+ 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 date Which 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? - - 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? - -Pam tells him that all requests must be in writing. Security involves the safekeeping of patient information by: - -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 work that is being done for lab collection. Which statement is true regarding this rule? - -This action is considered fraudulent. Services duplicated because of provider error should not be billed and the office is billing for services not rendered. An example of an overpayment that must be refunded is _____________? - -Duplicate processing of a claim Which of the following is true regarding provider credentialing? - -providers use a standard application and a common database to submit one application to one source to meet the needs of all of the health plans and hospitals participating in the CAQH effort. Which Act protects information collected by consumer reporting agencies? - -Fair Credit Reporting Act There is a written office policy to write off patients co-insurance and copayment amounts as a professional courtesy. Is this appropriate? - -No, it is considered fraud to write off the patients' responsibility for all patients.