CBCS STUDY GUIDE ALL ANSWERS AND QUESTIONS
SET A+
✔✔Which of the following security features is required during transmission of protected
health information and medical claims to third party payers?
-Unique used IDs and passwords
-Role based access controls
-Electronic data interchange
-Encryption - ✔✔encryption
✔✔Which of the following actions should the CBCS take to effectively manage accounts
receivable?
-Collect payment from the patient at the time of service
-Have the patient pat the balance up front and wait for reimbursement
-Delay submission until the patient pays the deductible
-Ask the patient to pay half now and bill the insurance for the balance - ✔✔Collect
payment from the patient at the time of service
✔✔Which of the following insurance carriers is considered the payer of last resort?
-Medicaid
-Medicare
-TRICARE
-Blue cross/shield - ✔✔Medicaid
✔✔Which of the following blocks on the CMS-1500 claim form is required to indicate a
worker's compensation claim?
11a
21
10a
22 - ✔✔10a
-11a primary injured date of birth and gender
-21 diagnosis code
-22 Medicaid resubmission number
,✔✔The provision of health insurance policies that specifies which coverage is
considered primary or secondary is called?
-Eligibility verification
-Explanation of benefits
-Assignment of benefits
-Coordination of benefits - ✔✔coordination of benefits
✔✔A provider receives a reimbursement from a third party payer accompanied by with
document?
-Monthly statement
-Explanation of benefits
-Age analysis
-Benefit summary sheet (guideline for billing) - ✔✔Explanation of benefits
✔✔When submitting claims, which of the following is the outcome if block 13 is left
blank?
-The provider accepts assignment and payment as payment in full
-The provider cannot collect deductible, copayment, and coinsurance amounts
-This has no effect on the claim processing and reimbursement
-The third party payer reimburses the patient, and the patient is responsible for
reimbursing the provider - ✔✔The third party payer reimburses the patient, and the
patient is responsible for reimbursing the provider
✔✔Which of the following situations constitutes a consultation?
- Services rendered by a physician whose opinion or advice is required by another
physician or agency.
- The physician needs to meet the family and the patient to discuss the medical
condition
- The transfer of the total or specific care of a patient from one physician to another for
known problem
- The physician has had the initial treatment and needs to follow-up with the patient
regarding the care plan - ✔✔Services rendered by a physician whose opinion or advice
is required by another physician or agency.
✔✔Which of the following billing patterns is the best practice action?
- Billing for diagnostic tests without a separate report in patient's health record
- Billing the patient for the difference between the charges and the allowed amounts
- Documenting the patient's chief complaint, history, exam, assessment, and plan for
care
- Separating service or procedure codes to increase reimbursement - ✔✔Documenting
the patient's chief complaint, history, exam, assessment, and plan for care
✔✔When billing a secondary insurance, which block should the CBCS fill out on the
CMS-1500 form?
9a
,28
24J
24F - ✔✔9a
- 28 (total billed amount)
- 24J (NPI)
- 24F (charge per service)
✔✔Which of the following describes an obstruction of the urethra?
-Urethralgia (pain)
-Urethratresia
-Urethrism (stricture)
-Uretritis - ✔✔Urethratresia
-Urethralgia (pain)
-Urethrism (stricture)
✔✔Which of the following is the correct entry of a charge of $150 in block 24F ?
150 00
150
150.00
15000 - ✔✔150 00
✔✔Which of the following organizations identifies improper payments made on CMS
claims?
- Office of inspector general (OIG)
- Quality improvement organization (QIOs)
- Recovery audit contractor (RAC)
- Medicare administrative Contractors (MACs) - ✔✔Recovery audit contractor (RAC)
- Office of inspector general (OIG) (protect the integrity of the department of Health and
Human services programs)
- Quality improvement organization (QIOs) (perform utilization and quality control review
of healthcare furnished to Medicare beneficiaries
- Medicare administrative Contractors (MACs)
✔✔If the patient has osteomyelitis, he has problems with which of the following?
- Bones and muscles
- Bones and bone marrow
- Bones and skin
- Bones and tendons - ✔✔bone and bone marrow
✔✔When coding on the UB-04 form, the CBCS must sequence the diagnosis codes
according to ICD guidelines. Which of the following is the first listed diagnosis code?
- Primary diagnosis
- Chief complaint
- Etiology (underlying cause of the disease)
- Principal diagnosis - ✔✔Principal diagnosis
, ✔✔A provider performs an examination of a patient's sore throat. Which of the following
describes the level of the examination?
- Expanded problem focused examination
- Detailed examination
- Problem focused examination
- Comprehensive examination - ✔✔Problem focused examination
- Expanded problem focused examination ( specific examination of an affected organ
system and related organ systems)
- Detailed examination (extended examination of an affected organ system, and other
related organ systems
- Comprehensive examination (general multi system examination)
✔✔Which of the following coding manuals is used to identify products, supplies and
services?
- ICD-10 manual (diagnosis codes)
- HCPCS level II manual
- ICD-10-PCS manual (inpatient facilities to assign procedures)
- CPT manual (outpatient professional service and procedure codes in an - ✔✔HCPCS
level II manual
- ICD-10 manual (diagnosis codes)
- ICD-10-PCS manual (inpatient facilities to assign procedures)
- CPT manual (outpatient professional service and procedure codes in an
✔✔A patient has an emergency appendectomy while on vacation. The claim is rejected
due to the patient obtaining services out of network. Which of the following information
should be included in the claim appeal?
- The provider's network status
- The names of the travelers who where with the patient during the emergency
- The patient was out of town during the emergency
- The reason why the patient was out of town - ✔✔The patient was out of town during
the emergency
✔✔After reading a provider's notes about a new patient, a CBCS decides to code for a
longer length of time than the actual office visit. Which of the following describes that
action?
- Unbundling
- Abuse
- Fraud
- Error - ✔✔fraud
✔✔Two providers from the same practice visit a patient in the ER using the same CPT
code. The claim may be denied due to which of the following reasons?
- Continuity of care
- Incident to service (non physician practitioner bills in place of the physician)
SET A+
✔✔Which of the following security features is required during transmission of protected
health information and medical claims to third party payers?
-Unique used IDs and passwords
-Role based access controls
-Electronic data interchange
-Encryption - ✔✔encryption
✔✔Which of the following actions should the CBCS take to effectively manage accounts
receivable?
-Collect payment from the patient at the time of service
-Have the patient pat the balance up front and wait for reimbursement
-Delay submission until the patient pays the deductible
-Ask the patient to pay half now and bill the insurance for the balance - ✔✔Collect
payment from the patient at the time of service
✔✔Which of the following insurance carriers is considered the payer of last resort?
-Medicaid
-Medicare
-TRICARE
-Blue cross/shield - ✔✔Medicaid
✔✔Which of the following blocks on the CMS-1500 claim form is required to indicate a
worker's compensation claim?
11a
21
10a
22 - ✔✔10a
-11a primary injured date of birth and gender
-21 diagnosis code
-22 Medicaid resubmission number
,✔✔The provision of health insurance policies that specifies which coverage is
considered primary or secondary is called?
-Eligibility verification
-Explanation of benefits
-Assignment of benefits
-Coordination of benefits - ✔✔coordination of benefits
✔✔A provider receives a reimbursement from a third party payer accompanied by with
document?
-Monthly statement
-Explanation of benefits
-Age analysis
-Benefit summary sheet (guideline for billing) - ✔✔Explanation of benefits
✔✔When submitting claims, which of the following is the outcome if block 13 is left
blank?
-The provider accepts assignment and payment as payment in full
-The provider cannot collect deductible, copayment, and coinsurance amounts
-This has no effect on the claim processing and reimbursement
-The third party payer reimburses the patient, and the patient is responsible for
reimbursing the provider - ✔✔The third party payer reimburses the patient, and the
patient is responsible for reimbursing the provider
✔✔Which of the following situations constitutes a consultation?
- Services rendered by a physician whose opinion or advice is required by another
physician or agency.
- The physician needs to meet the family and the patient to discuss the medical
condition
- The transfer of the total or specific care of a patient from one physician to another for
known problem
- The physician has had the initial treatment and needs to follow-up with the patient
regarding the care plan - ✔✔Services rendered by a physician whose opinion or advice
is required by another physician or agency.
✔✔Which of the following billing patterns is the best practice action?
- Billing for diagnostic tests without a separate report in patient's health record
- Billing the patient for the difference between the charges and the allowed amounts
- Documenting the patient's chief complaint, history, exam, assessment, and plan for
care
- Separating service or procedure codes to increase reimbursement - ✔✔Documenting
the patient's chief complaint, history, exam, assessment, and plan for care
✔✔When billing a secondary insurance, which block should the CBCS fill out on the
CMS-1500 form?
9a
,28
24J
24F - ✔✔9a
- 28 (total billed amount)
- 24J (NPI)
- 24F (charge per service)
✔✔Which of the following describes an obstruction of the urethra?
-Urethralgia (pain)
-Urethratresia
-Urethrism (stricture)
-Uretritis - ✔✔Urethratresia
-Urethralgia (pain)
-Urethrism (stricture)
✔✔Which of the following is the correct entry of a charge of $150 in block 24F ?
150 00
150
150.00
15000 - ✔✔150 00
✔✔Which of the following organizations identifies improper payments made on CMS
claims?
- Office of inspector general (OIG)
- Quality improvement organization (QIOs)
- Recovery audit contractor (RAC)
- Medicare administrative Contractors (MACs) - ✔✔Recovery audit contractor (RAC)
- Office of inspector general (OIG) (protect the integrity of the department of Health and
Human services programs)
- Quality improvement organization (QIOs) (perform utilization and quality control review
of healthcare furnished to Medicare beneficiaries
- Medicare administrative Contractors (MACs)
✔✔If the patient has osteomyelitis, he has problems with which of the following?
- Bones and muscles
- Bones and bone marrow
- Bones and skin
- Bones and tendons - ✔✔bone and bone marrow
✔✔When coding on the UB-04 form, the CBCS must sequence the diagnosis codes
according to ICD guidelines. Which of the following is the first listed diagnosis code?
- Primary diagnosis
- Chief complaint
- Etiology (underlying cause of the disease)
- Principal diagnosis - ✔✔Principal diagnosis
, ✔✔A provider performs an examination of a patient's sore throat. Which of the following
describes the level of the examination?
- Expanded problem focused examination
- Detailed examination
- Problem focused examination
- Comprehensive examination - ✔✔Problem focused examination
- Expanded problem focused examination ( specific examination of an affected organ
system and related organ systems)
- Detailed examination (extended examination of an affected organ system, and other
related organ systems
- Comprehensive examination (general multi system examination)
✔✔Which of the following coding manuals is used to identify products, supplies and
services?
- ICD-10 manual (diagnosis codes)
- HCPCS level II manual
- ICD-10-PCS manual (inpatient facilities to assign procedures)
- CPT manual (outpatient professional service and procedure codes in an - ✔✔HCPCS
level II manual
- ICD-10 manual (diagnosis codes)
- ICD-10-PCS manual (inpatient facilities to assign procedures)
- CPT manual (outpatient professional service and procedure codes in an
✔✔A patient has an emergency appendectomy while on vacation. The claim is rejected
due to the patient obtaining services out of network. Which of the following information
should be included in the claim appeal?
- The provider's network status
- The names of the travelers who where with the patient during the emergency
- The patient was out of town during the emergency
- The reason why the patient was out of town - ✔✔The patient was out of town during
the emergency
✔✔After reading a provider's notes about a new patient, a CBCS decides to code for a
longer length of time than the actual office visit. Which of the following describes that
action?
- Unbundling
- Abuse
- Fraud
- Error - ✔✔fraud
✔✔Two providers from the same practice visit a patient in the ER using the same CPT
code. The claim may be denied due to which of the following reasons?
- Continuity of care
- Incident to service (non physician practitioner bills in place of the physician)
