CPB

CPB Chapter 2 Glossary, Questions and answers, 100% Accurate, Rated A+ Accountable Care Organizations (ACO) - -A healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. Capitation - -Fixed payment remitted at regular intervals to a medical provider by a managed care organization for an enrolled patient. Carve-out - -A servi...

CPB - CHAPTER 8, Questions and answers, 100% Accurate, rated A+ What does the acronym NUCC stand for? a National Unified Claims Committee b National Uniform Criteria Committee c National Unified Claims Coordinators d National Uniform Claims Committee - -d National Uniform Claims Committee When a provider "accepts assignment" the difference between the charged amount and the allowed amount: a is billed to the patient. b can be submitted again for reconsideration. c is ...

CPB Exam B Top Questions and answers. 100% Accurate, graded A+ What is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? - -Deductible Which type of insurance covers physicians and other healthcare professionals for liability as to claims arising from patient treatment? - -Medical malpractice Which of the following does NOT fall under group policy insurance? I. The p...

CPB Board Study Questions and answers, 100% Accurate, Graded A+ When was the Code Of Conduct established? - -17 August 1955 under the Eisenhower Administration What Army Regulation covers the Code of Conduct? - -AR 350-30 If you become a prisoner of war, what information would you be required to give? - -Name, Rank, Service Number, Date of birth What Article of the Code of Conduct pertains to escape and evasion? - -Article 3 When was the Code of Conduct amended? - -May 1988 H...

CPB Final Exam Questions and answers, 100% Accurate, rated A+ Electronic data interchange - -EDI Treatment, payment and operations - -TPO Conditions of participation - -COP False claim act - -FCA Health information portability and accountability act - -HIPAA Preferred provider organization - -PPO Truth in lending act - -TILA Health maintenance organization - -HMO Release of information - -ROI Office of civil rights - -OCR Protected health information - -PHI ...

CPB Practice EXAM B Top exam Questions and answers, 100% Accurate, rated A What is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? A. Copayment B. Deductible C. Secondary Payment D. Coinsurance - -A deductible is the amount a policyholder pays for health care services before the health insurance begins to pay. Which type of insurance covers physicians and other he...

CPB Exam Top Questions with accurate answers, Graded A+. Verified. When a provider chooses not to participate in the Medicare program and does not accept assignment on claims, the maximum amount the provider can charge is _______ percent of the approved fee schedule amount for non-participating providers. A. 115 B. 100 C. 50 D. 25 - -A When a physician intentionally bills procedures to Medicaid that he did not perform he is in violation of which Act? A. Truth in Lending Act ...

CPB PRACTICE EXAM 1 Top Questions and answers. 100% Accurate. Rated A ________________________ is a legal proceeding involving a person that is unable to repay outstanding outstanding debts. A. Collection Agency B. Bankruptcy C. Dismissal of patient D. Bad debt - -B. Bankruptcy According to Chapter 30 of the Medicare Claims Processing Manual, any refund due a Medicare recipient must be made to the beneficiary within _____________ days. A. 5 B. 15 C. 30 D. 60 - -C. 30 The H...

CPB Final Exam Top Questions and answers. 100% Accurate. Graded A+ A practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice used x-rays of one patient to justify services on multiple other patients' claims. The office manager brought the civil suit. What type of case is this? - -Qui Tam In which of the following circumstances may PHI not be disclosed without the patient's authorization or permission? - -An office receives a call from the patient's husband as...

CPB PRACTICE EXAM A, Questions and answers, Rated A+. Verified. Joe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd. C. Mary, because her birth year is before Joe...

Mock CPB Exam Question and answers, 100% Accurate. Verified. Court decisions that establish a standard use legal decisions to serve as authoritative rules or patterns in future similar cases. The legal term for standard is ______. a. decision b. example c. precedent d. statute - -precedent Which is established in advance and based on reported health care charges from which a predetermined per diem rate is determined? a. prospective cost-based rate b. retrospective reasonable c...

CPB Practice Exam Questions and answers, 100% Accurate. Verified. Managed care organization were created to manage benefits and to develop participating provider networks. Managed care can now be categorized according to six models. Which model below listed below is not considered managed care? A. Triple Option Plan (TOP) B. Integrated Delivery System (IDS) C. Health Maintenance Organization (HMO) D. Value-added Network (VAN) - -D. Value-added Network (VAN) Medicare Part ______ hel...

CPB Exam Questions and answers, 100% Accurate, rated A+ Abuse - -An action that results in unnecessary costs to a federal healthcare program, directly or indirectly. Anti-kickback - -Knowingly and willfully offering or accepting rewards or remuneration for services that are billable to a federal healthcare plan. Benefiiciary - -An individual that is eligible for Medicare or Medicaid benefits based on the CMS guidelines. Conditions of Participation (CoP) - -Conditions that healthcar...

CPB Exam Questions and answers, 100% Accurate. Graded A+. A 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance is primary? - -Mother Which managed care plan has the patient receiving care from participating providers (network provider) and the providers are only paid for services provided? - -Exclusive Provider Organization Which TRICARE plan is similar to an...

CPB Practice Exam A. Questions & Answers. 100% Accurate. Rated A+ 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? - -workers' compensation, 121+ days Using the fee schedule and the payment policy provided, what is the expected reimbursement (including patient resp...

CPB Practice Exam Questions and answers, 100% Accurate. Graded A+ Who is covered by CHAMPVA? A) Veterans with service-connected disabilities and their family B) Active duty military and their families C) Retired military and their families D) Active duty military over the age of 65 - -A) Veterans with service-connected disabilities and their families Patient is brought to the local urgent care after falling from a ladder while hanging exterior lights on his house. X-rays revealed a c...

CPB Final Exam Questions & Answers, 100% Accurate. Graded A+ EPO - -...provides benefits to subscribers who are required to receive services from network providers IDS - -...organizations of affiliated providers sites that offer joint healthcare services to subscribers HMO - -...providers comprehensive healthcare services to voluntarily enrolled members on a prepaid basis POS - -...patients can use the managed care panel of providers (paying discounted healthcare cost) or self-refe...

CPB Certified Professional Biller Certification, Questions & Answers, rated A+ Abuse - -Actions inconsistent with accepted, sound medical business or fiscal practice Accept Assignment - -Provider accepts as payment in full whatever is paid on the cliam by the payer (except for any copayment and or coinsurance amounts.) Accounts Receivable - -The amount owed to a business for services or goods provided. Accounts Receivable Aging Report - -Shows the status (by date) of outstanding cl...

CPB PRACTICE EXAM QUESTIONS AND ANSWERS, Graded A. Verified. 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 - -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 PERMANEN...

CPB PRACTICE EXAM C, Questions and answers, 100% Accurate. Approved. A 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance is primary? A. Mother's insurance plan B. Father's insurance plan C. The policy that has the best benefits D. Either mother's or father's insurance plan depending who brings the child in for medical care. - -The birthday rule states the ...