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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...

AAPC CPB Exam Questions and answers, 100% Accurate, Graded A+ HRA - -Health Reimbursement Account What part of Medicare pays for prescriptions - -Part D What type of plan allows an insurer to administer straight indemnity insurance, an HMO, or a PPO insurance plans to its members? - -Triple Option Plan HIPAA - -Health Insurance Portability and Accountability Act of 1996 Fraud (CMS defines) - -Making false stmts or misrepresenting facts to obtain an undeserved benefit or payment ...

AAPC CPB - Chapter 1 Review, Questions and answers, 100% Accurate. Verified. What does the acronym PHI stand for? a. Patient Healthcare Information b. Patient History of Illness c. Protected Health Information d. Protected Healthcare Index - -c. Protected Health Information A new radiology company opens in town. The manager calls your practice and offers to pay $20 for every Medicare patient you send to them for radiology services. What does this offer violate? a. Stark Laws b....

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...

AAPC CPB - Practice Exam A. Questions and answers, Graded 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 be...

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...

AAPC CPB - Practice Exam B Questions and answers, 100% accurate. Graded A. Questions Bank 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 - -B. Deductible Which type of insurance covers physicians and other healthcare professionals for liability as to claims arising from patient treatment? ...

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...

AAPC CPB - Practice Exam C, 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? 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. - -A. Mother's ins...

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...

AAPC CPB Final Exam Questions & Answers, Rated A+ Health plan, clearinghouses, and any entity transmitting health information is considered by the Privacy Rule to be a: - -covered entity Which of the following is not a covered entity in the Privacy Rule - -healthcare consulting firm A request for medical records is received for a specific date of service from patient's insurance company with regards to a submitted claim. No authorization for release of information is provided. What a...

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...