CPB Final Exam Questions AND Correct Answers
A _____ is a correspondence sent from the insurance payer to
the patient after they receive healthcare services to explain
the status of their claim. - ✔✔Explanation of Benefits
A biller at a medical practice notices that all claims contain
CPT code 81002. She questions the nurse who tells her that
because they are an OB/GYN office they bill every patient for
a urinalysis. What does this violate? - ✔✔False Claims Act
A biller receives a request for medical records for patient A for
DOS 05/15/20XX. Patient A's entire medical record (multiple
dates of service) was copied and sent to the insurance carrier.
Which statement below is true? - ✔✔This is a violation of
HIPAA.
A claim has been denied as not medically necessary. The biller
has checked the medical record and the medical policy and
verified it is not covered according to the carrier's medical
policy. What is the next action the biller should take? -
✔✔Check with the provider to appeal the claim and if
necessary write off the balance.
,A denial is received for services bundled into the global
period. The record is reviewed and it is found that the denial
is for a staged service that fell within the global days of the
initial service. There were no modifiers appended to the codes
on the claim form. What should be done? - ✔✔A modifier
should be attached to the claim to show staged procedure and
the claim should be appealed.
A denial is received in the office from a patient's insurance
company. It stated that the services billed are not covered due
to exclusions under the patient's plan. What should be done
at this point? - ✔✔The patient should be balance billed
A hospital records transported is moving medical records from
the hospital to an off-site building. During the transport, a
chart falls from the box onto the street. It is discovered when
the transporter arrives at the off-site building and the number
of charts is not correct. What type of violation is this? - ✔✔A
breach
A Medicare patient is seen by a participating provider. A claim
is sent for $123.00 and an EOMB is received that states the
approved amount is $100.00. If the patient has met their
, deductible, what should the reimbursement on this claim be
from Medicare? - ✔✔$80.00
A patient is involved in an accident at work and their
commercial insurance is billed. What type of denial will be
received? - ✔✔Liability issue
A patient receiving inpatient care in a critical access
hospitable would be covered under which part of Medicare? -
✔✔Part A
A patient seeks care from a neurologist without a referral
from the patient's primary care physician which is required by
the insurance company. What is the likely outcome for the
neurologist's claim?
What type of plan did the patient have? - ✔✔Claim will be
denied
HMO
A physician office (covered entity) discovers that the billing
company (business associate) is in breach of their contract.
What is the first step to be taken? - ✔✔Take steps to correct
the problem and end the violation
A _____ is a correspondence sent from the insurance payer to
the patient after they receive healthcare services to explain
the status of their claim. - ✔✔Explanation of Benefits
A biller at a medical practice notices that all claims contain
CPT code 81002. She questions the nurse who tells her that
because they are an OB/GYN office they bill every patient for
a urinalysis. What does this violate? - ✔✔False Claims Act
A biller receives a request for medical records for patient A for
DOS 05/15/20XX. Patient A's entire medical record (multiple
dates of service) was copied and sent to the insurance carrier.
Which statement below is true? - ✔✔This is a violation of
HIPAA.
A claim has been denied as not medically necessary. The biller
has checked the medical record and the medical policy and
verified it is not covered according to the carrier's medical
policy. What is the next action the biller should take? -
✔✔Check with the provider to appeal the claim and if
necessary write off the balance.
,A denial is received for services bundled into the global
period. The record is reviewed and it is found that the denial
is for a staged service that fell within the global days of the
initial service. There were no modifiers appended to the codes
on the claim form. What should be done? - ✔✔A modifier
should be attached to the claim to show staged procedure and
the claim should be appealed.
A denial is received in the office from a patient's insurance
company. It stated that the services billed are not covered due
to exclusions under the patient's plan. What should be done
at this point? - ✔✔The patient should be balance billed
A hospital records transported is moving medical records from
the hospital to an off-site building. During the transport, a
chart falls from the box onto the street. It is discovered when
the transporter arrives at the off-site building and the number
of charts is not correct. What type of violation is this? - ✔✔A
breach
A Medicare patient is seen by a participating provider. A claim
is sent for $123.00 and an EOMB is received that states the
approved amount is $100.00. If the patient has met their
, deductible, what should the reimbursement on this claim be
from Medicare? - ✔✔$80.00
A patient is involved in an accident at work and their
commercial insurance is billed. What type of denial will be
received? - ✔✔Liability issue
A patient receiving inpatient care in a critical access
hospitable would be covered under which part of Medicare? -
✔✔Part A
A patient seeks care from a neurologist without a referral
from the patient's primary care physician which is required by
the insurance company. What is the likely outcome for the
neurologist's claim?
What type of plan did the patient have? - ✔✔Claim will be
denied
HMO
A physician office (covered entity) discovers that the billing
company (business associate) is in breach of their contract.
What is the first step to be taken? - ✔✔Take steps to correct
the problem and end the violation
