CPB Exam Questions and answers, 100% Accurate. Graded A+.

CPB Exam Questions and answers, 100% Accurate. Graded A+. A 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance is primary? - -Mother Which managed care plan has the patient receiving care from participating providers (network provider) and the providers are only paid for services provided? - -Exclusive Provider Organization Which TRICARE plan is similar to an HMO plan - -TRICARE Prime Which of the services are covered by Medicare Part A - -hospital care skilled nursing facility care nursing home care hospice home health services Bob sees his family physician for seasonal allergies.Before leaving, Bob pays the charge for the office visit. As a courtesy, the physician's staff submits a claim to Bob's insurance company. If the service is covered by the insurance company, Bob can expect to be reimbursed for the office visit. This is which type of insurance model - -Blue Cross/Blue Shield fee-for-service managed care plan in which enrollees must receive their care from doctors and hospitals within network. If an enrollee goes to a provider or hospital outside of the network the enrollee pays out of pocket. in network provider is reimbursed on fee-for-service basis. - -Exclusive Provider Organization EPO Blue Cross/Blue Shield fee-for-service - -individuals who do not have the access to a group plan and for small business employers two types of coverage basic coverage and major medical benefits. is required to cover Part A coinsurance and hospital costs - -Medigap is incorporated by CMS into the NCCI program to limit the number of times a service or procedure can be reported by a physician on the same date of service to a patient. - -Medically unlikely edits When a patient has Medigap in addition to Medicare, item 9a on the 1500 - -Medigap insurer's policy and or group number preceded by MEDIGAP MG or MGAP item 18 on a CMS-1500 claim form has dates of service for inpatient care, what is entered in item 32? - -Name and address of the facility that provided the service type of bill ub-04 - -digit 1 type of facility digit 2 for hospitals digit 3 type of bill The CPT® or HCPCS Level II code reported on a UB-04 is translated to what type of code by Medicare to reimburse for outpatient facility services? - -Ambulatory Payment Classification Which of the following are common identifiers for protected health information (PHI) which can be used to identify an individual? - -birth date past mental health condition mailing address medical record number requires lenders to follow standardized procedures and methods to make the cost and terms of credit known to their consumers - -Truth in Lending Act protects the Government from being overcharged or sold substandard goods or services - -False Claims Act criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a Federal health care program - -Anti-Kickback Statute prohibits knowingly and willfully executing, or attempting to execute, a scheme such as defrauding any health care benefit program. - -Criminal Health Care Fraud Statute MS-DRGs enable CMS to provide - -reimbursement to hospitals billing for inpatient services based on severity of illness and the consumption of resources. Medicare does not - -recognize consultation codes MSDRGS - -medicare severity diagnosis related groups UCR - -usual customary reasonable