©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
Review for CPB Exam Practice Questions
and Answers
To report co-management, Which below must be true? - ANSWER✔✔-A. Co-management only applies to
doctors in the same clinic.
B. Two physicians must be performing the surgical procedure.
C. Two doctors must be managing the Post-op Care.
D. Non of the answers are correct.
Answer: D None of the answers are correct. The doctors must be in separate office/clinics. Co-
management refers to another provider providing the post-operative care for a surgical procedure. Co-
management is not for two surgeons. Co-management refers to office visits and standard aftercare. Two
doctors cannot be paid for the same date's for post-op care (different dates, yes).
What is a Certificate of Authority used for? - ANSWER✔✔-Certificate of Authority (COA) is issued by the
state. It licenses the operation of an HMO (Health Maintenance Organization.
What are the three components of the Medicare Allowable fee for a specific clinic? - ANSWER✔✔-The
total RVUs, the GPCI and the current year Malpractice RVU.
Page 1/15
, ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
The work RVU, The Practice Expense RVU and the Malpractice RVU all add up to be the total RVU's for a
given service in either the office or hospital setting. The total RVUs, the GPCI and the current year
Medicare conversion factor are how the Medicare allowable for a given service is calculated.
Which is true concerning professional courtesy charges? - ANSWER✔✔-DDHS OIG is its 1991 Special
Fraud Alert, emphasized that the "routine" waiver of co-payments and/or deductibles is equivalent to
misstating the actual charge.
What is the time limit for filing notice of injury and claim for federal workers' compensation? -
ANSWER✔✔-Three years. A notice must be filed within three years of the date of injury. However, if a
claim is not filed within three years, compensation may still be paid if written notice of injury was given
within 30 days, or the employer had actual knowledge of the injury within 30 days after it occurred.
What is a good example of a "Carrier-Specific" Rule or Guideline? - ANSWER✔✔-MOD-50 or RT/LT on
separate lines. Carrier-Specific Rules or Guidelines are unique to a specific carrier, Medicare (10
Jurisdictions) or private carrier (Blue-Cross/Blue Shield). Examples include MOD-50 versus RT/LT usage,
billing an E & M with a minor procedure. Most all carriers will follow the Medicare lead on NCCI edits,
Bilateral Surgery Modifiers and 1997 E & M Guidelines. These should not vary by carrier except in the
most non-standard cases.
What is the difference between a rejection and a denial? - ANSWER✔✔-A rejection is most often from
the clearinghouse, before the claim gets to the carrier where you will get a specific denial code on the
Page 2/15
FIRST PUBLISH OCTOBER 2024
Review for CPB Exam Practice Questions
and Answers
To report co-management, Which below must be true? - ANSWER✔✔-A. Co-management only applies to
doctors in the same clinic.
B. Two physicians must be performing the surgical procedure.
C. Two doctors must be managing the Post-op Care.
D. Non of the answers are correct.
Answer: D None of the answers are correct. The doctors must be in separate office/clinics. Co-
management refers to another provider providing the post-operative care for a surgical procedure. Co-
management is not for two surgeons. Co-management refers to office visits and standard aftercare. Two
doctors cannot be paid for the same date's for post-op care (different dates, yes).
What is a Certificate of Authority used for? - ANSWER✔✔-Certificate of Authority (COA) is issued by the
state. It licenses the operation of an HMO (Health Maintenance Organization.
What are the three components of the Medicare Allowable fee for a specific clinic? - ANSWER✔✔-The
total RVUs, the GPCI and the current year Malpractice RVU.
Page 1/15
, ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
The work RVU, The Practice Expense RVU and the Malpractice RVU all add up to be the total RVU's for a
given service in either the office or hospital setting. The total RVUs, the GPCI and the current year
Medicare conversion factor are how the Medicare allowable for a given service is calculated.
Which is true concerning professional courtesy charges? - ANSWER✔✔-DDHS OIG is its 1991 Special
Fraud Alert, emphasized that the "routine" waiver of co-payments and/or deductibles is equivalent to
misstating the actual charge.
What is the time limit for filing notice of injury and claim for federal workers' compensation? -
ANSWER✔✔-Three years. A notice must be filed within three years of the date of injury. However, if a
claim is not filed within three years, compensation may still be paid if written notice of injury was given
within 30 days, or the employer had actual knowledge of the injury within 30 days after it occurred.
What is a good example of a "Carrier-Specific" Rule or Guideline? - ANSWER✔✔-MOD-50 or RT/LT on
separate lines. Carrier-Specific Rules or Guidelines are unique to a specific carrier, Medicare (10
Jurisdictions) or private carrier (Blue-Cross/Blue Shield). Examples include MOD-50 versus RT/LT usage,
billing an E & M with a minor procedure. Most all carriers will follow the Medicare lead on NCCI edits,
Bilateral Surgery Modifiers and 1997 E & M Guidelines. These should not vary by carrier except in the
most non-standard cases.
What is the difference between a rejection and a denial? - ANSWER✔✔-A rejection is most often from
the clearinghouse, before the claim gets to the carrier where you will get a specific denial code on the
Page 2/15
