CBCS practice test Exam QUESTIONS AND VERIFIED ANSWERS 2025(GRADED A+)
DETAILED ANSWERS!!
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 biller will electronically submit a claim to the carrier via which of the
following?
-Electronic remittance advice (response from insurance)
-Direct data entry
-Electronic fund transfer
-Charge data entry - ✔✔Direct data entry
A CBCS can ensure appropriate insurance coverage for an outpatient procedure
by first using which of the following processes?
- Predetermination (finals step to determine insurance reimbursement and
patient responsibility)
- Precertification (first step to determine if the patient has coverage)
- Preaudit (review of claim before adjudication)
- Preauthorization ( insurance approval for the procedure) - ✔✔Precertification
(first step to determine if the patient has coverage)
- Predetermination (finals step to determine insurance reimbursement and
patient responsibility
,- Preaudit (review of claim before adjudication)
- Preauthorization ( insurance approval for the procedure)
A CBCS has four past-due charges: $400 that is 10 weeks past due; $800 that is 6
weeks past due; $1000 that is 4 weeks past due; and $2000 that is 8 weeks past
due. Which of one should be sent to collection first?
-$400
-$800
-$1000
- $2000 - ✔✔$2000 (the largest amount first)
A CBCS is preparing a claim from a provider from a group practice.. The CBCS
should enter the rendering provider's NPI into which of the following blocks on
the CMS-1500?
- 17b (referring provider NPI)
- 24J
- 31 (providers signature)
- 25 (federal tax id number) - ✔✔24J
- 17b (referring provider NPI)
- 31 (providers signature)
- 25 (federal tax id number)
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
A CBCS needs to know how much Medicare paid on a claim before billing the
secondary insurance. To which of the following should the specialist refer?
-Assignment of benefits
-Medicare summary notice (how much the provider was billed and how much
the patient has to pay)
-Remittance advice
-Coordination of benefits - ✔✔remittance advice
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
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)
A CBCS should routinely analyze which of the following to determine the
number of outstanding claims?
- Accounts payable report
- Aging report
- Remittance advice
- Explanation of benefits - ✔✔aging report
A CBCS should understand that the financial record source that is generated by
the provider's office is called a _______ .
- Chargemaster
- Fee schedule
- Encounter form
- Patient ledger account - ✔✔Patient ledger account (history of patient's
financial record)
A CBCS submitted a claim to Medicare electronically. No errors were found by
the billing software or clearinghouse. Which of the following describes this
claim?
- Pending claim
- Clean claim
- Tertiary claim (processed by both primary and secondary insurance)
- Physically clean claim (no staples, no highlighters) - ✔✔clean
DETAILED ANSWERS!!
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 biller will electronically submit a claim to the carrier via which of the
following?
-Electronic remittance advice (response from insurance)
-Direct data entry
-Electronic fund transfer
-Charge data entry - ✔✔Direct data entry
A CBCS can ensure appropriate insurance coverage for an outpatient procedure
by first using which of the following processes?
- Predetermination (finals step to determine insurance reimbursement and
patient responsibility)
- Precertification (first step to determine if the patient has coverage)
- Preaudit (review of claim before adjudication)
- Preauthorization ( insurance approval for the procedure) - ✔✔Precertification
(first step to determine if the patient has coverage)
- Predetermination (finals step to determine insurance reimbursement and
patient responsibility
,- Preaudit (review of claim before adjudication)
- Preauthorization ( insurance approval for the procedure)
A CBCS has four past-due charges: $400 that is 10 weeks past due; $800 that is 6
weeks past due; $1000 that is 4 weeks past due; and $2000 that is 8 weeks past
due. Which of one should be sent to collection first?
-$400
-$800
-$1000
- $2000 - ✔✔$2000 (the largest amount first)
A CBCS is preparing a claim from a provider from a group practice.. The CBCS
should enter the rendering provider's NPI into which of the following blocks on
the CMS-1500?
- 17b (referring provider NPI)
- 24J
- 31 (providers signature)
- 25 (federal tax id number) - ✔✔24J
- 17b (referring provider NPI)
- 31 (providers signature)
- 25 (federal tax id number)
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
A CBCS needs to know how much Medicare paid on a claim before billing the
secondary insurance. To which of the following should the specialist refer?
-Assignment of benefits
-Medicare summary notice (how much the provider was billed and how much
the patient has to pay)
-Remittance advice
-Coordination of benefits - ✔✔remittance advice
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
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)
A CBCS should routinely analyze which of the following to determine the
number of outstanding claims?
- Accounts payable report
- Aging report
- Remittance advice
- Explanation of benefits - ✔✔aging report
A CBCS should understand that the financial record source that is generated by
the provider's office is called a _______ .
- Chargemaster
- Fee schedule
- Encounter form
- Patient ledger account - ✔✔Patient ledger account (history of patient's
financial record)
A CBCS submitted a claim to Medicare electronically. No errors were found by
the billing software or clearinghouse. Which of the following describes this
claim?
- Pending claim
- Clean claim
- Tertiary claim (processed by both primary and secondary insurance)
- Physically clean claim (no staples, no highlighters) - ✔✔clean
