CBCS CORE REVIEWS ANSWERS AND QUESTIONS
SET A+
✔✔In 1995 and 1997 , which of the following introduced documentation guidelines to
Medicare carriers to ensure that service paid for have been provided and were
medically necessary?
- HIPAA
- OIG
- CMS
- AMA - ✔✔CMS
- OIG - fraud and abuse
- AMA - physician patient relationship
✔✔For which of the following time periods should the CBCS track unpaid claims before
taking follow up action?
10 days
30 days
60 days
90 days - ✔✔30 days
✔✔A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating
provider is responsible for which of the following percentage?
40%
20%
10%
0% - ✔✔0%
✔✔A CBCS should add modifier -50 to codes when reporting which of the following?
- A bilateral procedure
- A unilateral procedure
- Multiple procedure
- Reduces services - ✔✔A bilateral procedure
✔✔Z codes are used to identify which of the following?
,-Behavior disorders
- Digestive diseases
- Infectious diseases
- Immunizations - ✔✔Immunizations
Behavior disorders (F)
Digestive diseases (K)
Infectious diseases (A and B)
✔✔Which of the following was developed to reduce Medicare program expenditure by
detecting in appropriate cades and eliminating improper coding practice?
- NCCi
- HIPAA
- MAC
- NPI - ✔✔NCCi (national correct coding initiative - detect inappropriate codes and
eliminate improper coding practices)
- HIPAA
- MAC (Medicare administrative contractor)
- NPI
✔✔Which of the following is a verbal or written agreement that gives approval to release
PHI?
- Notice of privacy practices
- Right to privacy
- Consent
- Assignment of benefits - ✔✔consent
✔✔After a third party validates a claim, which of the following takes place next?
- Claim payment
- Claim adjudication (process of analyzing the claim)
- Claim resolution (small claims court)
- Claim attachment - ✔✔Claim adjudication (process of analyzing the claim)
- Claim payment
- Claim resolution (small claims court)
- Claim attachment
✔✔A CBCS is reviewing a CMS-1500 claim form. The assignment of the benefits box
has been checked "yes". The check box indicates which of the following?
- The provider receives payment directly from payer
- The payer sends reimbursement for service to the patient
- The payer pays the provider a set amount for each enrolled person assignment of
benefit box
- The provider can collect full payment from the patient - ✔✔The provider receives
payment directly from payer
,✔✔Which of the following forms must the patient or representative sign to allow the
release of PHI?
- An authorization
- An affidavit
- A copy of the HIPAA security rule
- A copy of the HIPAA privacy rule - ✔✔an authorization
✔✔Which of the following is the primary information used to determine the priority of
collection letters to patients?
- The age of the account
- The type of the account
- The type of the insurance
- The last payment received - ✔✔the age of the account
✔✔Which of the following claims would appear on an aging report?
- A claim paid in full within the past 90 days
- A claim that is delinquent for 60 days
- A claim processed and paid within past 60 days
- A claim that billed and reimbursed the patient within the past 30 days - ✔✔A claim that
is delinquent for 60 days
✔✔A CBCS should enter the prior authorization number on the CMS-1500 claim form in
which of the following blocks?
- 21A (diagnosis code)
- 24 D (procedures and services)
- 23 (prior authorization)
- 24E (federal tax id) - ✔✔23 (prior authorization)
- 21A (diagnosis code)
- 24 D (procedures and services)
- 24E (federal tax id)
✔✔Which of the following blocks require the patient's authorization to release medical
information to process a claim?
- 12
- 13 (patient authorization for assignment of benefits required for third party payer
- 27 (accepting assignment of benefits)
- 31 (treating physician's name) - ✔✔12
- 13 (patient authorization for assignment of benefits required for third party payer
- 27 (accepting assignment of benefits)
- 31 (treating physician's name)
✔✔Which of the following claims is submitted and then optically scanned by the
insurance and converted to an electronic form?
- Paper claim
- Pending claim
, - Clean claim
- Rejected claim - ✔✔paper claim
✔✔Which of the following actions by a CBCS would be considered fraud?
- Submitting a claim for services that are not medically necessary
- Violating participating provider agreements with third party payer
- Billing for services not provided
- Billing non-covered services as covered services - ✔✔billing for services not provided
✔✔Which of the following privacy measures ensures PHI?
- Confirming test results with the patient over the phone at the reception
- Asking patients the reason for their visit at check in
- Using data encryption software on office workstation
- Calling a patient into the clinical area using first and last name. - ✔✔Using data
encryption software on office workstation
✔✔A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment
information is called which of the following?
- Encounter form
- Itemized bill
- Chargemaster
- Remittance advice - ✔✔encounter form
✔✔Which of the following medical terms refers to the sac that encloses the heart?
-Endocardium
-Epicardium
-Myocardium
-pericardium - ✔✔pericardium
✔✔When completing CMS-1500 paper claim form, which of the following is an
acceptable action for the CBCS to take?
- Use appropriate title for all patients
- Fold the form in half for mailing
- Use Arial size 10 font
- Attach documents with staples in the left hand corner - ✔✔use Arial size 10 font
✔✔Which of the following describes a delinquent claim?
- The claim was submitted beyond the timely filing limit
- The claim had more than one procedure submitted
- The claim is an incoming claim
- The claim is overdue for payment - ✔✔the claim is overdue for payment
✔✔A patient is upset about a bill she received. Her insurance denied the claim. Which
of the following actions is an appropriate way to handle the situation?
SET A+
✔✔In 1995 and 1997 , which of the following introduced documentation guidelines to
Medicare carriers to ensure that service paid for have been provided and were
medically necessary?
- HIPAA
- OIG
- CMS
- AMA - ✔✔CMS
- OIG - fraud and abuse
- AMA - physician patient relationship
✔✔For which of the following time periods should the CBCS track unpaid claims before
taking follow up action?
10 days
30 days
60 days
90 days - ✔✔30 days
✔✔A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating
provider is responsible for which of the following percentage?
40%
20%
10%
0% - ✔✔0%
✔✔A CBCS should add modifier -50 to codes when reporting which of the following?
- A bilateral procedure
- A unilateral procedure
- Multiple procedure
- Reduces services - ✔✔A bilateral procedure
✔✔Z codes are used to identify which of the following?
,-Behavior disorders
- Digestive diseases
- Infectious diseases
- Immunizations - ✔✔Immunizations
Behavior disorders (F)
Digestive diseases (K)
Infectious diseases (A and B)
✔✔Which of the following was developed to reduce Medicare program expenditure by
detecting in appropriate cades and eliminating improper coding practice?
- NCCi
- HIPAA
- MAC
- NPI - ✔✔NCCi (national correct coding initiative - detect inappropriate codes and
eliminate improper coding practices)
- HIPAA
- MAC (Medicare administrative contractor)
- NPI
✔✔Which of the following is a verbal or written agreement that gives approval to release
PHI?
- Notice of privacy practices
- Right to privacy
- Consent
- Assignment of benefits - ✔✔consent
✔✔After a third party validates a claim, which of the following takes place next?
- Claim payment
- Claim adjudication (process of analyzing the claim)
- Claim resolution (small claims court)
- Claim attachment - ✔✔Claim adjudication (process of analyzing the claim)
- Claim payment
- Claim resolution (small claims court)
- Claim attachment
✔✔A CBCS is reviewing a CMS-1500 claim form. The assignment of the benefits box
has been checked "yes". The check box indicates which of the following?
- The provider receives payment directly from payer
- The payer sends reimbursement for service to the patient
- The payer pays the provider a set amount for each enrolled person assignment of
benefit box
- The provider can collect full payment from the patient - ✔✔The provider receives
payment directly from payer
,✔✔Which of the following forms must the patient or representative sign to allow the
release of PHI?
- An authorization
- An affidavit
- A copy of the HIPAA security rule
- A copy of the HIPAA privacy rule - ✔✔an authorization
✔✔Which of the following is the primary information used to determine the priority of
collection letters to patients?
- The age of the account
- The type of the account
- The type of the insurance
- The last payment received - ✔✔the age of the account
✔✔Which of the following claims would appear on an aging report?
- A claim paid in full within the past 90 days
- A claim that is delinquent for 60 days
- A claim processed and paid within past 60 days
- A claim that billed and reimbursed the patient within the past 30 days - ✔✔A claim that
is delinquent for 60 days
✔✔A CBCS should enter the prior authorization number on the CMS-1500 claim form in
which of the following blocks?
- 21A (diagnosis code)
- 24 D (procedures and services)
- 23 (prior authorization)
- 24E (federal tax id) - ✔✔23 (prior authorization)
- 21A (diagnosis code)
- 24 D (procedures and services)
- 24E (federal tax id)
✔✔Which of the following blocks require the patient's authorization to release medical
information to process a claim?
- 12
- 13 (patient authorization for assignment of benefits required for third party payer
- 27 (accepting assignment of benefits)
- 31 (treating physician's name) - ✔✔12
- 13 (patient authorization for assignment of benefits required for third party payer
- 27 (accepting assignment of benefits)
- 31 (treating physician's name)
✔✔Which of the following claims is submitted and then optically scanned by the
insurance and converted to an electronic form?
- Paper claim
- Pending claim
, - Clean claim
- Rejected claim - ✔✔paper claim
✔✔Which of the following actions by a CBCS would be considered fraud?
- Submitting a claim for services that are not medically necessary
- Violating participating provider agreements with third party payer
- Billing for services not provided
- Billing non-covered services as covered services - ✔✔billing for services not provided
✔✔Which of the following privacy measures ensures PHI?
- Confirming test results with the patient over the phone at the reception
- Asking patients the reason for their visit at check in
- Using data encryption software on office workstation
- Calling a patient into the clinical area using first and last name. - ✔✔Using data
encryption software on office workstation
✔✔A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment
information is called which of the following?
- Encounter form
- Itemized bill
- Chargemaster
- Remittance advice - ✔✔encounter form
✔✔Which of the following medical terms refers to the sac that encloses the heart?
-Endocardium
-Epicardium
-Myocardium
-pericardium - ✔✔pericardium
✔✔When completing CMS-1500 paper claim form, which of the following is an
acceptable action for the CBCS to take?
- Use appropriate title for all patients
- Fold the form in half for mailing
- Use Arial size 10 font
- Attach documents with staples in the left hand corner - ✔✔use Arial size 10 font
✔✔Which of the following describes a delinquent claim?
- The claim was submitted beyond the timely filing limit
- The claim had more than one procedure submitted
- The claim is an incoming claim
- The claim is overdue for payment - ✔✔the claim is overdue for payment
✔✔A patient is upset about a bill she received. Her insurance denied the claim. Which
of the following actions is an appropriate way to handle the situation?
