CPB PRACTICE EXAM QUESTIONS AND ANSWERS 2023

WHO IS COVERED BY CHAMPVA? A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR FAMILIES B) ACTIVE DUTY MILITARY AND THEIR FAMILIES C) RETIRED MILITARY AND THEIR FAMILIES D) ACTIVE DUTY MILITARY OVER THE AGE OF 65 - Answer- A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR FAMILIES RATIONALE: THE CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE DEPARTMENT OF VETERANS AFFAIRS (CHAMPVA) COVERS VETERANS WHO ARE PERMANENTLY AND TOTALLY DISABLED DUE TO A SERVICE-RELATED DISABILITY AND THEIR SPOUSE AND CHILDREN. PATIENT IS BROUGHT TO THE LOCAL URGENT CARE AFTER FALLING FROM A LADDER WHILE HANGING EXTERIOR LIGHTS ON HIS HOUSE. X-RAYS REVEALED A CLOSED FRACTURE OF HIS LEFT FEMUR. THE PATIENT IS COVERED BY HIS EMPLOYER'S GROUP HEALTH PLAN AND HE ALSO HAS A HOMEOWNER'S LIABILITY INSURANCE POLICY. WHICH INSURANCE SHOULD BE BILLED? A) THE HOMEOWNER'S INSURANCE FIRST, FOLLOWED BY THE GROUP HEALTH PLAN B) THE EMPLOYER'S GROUP HEALTH PLAN C) THE HOMEOWNER'S INSURANCE ONLY D) FILE THE EMPLOYER'S GROUP HEALTH PLAN AS PRIMARY AND LIST THE HOMEOWNER'S INSURANCE AS SECONDARY. - Answer- B) THE EMPLOYER'S GROUP HEALTH PLAN RATIONALE: THE HEALTH INSURANCE PLAN IS BILLED FIRST AND THEN THROUGH THE PROCESS OF SUBROGATION IT WILL BE DETERMINED IF A LIABILITY PAYER SHOULD BE CONSIDERED PRIMARY. 3. PRIVATE COMPANIES CONTRACT WITH CMS TO ADMINISTER: A) MEDICARE PART A & B B) MEDICARE PART B C) MEDICARE PART C D) MEDICARE PART A, B, & C - Answer- D) MEDICARE PART A, B, AND C RATIONALE: MEDICARE PART A, B, AND C ARE ALL ADMINISTERED BY PRIVATE COMPANIES THAT CONTRACT WITH CMS AS MEDICARE ADMINISTRATIVE CONTRACTORS OR MACs. WHAT IS A CO-PAYMENT? A) AN AMOUNT PAID EVERY MONTH BY THE POLICYHOLDER TO MAINTAIN HEALTH INSURANCE COVERAGE B) A PERCENTAGE OF THE ALLOWED AMOUNT THAT THE PATIENT IS RESPONSIBLE FOR. C) A FLAT AMOUNT PAID TO THE HEALTHCARE PROVIDER WHEN THE POLICYHOLDER IS SEEN FOR AN OFFICE VISIT. D) THE ADJUSTED AMOUNT BASED ON THE INSURANCE POLICY REQUIREMENT. - Answer- C) A FLAT AMOUNT PAID TO THE HEALTHCARE PROVIDER WHEN THE POLICY HOLDER IS SEEN FOR AN OFFICE VISIT. WHICH OF THE FOLLOWING STATEMENTS IS TRUE REGARDING THE NON-PAR MEDICARE ALLOWED FEE SCHEDULE? A) THE NON-PAR PROVIDER CAN BILL THE PATIENT THE DIFFERENCE BETWEEN THE CHARGE AND THE MEDICARE ALLOWABLE. B) THE NON-PAR LIMITING CHARGE IS 115% OF THE NON-PAR MEDICARE PHYSICIAN FEE SCHEDULE C) THE NON-PAR PHYSICIAN FEE SCHEDULE IS 115% OF THE PAR MEDICARE PHYSICIAN FEE SCHEDULE D) THE NON-PAR LIMITING CHARGE IS 95% OF THE PAR MEDICARE PHYSICIAN FEE SCHEDULE. - Answer- B) THE NON-PAR LIMITING CHARGE IS 115% OF THE NON-PAR MEDICARE PHYSICIAN FEE SCHEDULE. RATIONALE: PER CMS, THE NON-PAR LIMITING CHARGE IS 115% OF THE NON-PAR MEDICARE PHYSICIAN FEE SCHEDULE. WHAT IS A MEDIGAP POLICY? A) A POLICY THAT COVERS HEALTHCARE SERVICES THAT MEDICARE DOES NOT COVER. B) A POLICY THAT WILL NOT REIMBURSE FOR OUT-OF-POCKET COSTS NOT COVERED BY MEDICARE