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(CBCS) Study Guide 2026
Which of the following accurately describes the difference between informed and implied consent? A) Informed consent is required after a procedure, while implied consent is required before a procedure. B) Informed consent only refers to electronic documents, while implied consent refers to written and electronic documents. C) Informed consent is required in writing after explanation of a procedure, with time to ask questions, while implied consent is assumed. D) Informed consent applies to hospitals, while implied consent applies to physicians'' offices. - correct answer ✅C) Informed consent is required in writing after explanation of a procedure, with time to ask questions, while implies consent is assumed. The correct distinction between informed consent, which requires the patients' signature, and implied consent What is documentation? - correct answer ✅Documentation is a complete, accurate, up-to-date record of care a patient receives at a health care facility. Disclosure refers to the way health information is: A) Handled by doctors B) Given to an outside person or organization C) Stored D) Organized - correct answer ✅B) Given to an outside person or Organization Disclosure refers to the dissemination of personal health information, which is covered by the HIPAA Privacy Rule
(CBCS) Study Guide 2026
What is the difference between consent and authorization? - correct answer ✅Authorization: Permission granted by the patient or the patient's representative to release information for reasons other than treatment, payment, or health care operations Consent: Is used only when the permission is for treatment, payment, or health care operations True or False: Physicians have the option to decide whether to explain privacy rules to their patients. - correct answer ✅False Physicians are legally obligated to explain privacy rules to their patients Auditing refers to which of the following? A) Writing claims B) Signing off on claims C) Sending claims to third-party payers D) Reviewing claims for accuracy and completeness - correct answer ✅D) Reviewing claims for accuracy and completeness Many facilities have internal auditing systems to review claims for accuracy and completeness. One of the main things an audit looks for is nonspecific or inaccurate use of diagnosis and procedure codes.
(CBCS) Study Guide 2026
D) Private health information must be kept secure - correct answer ✅C) Physicians can't refer patients to practitioners with whom they have a financial relationship Also referred to as the Physician Self-Referral Law, the Stark Law also prohibits the referred practitioner from presenting claims to Medicare The Office of the Inspector General is responsible for A) Protecting health information B) Fighting fraud C) Helping health care professionals stay compliant with the laws D) Disclosing health information - correct answer ✅B) Fighting fraud HIPAA established a comprehensive programs to combat fraud called the Health Care Fraud and Abuse Control (HCFAC) program, which is run by the OIG What is a claim? - correct answer ✅Claims are a complete record of the services provided by the health care professional, along with appropriate insurance information Identify two items of information that need to be on a claim - correct answer ✅Patient name, Patient's health record number, Patient's account number, Patient's demographic information, Subscribe, Subscriber (member) number, Group or plan number, Prior approval number, Provider name, National Provider Identifier (NPI), Provider's address and telephone number, Date(s) of service, Diagnosis code, Procedure code, Revenue code, Itemized charges for services, Number of services or duration of time, Secondary or other insurance information
(CBCS) Study Guide 2026
Which of the following describes a clean claim? A) All of the data elements are completed B) All of the data elements are written on a white piece of paper C) Almost all the data elements are right D) All the necessary data elements are completed - correct answer ✅D) All the necessary data elements are completed Clean claims are accurate and complete. They have all the information needed for processing. True or False: In 2012, the Administration Simplification Compliance Act (ASCA) , part of HIPAA, mandated that health care claims be submitted electronically, with some exceptions. - correct answer ✅True One exception is if a provider uses a clearinghouse to submit claims. In this case, the draft sent to the clearinghouse may be completed on paper, and the correct form to use is CMS- The Primary insurance plan does which of the following? A) Pays for everything B) Pays first C) Pays second D) Has the option of paying first or second - correct answer ✅B) Pays first
(CBCS) Study Guide 2026
By signing block 12 on the CMS-1500 form, a patient is doing which of the following? A) Authorizing the release of funds to a provider B) Authorizing the provider to perform a procedure C) Authorizing the release of medical information needed to process a clam D) Authorizing hospice care - correct answer ✅C) Authorizing the release of medical information needed to process a claim Block 12 is an important field where the patient or an authorized person signs to authorize the release of medical information. The field must be dated and entered as a six- or eight digit date. A signature on file or a computer-generated signature can also be used. The patient's signature authorizes release of information necessary to process the claim Name the kinds of insurance information that needs to be collected from the patient - correct answer ✅Correct policy number and group number, Policy effective dates, Type of policy, Which benefit covers the primary treatment, Policy limitations, Deductible amounts Coordination of benefits involves which of the following: A) Double-checking each patient's insurance information B) Collecting demographic information C) Determining which insurance is the primary and which is secondary D) Submitting a claim - correct answer ✅C) Determining which insurance is the primary and which is secondary
(CBCS) Study Guide 2026
The coordination of benefits process, which determines primary and secondary insurance, ensures that there is no duplication in the payment of benefits. The primary insurance pays first, up to its coverage limits, and the secondary insurance pays second True or False: The birthday rule is a way to mark how long a patient has had his insurance policy - correct answer ✅False The birthday rule is a way to determine primary insurance if both parents have insurance and list their children as dependents. The insurance of the parent whose birthday is first in the calendar year is considered the primary insurance What is the difference between Medicare and Medicaid? - correct answer ✅Medicare is a government-based insurance plan that covers people older than 65, those younger than 65 with disabilities, and those with end-stage kidney disease. Medicaid covers low-income families and individuals What is the advantage of employer=based self-insured health plans? - correct answer ✅Due to economies of scale, employer-based self-insured health plans are more reasonably priced than private insurance Which of the following accurately describes a deductible? A) The cost of a health insurance premium B) A patient's share of the cost of health insurance C) The fee a patient pays for a doctor's visit
(CBCS) Study Guide 2026
What is the role of the account receivable department? - correct answer ✅The account receivable department manages follow-up to the billing process for a provider's office What two kinds of information the CDM stores? - correct answer ✅Descriptions of service, CPT/HCPCS code, Revenue code, Charge amount, Charge or service code, General ledger key, Activity/ status date An aging report refers to which of the following? A) The length of time the report has been in the CDM B) The ages of all patients in a provider's practice C) The claims that are outstanding D) The amount of money the provider's office has received in the last 6 months - correct answer ✅C) The claims that are outstanding Aging reports refer to paid or unpaid status of invoices True or False: An RA is sent to policyholders - correct answer ✅False RA is sent to the provider, not to policyholders The allowable charge is which of the following? A) Amount the provider charges for a service B) Amount the patient agrees to pay C) Amount the health insurance company will pay providers
(CBCS) Study Guide 2026
D) Amount set by hospitals - correct answer ✅C) Amount the health insurance company will pay providers The allowable charge, also called allowable fee, maximum fee, maximum allowable, usual-reasonable-customary, UCR charge, or prevailing rate, is the amount the insurer will actually pay Which of the following is NOT a charge the patient is expected to pay? A) Coinsurance B) Deductible C) Difference between a provider's charges and what the insurance will pay D) Copayment - correct answer ✅C) Difference between a provider's charges and what the insurance will pay Write-offs are the amount a provider agrees to accept as payment minus deductibles, copayments, and coinsurance The term reconciliation means which of the following? A) Resolving difference with the insurance company B) Working with Medicare on a problem C) Getting more information about a patient from a physician D) Determining how much the provider has been reimbursed and how much patients owe - correct answer ✅D) Determining how much the provider has been reimbursed and how much patients owe
(CBCS) Study Guide 2026
How does ICD-10-CM improve upon ICD-9-CM? - correct answer ✅ICD-10-CM provides more detailed clinical information, resulting in improved ability to measure health care services, such as the addition of information relevant to ambulatory and managed care encounters and expanded injury codes. It also has updated medical terminology and classification of diseases and codes that allow comparison of mortality and morbidity True or False: The following represents a disease coded under ICD-10-CM: E10.2 - correct answer ✅True For ICD-10-CM codes, the first character is a letter, followed by digits. Characters three through seven can be numbers or letters What are the goals of ICD-10-PCS? - correct answer ✅The goals of ICD-10-PCS are to improve accuracy and efficiency of coding, reduce training effort, and improve communication with physicians What character of ICD-10-PCS for medical or surgical procedure would identify the body part? A) Character 1 B) Character 2 C) Character 3 D) Character 4 - correct answer ✅D) Character 4 Character 1 identifies the site Character 2 identifies the body system
(CBCS) Study Guide 2026
Character 3 identifies the root operation Character 4 identifies the body part CPT codes are used to describe which of the following? A) Supplies used during surgery B) Type of insurance a patient has C) Services rendered by the provider D) Payments received from third-party payers - correct answer ✅C) Services rendered by the provider Physicians use CPT codes for hospital inpatient and outpatient services and for those performed in other facilities What is the purpose for using modifiers? - correct answer ✅Modifiers provide the means to report or indicate a service or procedure that has been altered by some specific circumstance but not changed in its definition or code What are HCPCS Level II codes used for? - correct answer ✅HCPCS Level II codes were establish to report services, supplies, and procedures not represented in CPT Abstracting involves which of the following? A) Writing notes about codes B) Selecting relevant information from the health record C) Coding physicians' notes
