CPB Practice Exam Questions and answers, 100% Accurate. Verified.

CPB Practice Exam Questions and answers, 100% Accurate. Verified. Managed care organization were created to manage benefits and to develop participating provider networks. Managed care can now be categorized according to six models. Which model below listed below is not considered managed care? A. Triple Option Plan (TOP) B. Integrated Delivery System (IDS) C. Health Maintenance Organization (HMO) D. Value-added Network (VAN) - -D. Value-added Network (VAN) Medicare Part ______ helps pay for inpatient care in a hospital, skilled nursing facility, following a hospital stay, some health care, and hospice care. A. C B. A C. D D. B - -B. A What type of insurance coverage offers assistance for some low-income people, particularly children and pregnant women and is sponsored by state and federal government? A. Medicaid B BC/BS C. Tricare/Champus D. Commercial Payers - -A. Medicaid What type of health insurance policy or other health benefit plan is offered to persons entitled to Medicare benefits? A. BC/BS B. Medigap C. Managed Care Plans D. Public Health Care - -B. Medigap ______ covers the medical expenses of individuals and groups. Premiums and benefits vary according to the type of plan offered. Group health plans usually cost less than individual health plans. A. Liability Insurance B. Disability Insurance C. Automobile Insurance D. Commercial Insurance - -D. Commercial Insurance which statement is not true regarding blue cross blue shield? A. They maintain negotiated contract with providers of care, and they possess features that distinguish them from other commercial health insurance groups. B. Covers losses to a third party caused by the insured or by an object owned by the insured or on the premises owned by the insured. C. Allow conversion from group to individual coverage. D. Guarantees the transferability of membership from one local plan to another when a change in residency moves a policy holder into an area served by a different BCBS corporation. - -B. Covers losses to a third party caused by the insured or by an object owned by the insured or on the premises owned by the insured. who is eligible for TRICARE healthcare? A. Active duty members of the military and their qualified family members B. CHAMPUS-eligible retirees and qualified family members C. Eligible survivors of members of the uniformed services D. All of the above - -D. All of the above in workers' compensations, the ______ requires a statement from the patient describing the circumstances and event surrounding the injury. A. The First Report of Injury form B. The CMS-1500 form C. The state fiscal agent form D. None of the above - -A. The First Report of Injury form Which statement is true? Federal law requires that all providers and suppliers submit claims to medicare if they provide a medicare-covered service to a patient enrolled in medicare part B. This regulation does not apply if the: A. Patient is enrolled before the service was furnished B. Patient is not enrolled in Medicare part B C. Patient or the patient's legal representative signs an authorization for release of medical record D. Provider opts out of the Medicare program but does offer medicare private contracting - -B. Patient is not enrolled in Medicare part B Medicare Advantage Plans (Medicare Part C) __________. A. Do not require referrals to see specialists B. Charge higher premiums and deductibles compared to the Original Medicare Plan C. Do not offer extra benefits, such as prescription drug coverage D. Have networks, which means patients may have to see doctors who belong to the plan or go to certain hospitals to get covered service - -D. Have networks, which means patients may have to see doctors who belong to the plan or go to certain hospitals to get covered service which statement is not true? A. A person who is eligible for medicaid in one state may not be eligible in another state. B. medicaid eligibility is limited to individuals who can be classified as categorically needy, medically needy or a special group C. medicaid does not cover nursing facility services for beneficiaries age 21 and older D. medicare beneficiaries with low incomes and limited resources may receive help with out-of-pocket medical expenses from state medicaid programs - -C. medicaid does not cover nursing facility services for beneficiaries age 21 and older group health insurance is available through: A. Employers B. labor unions C. rural and consumer health cooperatives D. all of the above - -D. all of the above healthcare regulations are not always definitive and may vary by payer, ________, and the setting in which patient care is provided. A. Clearinghouse B. Patient's age C. Geographic area D. None of the Above - -C. Geographic area what Act, which included the American Recovery and Reinvestment Act of 2009, amended the Public Health Service Act to establish an Office of National Coordinator for Health Information Technology within Health and Human Services to improve health care quality, safety, and efficiency? A. Patient Protection and Affordable Care Act (PPACA) B. Health Information Technology for Economic and Clinical Health Act (HITECH) C. Health Insurance Portability and Accountability Act (HIPAA) D. Financial Service Modernization Act (FSMA) - -B. Health Information Technology for Economic and Clinical Health Act (HITECH) What standard is a key protection of the HIPAA Privacy Rule which requires covered entities to take reasonable steps to limit the use or discloser of, and requests for PHI? A. Minimum necessary B. Incidental disclosure C. Quality Improvement D. Informal provisions - -A. Minimum necessary How many standards are there for electronic healthcare transactions and code sets? A.Twelve B. Six C. Eight D. Twenty-one - -C. Eight According to CMS, medical records must be retained in their original or legally reproduced form for a period of at least ______ years. A. 7 years B. 10 years C. 5 years D. None of the above - -C. 5 years Which is not an example of fraud? a. altering claim forms to receive a higher payment amount b. billing for services at a higher level than provider or necessary c. falsifying documentation d. billing medicare patients a higher fee schedule than non-medicare patients - -d. billing medicare patients a higher fee schedule than non-medicare patients the false claims act is an American federal law that imposes liability on persons and companies who defraud governmental programs such as medicare and medicaid. what statement below demonstrates violation of the false claims act? a. upcoding and/or unbundling service are considered a false claim act violation b. failure to return overpayment is a false claims act violation c. submitting claims for physician services performed by a non-physician provider (NPP) without regard to incident-to guidelines is a false claim act d. all of the above - -d. all of the above _______ include CHAMPVA, indian health services, medicaid, medicare, tricare, and workers' compensation a. federal health care programs b. state health care programs c. local health care programs d. none of the above - -a. federal health care programs What is the maximum amount the payer will reimburse for each procedure or service, according to the patient's policy? a. allowed charge b. universal charge c. limiting charge d. assessment charge - -a. allowed charge the _______ determines coverage by primary and secondary payer policies when both parents subscribe to a different health insurance plan. a. assignment of benefits b. certificate of benefits c. advance beneficiary notice d. birthday rule - -d. birthday rule ______ reimburses non-institutional health care providers for outpatient services. a. medicare part A b. medicare part B c. medicare part C d. medicare part D - -b. medicare part B what is the name of the payment system that reimburses physicians' practice expenses based on relative values for three components of each physician's services: physician work, practice expense, and malpractice insurance expense? a. resource allocation monitoring system b. retrospective reasonable cost system c. national correct coding initiative d. resource-based relative value scale system (RBRVS) - -d. resource-based relative value scale system (RBRVS) ______ managers the delivery of health care services offered by hospitals, physicians employed by the IPO, and other health care organizations (e.g., ambulatory surgery clinic and a nursing facility). a. integrated delivery system b. large group health plan c. integrated provider organization d. managed care organization - -c. integrated provider organization typical information for a _____ is the patient name, the insured ID number, CPT/HCPCS Level II code(s), ICD-10-CM code(s), site where the service is to be performed, ordering physician, and date if service for the procedure if already scheduled. a. referral b. patient registration c. prior authorization d. advance beneficiary notice - -c. prior authorization common edits that are identified by claims scrubbers are ______ errors. a. date entry b. medical necessity c. local coverage determination d. insurance contract discrepancy - -a. date entry the physician payment schedule is determined by: a. national correct coding initiative