CPB (Certified Professional Biller) PRACTICE EXAM A (with complete solutions)

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? correct answers 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)? correct answers $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? correct answers 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? correct answers 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) correct answers 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? correct answers 99213-25, 17110