CPB CERTIFICATION EXAM PREP
(BASED OFF PRACTICE EXAM #2)
CORRECT 100%
What organization is responsible in evaluating the medical necessity, appropriateness,
and efficiency of the use of healthcare services and procedures?
A. Utilization Review Organization
B. Managed Care Organization
C. Quality Assurance Organization
D. External Quality, Review, Organization - ANSWERA. Utilization Review Organization
Which of the following does NOT fall under group policy insurance?
I. The premium is paid for by the employee.
II. The premium is paid for (or partially paid) by an employer.
III. The employer selects the plan(s) to offer to employees.
IV. Physical exams and medical history questionnaires are a mandatory part of the
application process.
V. The employee's spouse and children are not eligible for coverage.
A. I, IV, V, and VI
B. II, III, and VI
C. II, IV, and V
D. III, IV, and V - ANSWERA. I, IV, V, and VI
When a minor procedure is performed on a Medicare patient, what is the global period
and what time frame is covered?
A. 90-day global period - the day before the procedure and 90 days following the
procedures.
B. 10-day global period - the day of the procedure and 10 days following the procedure.
C. 10-day global period - the day before the procedure and 10 days following the
procedure.
D. 90-day global period - the day of the procedure and 90 days following the procedure.
- ANSWERB. 10-day global period - the day of the procedure and 10 days following the
procedure.
Which of the following falls under the Prompt Payment Act?
A. Clean claims must be paid or denied within 30 days from the date of receipt by
MACs.
B. Penalty fees will only be issued on clean claims if payments are 60 days overdue
starting the day after the receipt date.
C. Medicare and MACs have 60 days to pay or deny electronic clean claims.
, D. Physician needs to refund overpayments within 30 days to the Medicare
Administrative Contractor (MAC) from the date of receipt. - ANSWERA. Clean claims
must be paid or denied within 30 days from the date of receipt by MACs.
What is the Prompt Payment Act? - ANSWERRequires federal agencies, such as MACs
to pay or deny clean claims (also electronic claims) within 30 days from receipt.
What is another term for balance billing?
A. Surprise medical bill
B. Medicare bill
C. Unauthorized bill
D. Clean bill - ANSWERA. Surprise medical bill
What is balance billing? - ANSWERBilling patients for Medicaid covered services.
Medical providers are forbidden by law to:
A. Refer patients to specialists
B. Balance bill patients
C. Bill patients for non-covered services
D. Accept co-payments - ANSWERB. Balance bill patients
What is a capitation contract? - ANSWERMoney received before services even
provided so don't have to wait for reimbursement.
Dr. Wallace is in a capitation contract with Belleview Managed Care Health Plan. He
received $25,000 from the health plan to provide services for the 175 enrollees on the
health plan. The services provided by Dr. Wallace to the enrollees cost $23,000. Based
on the information, what must be done?
A. Dr. Wallace can keep the $2,000 profit under the terms of the capitated plan.
B. Dr. Wallace experienced a loss under the capitated plan and will need to pay $2,000
to the health plan.
C. Dr. Wallace will need to payout the $2,000 to the 175 enrollees.
D. Dr. Wallace is required to put the $2,000 in a mutual fund. - ANSWERA. Dr. Wallace
can keep the $2,000 profit under the terms of the capitated plan.
Which of the following is NOT in the HIPAA Privacy Rule?
A. Doctor's office leaving a message on the patient's answering machine to confirm an
appointment time.
B. Implementing hardware, software, and/or procedural mechanisms to record and
examine access and other activity in information systems that contains or use electronic
PHI (e-PHI).
C Physician must obtain a patient's written consent and authorization before using or
disclosing PHI to carry out treatment.
D. Patient is given greater access to his own medical record(s) and control over how his
PHI is used. - ANSWERB. Implementing hardware, software, and/or procedural
(BASED OFF PRACTICE EXAM #2)
CORRECT 100%
What organization is responsible in evaluating the medical necessity, appropriateness,
and efficiency of the use of healthcare services and procedures?
A. Utilization Review Organization
B. Managed Care Organization
C. Quality Assurance Organization
D. External Quality, Review, Organization - ANSWERA. Utilization Review Organization
Which of the following does NOT fall under group policy insurance?
I. The premium is paid for by the employee.
II. The premium is paid for (or partially paid) by an employer.
III. The employer selects the plan(s) to offer to employees.
IV. Physical exams and medical history questionnaires are a mandatory part of the
application process.
V. The employee's spouse and children are not eligible for coverage.
A. I, IV, V, and VI
B. II, III, and VI
C. II, IV, and V
D. III, IV, and V - ANSWERA. I, IV, V, and VI
When a minor procedure is performed on a Medicare patient, what is the global period
and what time frame is covered?
A. 90-day global period - the day before the procedure and 90 days following the
procedures.
B. 10-day global period - the day of the procedure and 10 days following the procedure.
C. 10-day global period - the day before the procedure and 10 days following the
procedure.
D. 90-day global period - the day of the procedure and 90 days following the procedure.
- ANSWERB. 10-day global period - the day of the procedure and 10 days following the
procedure.
Which of the following falls under the Prompt Payment Act?
A. Clean claims must be paid or denied within 30 days from the date of receipt by
MACs.
B. Penalty fees will only be issued on clean claims if payments are 60 days overdue
starting the day after the receipt date.
C. Medicare and MACs have 60 days to pay or deny electronic clean claims.
, D. Physician needs to refund overpayments within 30 days to the Medicare
Administrative Contractor (MAC) from the date of receipt. - ANSWERA. Clean claims
must be paid or denied within 30 days from the date of receipt by MACs.
What is the Prompt Payment Act? - ANSWERRequires federal agencies, such as MACs
to pay or deny clean claims (also electronic claims) within 30 days from receipt.
What is another term for balance billing?
A. Surprise medical bill
B. Medicare bill
C. Unauthorized bill
D. Clean bill - ANSWERA. Surprise medical bill
What is balance billing? - ANSWERBilling patients for Medicaid covered services.
Medical providers are forbidden by law to:
A. Refer patients to specialists
B. Balance bill patients
C. Bill patients for non-covered services
D. Accept co-payments - ANSWERB. Balance bill patients
What is a capitation contract? - ANSWERMoney received before services even
provided so don't have to wait for reimbursement.
Dr. Wallace is in a capitation contract with Belleview Managed Care Health Plan. He
received $25,000 from the health plan to provide services for the 175 enrollees on the
health plan. The services provided by Dr. Wallace to the enrollees cost $23,000. Based
on the information, what must be done?
A. Dr. Wallace can keep the $2,000 profit under the terms of the capitated plan.
B. Dr. Wallace experienced a loss under the capitated plan and will need to pay $2,000
to the health plan.
C. Dr. Wallace will need to payout the $2,000 to the 175 enrollees.
D. Dr. Wallace is required to put the $2,000 in a mutual fund. - ANSWERA. Dr. Wallace
can keep the $2,000 profit under the terms of the capitated plan.
Which of the following is NOT in the HIPAA Privacy Rule?
A. Doctor's office leaving a message on the patient's answering machine to confirm an
appointment time.
B. Implementing hardware, software, and/or procedural mechanisms to record and
examine access and other activity in information systems that contains or use electronic
PHI (e-PHI).
C Physician must obtain a patient's written consent and authorization before using or
disclosing PHI to carry out treatment.
D. Patient is given greater access to his own medical record(s) and control over how his
PHI is used. - ANSWERB. Implementing hardware, software, and/or procedural
