CPB Practice Exam A. Questions & Answers. 100% Accurate. Rated A+

CPB Practice Exam A. Questions & Answers. 100% Accurate. Rated A+ The office policy for claims follow-up is to prioritize the insurance balance accounts past 90 days by highest outstanding balance. Based on the A/R report provided, which payer type and aging category would be one of the top priorities on which to focus collection efforts? - -workers' compensation, 121+ days Using the fee schedule and the payment policy provided, what is the expected reimbursement (including patient responsibility) when a provider performs a nasal endoscopy and dilation of the left maxillary sinus (31295) and a diagnostic nasal endoscopy of the right maxillary sinus (31233)? - -$2475 Policy applies to all professional services performed in an office place of service: When a significant, separately identifiable E/M service (appended with modifier 25) and any service that has a global period indicator—as designated by CMS of 0, 10, 90 or YYY—is performed on the same day, the E/M service will be reimbursed at 50% of the contracted allowable. When performed in a facility, both services are paid at 100%. When the E/M value is greater than the procedure, the reduction will be applied to the global procedure code. Based on the remittance advice and the payment policy provided, what action is required for this claim? - -D. The claim did not pay correctly. Both services should be paid at 100%. Contact the payer to reprocess the claim for full payment. Balloon Sinusplasty Medical Coverage Policy According to the LCD, how is an extracapsular cataract surgery with insertion of an intraocular lens for a drug induced cataract in the left eye reported? - -66984, H26.32, T38.0X5A I. Primary insurance II. Primary insurance ID number III. Relationship to the insured IV. Place of service V. Provider NPI VI. CPT® code(s) VII. Modifier VIII. Diagnosis code correlation IX. Units of service X. Service Facility Location Information (Robert Roberts) - -VI , VIII and X The provider performs an office visit with an expanded problem focused history, expanded problem focused exam and low MDM to manage the patient's hypertension. The provider also destroys two plantar warts. How is this reported? - -99213-25, 17110 What is the correct HCPCS Level II code for Depo-Provera (medroxyprogesterone acetate) injection of 100 mg? - -J1050 x 100 55-year-old female presents to the office with ongoing history of type I diabetes which has been controlled with insulin. During the exam the physician notes that gangrene has set in due to the diabetic peripheral angiopathy on her left great toe. Patient is recommended to see a general surgeon for treatment of the gangrene on her left great toe. - -E10.52 A dermatologist performed an excision of a squamous cell carcinoma from the patients forehead with a 1.2 cm excised diameter. The excision site required an intermediate wound closure measuring 1.8 cm. What is/are the correct code(s)? - -C. 11642, 12051-51 Procedures Performed: 1. Bilateral tympanotomy with insertion of ventilation tubes (69436 RVU 4.62) 2. Adenotonsillectomy (42820 RVU 8.41) What is/.are the correct code(s) and proper billing sequence for the following procedures performed by a physician? Procedures Performed: Bilateral tympanostomy with insertion of ventilationg tubes (69436 RVU 4.63582) Adenotonsillectomy (42820 RVU 8.45321) - -A. 42820, 69436 When you respond to a patient with "How may I help you, Mrs Jones?", the use of the patient's name: - -C. Indicates to the caller you are interested and listening Ms. Turner had surgery one month ago for hernia repair. She is still in the post-operative period and comes in today to the see the same physician that performed the hernia repair surgery about a lump that she has noticed on her tailbone. The physician performs an examination and the diagnosis is that she has a pilonidal cyst which is unrelated to the surgery. Can the physician bill an E/M service for today's visit during the post-operative period? - -Yes, the E/M service can be reported with modifier 24 to indicate it is unrelated to the surgery. CMS has a standard enrollment form in which the provider agrees to: I. Submit claims to Medicare II. Have authorization from the Medicare beneficiary to file claims III. Retain all source documentation and medical records IV. Submit claims within 60 days of the date of service V. Submit all claims with a group NPI number VI. Research and correct claim discrepancies. - -D. I, II, III, and VI Incorrect entry of the patient demographics can have an affect on many areas of the practice. What documents are necessary to verify demographics? I. Photo Identification II. Insurance card III. Credit card information IV. Social Security card V. Patient completed demographic form - -I, II, and V What should a biller do when a claim is denied for not being submitted within the timely filing period? - -Track the transmission date of the claim. If within the timely filing period, provide the information to the payer to reprocess the claim. Which of the following steps should be completed when filling an appeal? I. Submit in the format required by the payer. II. Review the reason for the denial and determine if the payer made an error. III. Provide supporting documentation from an official source to support your reason for appeal. IV. Keep a copy of the information submitted to the payer for the appeal. V. Appeal the claim as soon as a denial is received. VI. Appeal the claim as soon as you are certain the payer denied in error and the claim can not be reprocessed. - -C. I, II, III, IV, and VI A patient with an acute myocardial infarction is brought by ambulance to the emergency department. The patient is taken into the cardiac catheterization lab. Angioplasty and a stent was placed in the LAD. The patient's insurance requires preauthorization for all surgical procedures. Which of the following statements is true for most payers? - -Because this was an emergency, it is acceptable to obtain authorization following the surgery. According to this clearinghouse rejections report, what action should be taken on the claims for Jerry McMahon, Date of Service 11/09/XX? - -. C44.50 requires an additional character. Review the medical record for the correct sixth character, correct the claim in your system and re-file electronically. Which of the following is an allowed collection policy after a patient files for bankruptcy? - -Unpaid insurance claims for dates of service occurring after the date of the bankruptcy can be collected. Which statement is TRUE regarding the Fair Debt Collection Practices Act (FDCPA)? - -Collectors are not allowed to contact debtors at odd hours. 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 Which Act protects information collected by consumer reporting agencies? - -Fair Credit Reporting Act Provided above is a sample of a report containing accounts with an outstanding balance. The office policy is to follow up on the oldest accounts with the highest dollar amount. Which statement below is true? - -Review the account for Bridget Smith to determine the adjustment and patient responsibility if the payment is from Medicare. Follow up with Medicare if the payment is from the patient. Which of the following is true regarding provider credentialing? - -A provider can complete an application with CAQH which handles credentialing for many payers. An example of an overpayment that must be refunded is _____________? - -Duplicate processing of a claim 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 on 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? - -The rule is fraudulent because the office is billing for services not performed and services that are a result of provider error. Security involves the safekeeping of patient information by: I. Setting office policies to protect PHI from alteration, destruction, tampering, or loss II. Allowing full access to all employees to the electronic medical records III. Giving employees a policy on confidentiality to read IV. Requiring employees to sign a confidentiality statement that details the consequences of not maintaining patient confidentiality, including termination - -I and IV Pam works for a medical practice. She discovered a claim was overpaid by Medicare. What Act requires the money to be refunded? - -False Claims Act Which of the following indicates the frequency of care on a UB-04 claim form? - -Type of Bill 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? I. Dental services are reported with CDT codes II. Inpatient procedures are reported with HCPCS Level II codes III. Diagnosis codes are reported with ICD-10-CM and ICD-10-PCS codes IV. Outpatient services are reported with CPT® and HCPCS Level II codes V. Physician services are reported with ICD-10-PCS codes - -I and IV A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate? - -The code can only be reported for one unit of service on a single date of service Which CPT® code below can be reported with modifier 51? - -19101