CPB Final Exam 2023-2024 REAL EXAM 170 QUESTIONS & ANSWERS (VERIFIED ANSWERS). GRADED A+, Exams of Nursing

Download CPB Final Exam 2023-2024 REAL EXAM 170 QUESTIONS & ANSWERS (VERIFIED ANSWERS). GRADED A+ and more Exams Nursing in PDF only on Docsity! CPB Final Exam 2023-2024 REAL EXAM 170 QUESTIONS & ANSWERS (VERIFIED ANSWERS). GRADED A+ A dermatologist performed an excision of a squamous cell carcinoma from the patients forehead with a 1.2 cm excised diameter. The excision site required an intermediate wound closure measuring 1.8 cm. What is/are the correct code(s)? - ANS A document provided to Medicare patients explaining their financial responsibility if Medicare denies a service is a(n): - ANSAdvanced Beneficiary Notice? A female patient who was involved in an auto accident presents to the emergency room for evaluation. She does not have any complaints. The provider evaluates her and determines there are no injuries. The provider informs the patient to come back to the ER or see her primary care physician if she develops any symptoms. How is the claim processes for this encounter? - ANSThe auto insurance is billed primary and the medical insurance is billed secondary. A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate? - ANS A patient covered by a PPO is scheduled for knee replacement surgery. The biller contacts the insurance carrier to verify benefits and preauthorize the procedure. The carrier verifies the patient has a $500 deductible which must be met. After the deductible, the PPO will pay 80% of the claim. The contracted rate for the procedure is $2,500. What is the patient's responsibility? - ANSThe contracted rate is $2500. The patient must pay the deductible ($500) and 20% of $2,000 ($400). The total patient responsibility is $900. A patient with an acute myocardial infarction is brought by ambulance to the emergency room. The patient is taken into the cardiac catheterization lab. Angioplasty and a stent was placed in the LAD. The patient's insurance requires preauthorization for all surgical procedures. Which of the following statements is true for most payers? - ANSBecause this was an emergency, it is acceptable to obtain authorization following the surgery A patient's Medicare card contains which of the following information? - ANSname, medicare claim number, sex, is entitled to, effective date According to CMS, which of the following services are included in the global package for surgical procedures? - ANSLocal infiltration, metacarpal/metatarsal/digital block or topical anesthesia Subsequent to the decision for surgery, one related Evaluation and Management (E/M) encounter on the date immediately prior to or on the date of procedure (including history and physical). Immediate postoperative care, including dictating operative notes, talking with the family and other physicians or other qualified health care professionals. Writing orders Evaluating the patient in the postanesthesia recovery area Typical postoperative follow-up care An example of an overpayment that must be refunded is _____________? - ANSDuplicate processing of a claim At which point is the superbill/encounter form completed? - ANSAt the end of the patient visit Birthday rule - ANSthe policyholder whose birth month and day occurs earlier in the calendar year holds the primary policy when each parent subscribes to a different health insurance plan Dr. Taylor's office has a new medical assistant (MA) who is responsible for blood collection for lab specimens. Because the MA is new, she often misses when obtaining blood at the first stick. To be sure the office is billing for all services, the office now has a rule that all patients will be billed a minimum of two blood draws to demonstrate the work that is being done for lab collection. Which statement is true regarding this rule? - ANSThis action is considered fraudulent. Services duplicated because of provider error should not be billed and the office is billing for services not rendered. Electronic Healthcare Transactions and code sets are required to be used by health plans, healthcare clearinghouses and healthcare providers that participate in electronic data interchanges. Which of the following are requirements for the code sets? - ANS EPO - ANS...provides benefits to subscribers who are required to receive services from network providers GA modifier - ANSAdvance notice of non-coverage provided Use this modifier to tell us that you provided a notice of Medicare non-coverage to the patient. - If you bill us for non-covered services without using the GA modifier indicating you did not give notice of non-coverage to the patient, Priority Health Medicare will deny your claim. It will go to provider liability - See more at: http://www.priorityhealth.com/provider/manual/billing-and-payment/modifiers/ga-and- gy#sthash.UQjGZjvJ.dpuf GY modifier - ANSService is not covered by Medicare by statute HMO - ANS...providers comprehensive healthcare services to voluntarily enrolled members on a prepaid basis