CPB PRACTICE EXAM QUESTIONS & ANSWERS 2024 ACTUAL EXAM 120 QUESTIONS & CORRECT ANSWERS, Exams of Health sciences

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[Date]

CPB PRACTICE EXAM QUESTIONS &

ANSWERS 2024 ACTUAL EXAM 120

QUESTIONS & CORRECT DETAILED

ANSWERS. GRADED A

3. Private companies contract with cms to administer: A) medicare part a & b B) medicare part b C) medicare part c D) medicare part a, b, & c - ansd) medicare part a, b, and c Rationale: medicare part a, b, and c are all administered by private companies that contract with cms as medicare administrative contractors or macs. A 16-year-old patient is seen for an evaluation of left ankle pain. He has been a patient of dr. Smith's since infancy and dr. Smith always performs the patient's annual sports physical exam. During this visit the physician performs a problem focused history, expanded problem focused exam, and medical decision making is of low complexity. Using the office equipment, a 2-view x-ray is taken of the left ankle which shows normal skeletal structures, no fractures identified. The cpt codes for this encounter would be? A) 99202, 73590-lt B) 99213, 73590-lt C) 99213, 73600-lt D) 99212, 73610-lt - ansc) 99213, 73600-lt

[Date] A claim has been processed by the payer, payment received and posted to the patient's account. What is the next step in the billing process? A) no further steps need to be taken B) a receipt of payment is sent to the payer. C) patient is notified at 60 days of any remaining patient responsibility D) a statement is sent notifying the patient of their remaining responsibility - ansd) a statement is sent notifying the patient of their remaining responsibiity Rationale: the final step in the billing process is to inform the patient of the remaining portion due for the services they received. The statement should reflect the amount paid by the insurance, any adjustments made, and the final amount due from the patient. The statement should also include the date the payment is due from the patient. A medicare patient has been treated for four (4) diagnoses during his last visit: hypertension, type 2 diabetesl osteoarthritis, & ckd. How many diagnoses can be reported in box 24e (diagnosis code pointer) cms- claim form for each service provided for this patient? A) one B) two C) three D) four - ansa) one

[Date] Rationale: medicare requires that only one diagnosis be reported for each service provided. Commerical payers may or may not have this same requirement A medicare patient is seen on may 1, 2017 and the claim is submitted for this visit on may 5, 2018. What will be the expected outcome for payment of this claim? A) medicare will reimburse at a 40% reduction based on timely filing regulations B) medicare will require an addendum explaining the reason for the delayed claim submission C) medicare will deny the claim based on timely filing rule D) medicare will pay the claim for provided services. - ansc) medicare will deny the claim based on timely filing rule. Rationale: medicare requires all claims for services be billed within one year of the date of service. Any claims received after the one year date will be denied due to the timely filing statute. A patient by the name of charles daniel johnson lists his name as danny johnson when he completes his patient demographic sheet. His insurance card lists his name as c. Daniel johnson. How should his name be listed when entering his demographic information into the billing system? A) his full given name, charles daniel johnson B) the name he "goes by". Danny johnson C) danield johnson as listed on his insurance card

[Date] D) charlie daniel johnson - ansc) daniel johnson as listed on his insurance card Rationale: claims should be submitted using the name that is listed on the insurance card to prevent denials for incorrect policyholder information A patient is seen in the provider's office for a follow-up visit eight days after a procedure. The procedure has a global period of 90 days. The provider submits an e/m code based on documentation of the follow-up visit. The claim is submitted and denied. What is the next step for the biller? A) post the denial without adjusting the patient's balance because the denied amount will become the patient's responsiblity B) post the denial and notify the patient of the denial C) post the denial and adjust the patient's balance because the follow-up visit is included in the global period. D) resubmit the e/m code with modifier -24 to indicate the visit was unrelated to the procedure that was performed eight days ago. - ansc) post the denial and adjust the patient's balance because the follow-up visit is included in the global period. Rationale: normal follow-up visits following a procedure with a global period are considered to be included in the procedure global period and not separately billable. If a patient is seen during a global period for a separate condition not related to the procedure, an e/m may be billed based on documentation of the separate condition.

[Date] A revenue code indicating the type or location of service would be reported on the A) cms-1500 claim form B) ub-02 claim form C) ub-04 claim form D) abn form - ansc) ub-04 claim form Rationale: ub-04 claim form is used to bill facility services. Revenue codes are four digit codes that indicate location or type of services provided to a patient in a health care facility. An indicator that a practice has a sucessful billing process would be which of the following? A) a low amount of contractual adjustments B) a high amount of contractual adjustments C) a high number of a/r days D) a low number of a/r days - ansd) a low number of a/r days Rationale: a practice that maintains a low number of a/r (accounts receivable days indicates that the practice's revenue is flowing in at a healthy rate. Low a/r days is indicative of billing clean claims, payers prompt reimbursement, patient's payment of co-pays/co-insurance balances. In short, funds due to the practice are flowing in at a desirable rate.

[Date] An uncontrolled type 2 diabetic patient is diagnosed with peripheral angiopathy. Patient is compliant with self administered insulin injections and will be started on physical therapy 2 x a week to support increased circulation to the limbs. What are the correct diagnosis codes to report this patient's condition? A) eo8.51, z79. B) eo9.51, z79. C) e11.51, i96, z79. D) e11.51, z79.4 - ansd) e11.51, z79. By signing the assignment of benefits in item 13 of the cms-1500 claim form, the patient is: A) directing the insurance company to send the reimbursement to the patient. B) directing the insurance company to send the reimbursement to the provider. C) agreeing that services were provided. D) preventing the claim from being paid. - ansb) directing the insurance company to send the reimbursement to the provider. Rationale: as stated on the cms-1500 claim form item 13. "insured's or authorized person's signature: i authorize payment of medical benefits to the undersigned physician or supplier for services described below."

[Date] Contacting debtors at a very early hour of the day or revealing to an employer that there is debt would be violations of which federal law? A) hipaa B) federal claims collection act C) fair debt collection practices act D) tax equity and fiscal responsibility act - ansc) fair debt collection practices act Rationale: the fair debt collection practices act (fdcpa) outlines specific collection practices that are considered illegal. Cpt codes 64418 and 19380 were reported together for the injection of the supra capsular nerve with anesthetic agent (64418) with reversion of a reconstructed breast (19380). The injection was denied as a bundled service. What would be the next step for the biller? A) resubmit corrected claim adding modifier -59 to 64418 B) resubmit corrected claim adding modifier -51 to 64418. C) move the charge for the bundled procedure to patient responsibility D) write-off the charge for 64418 because it is a bundled procedure - ansd) write-off the charge for 64418 because it is a bundled procedure. Rationale: services or procedures that are determined to be bundled as part of the payer's contract must be written off. Costs for the bundled procedure cannot be shifted to patient responsibility.

[Date] Do annual cpt code charges affect a physician's office superbill? A) no, because the physician performs the same procedures year after year B) yes, it is necessary to update the superbill with current cpt codes but deleted cpt codes should remain on the superbill for cross referencing C) yes, the superbill needs to be updated with current cpt codes and the deleted cpt codes removed D) no, because new codes can be accessed in the cpt code book if needed

• ansc) yes, the superbill needs to be updated with current cpt codes and the deleted cpt codes removed. Rationale: superbills should reflect the cpt and diagnosis codes for the current year. Deleted codes should be removed to avoid submitting invalid codes which results in denied and/or delayed claims payment. How often should authorization forms be updated for established patients who are seen on a regular basis? A) twice a year B) once a year C) every visit D) when insurance coverage changes - ansb) once a year Rationale: it is recommended that authorization forms be updated anually for established patients.

[Date] John is tasked to perform an aduit on dr. Corbel's practice. What are the key elements john needs for the audit process on 20 records to support what dr. Corbel is charging? A) patient account record, encounter form, and cms-1500 form B) patient registration form, encounter form, and cms-1500 form C) medical record, encounter form, and cms-1500 form D) medical record, daysheet, and ledger - ansc) medical record, encounter form, and cms-1500 form Rationale: john should use the medical record and cms-1500 claim form to ensure the charges are documented and supported. Also the encounter form should be used to review the diagnosis codes, procedures, supplies, and other services were provided. Medicaid covers epsdt services. What is the definition of this acronym? A) early postoperative screening, diagnostic, and treatment B) early pregnancy screening, diagnostic, and treatment C) established patient screening, diagnostic, and treatment D) early and periodic screening, diagnostic, and treatment - ansd) early and periodic screening, diagnostic, and treatment. Rationale: the acronym epsdt stands for early and periodic screening, diagnostic, and treatment and refers to routine pediactric pediatric checkups that include dental, hearing, vision, and other screening services to detect potential problems in all children enrolled in medicaid.

[Date] Medicare conditions of participation requires that medical records be retained for: A) 12 years B) 7 years C) 5 years D) 2 years - ansc) 5 years Rationale: medicare conditions of participation require patient records to be retained in their original or legally reproduced form for at least 5 years. Some states may require a longer period of retention, but all medicare participants must be retained for at least 5 years. Medicare part a is available to individuals under the age of 65 who have: A) diabetes mellitus type i or ii B) ckd (chronic kidney disease) C) esrd and meet certain requirements D) any chronic health condition - ansc) esrd and meet certain requirements. Rationale: medicare part a coverage is available to individuals below the age of 65 who have; 1) received social security or rrb disability benefits for 24 months, 2) end-stage renal disease and meet certain requirements Multiple cpt and hcpcs level ii codes should be listed on a cms-1500 claim form in what order?

[Date] A) in the order the procedures were performed B) from highest to lowest rvu C) from lowest to highest rvu D) there is not a recommended order - ansb) from highest to lowest rvu Rationale: cpt and hcpcs level ii codes should be reported with the highest rvu (relative value unit) first then sequentially down to the lowest. Payers often reduce the reimbursement for the second procedure by 50 percent of the usual fee, and by 50 to 75 percent for the third, fourth, fifth procedures. Reporting the procedure with the highest rvu first provides the maximum reimbursement on the highest costing procedure or service. Patient is brought to the local urgent care after falling from a ladder while hanging exterior lights on his house. X-rays revealed a closed fracture of his left femur. The patient is covered by his employer's group health plan and he also has a homeowner's liability insurance policy. Which insurance should be billed? A) the homeowner's insurance first, followed by the group health plan B) the employer's group health plan C) the homeowner's insurance only D) file the employer's group health plan as primary and list the homeowner's insurance as secondary. - ansb) the employer's group health plan

[Date] Rationale: the health insurance plan is billed first and then through the process of subrogation it will be determined if a liability payer should be considered primary. The drug trisenox is administered by which route? A) intramuscular B) intravenous C) inhalation D) subcutaneous - ansb) intravenous Rationale: hcpcs level ii indicates in appendix i - table of drugs and bilogicals that risenox route of administration is iv, intravenous. The fair credit reporting act protects: A) the healthcare provider by identifying individuals with bad credit histories. B) the information collected by consumer reporting agencies. C) debtors from facing collection proceedings D) both a&c - ansb) the information collected by consumer reporting agencies Rationale: the fair credit reporting act was designed to protect information collected by various consumer reporting entities such medical information companies, credit bureaus, and tenant screening services. The organizations that contribute information to consumer reporting agencies

[Date] must also comply with certain legal obligations such as conducting investigations when information is disputed. The following type of charges would be reported on the cms-1500 claim form except: A) ambulatory surgery center (asc) B) observation services reported by a physician C) inpatient services provided by a physician D) room and board - ansd) room and board Rationale: asc, observation, and inpatient services provided by a physician are reported on the cms-1500 claim form. Room and board would be provided in a facility and would therefore be reported on the ub-04 claim form. The health insurance portability and accountability act defines abuse as A) actions causing physical or emotional abuse B) duplicating charges on a claim C) actions not consistent with accepted and sound medical, business, or fiscal practices D) excessive charges for supplies - ansc) actions not consistent with accepted and sound medical, business, or fiscal practices Rationale: hipaa defines abuse as "involving actions that are not consistent with accepted, and sound medical, business, or fiscal practices.

[Date] Timely filing of cross-over claims for medicare-medicaid: A) will vary depending on each state's medicaid timely filing guidelines B) follow medicare's timely following guidelines C) may change from year to year D) depend on individual contract timely filing guidelines. - ansb) follow medicare's timely following guidelines. Rationale: medicare-medicaid cross-over claims must adhere to the medicare's timely filing statute. To compare units of service with cpt and hcpcs level ii codes, cms added which of the following to the ncci program? A) medically utilized edits B) medically undetermined edits C) medically unlikely edits D) medically unusual edits - ansc) medically unlikely edits Rationale: mue (medically unlikely edits) determine cpt and hcpcs level ii codes that have a maximum number of units of service (uos) that can reasonably be performed by the same provider on the same patient on the same date of service. To managed patient accounts effectively claims should be tracked for:

[Date] A) dates of service and coding errors B) overpayments and compliance C) coding errors and overpayments D) dates of service and overpayments - ansc) coding errors and overpayments Rationale: coding errors and overpayments are key areas to track in order to properly managed patient accounts To perform a proper audit, which of the following documents should be utilized? A) patient's medical record, copy of submitted cms-1500 claim form, and patient's insurance information B) patient's medical record, copy of submitted cms-1500 claim form, and encounter form for patient's visit. C) patient's medical record, copy of submitted cms-1500 claim form, and patient's demographic information D) both a&c - ansb) patient's medical record, copy of submitted cms- claim form, and encounter form for patient's visit Rationale: to properly perform an audit the patient's medical record, a copy of the cms-1500 form that was submitted, and the encounter form would all be necessary to verify that documentation supports the diagnostic and procedure codes that were reported on the cms-1500 claim form.

[Date] To report the location, condition, or circumstances of an injury, poisoning, or adverse effect, which type of icd-10-cm code is reported? A) z-code B) external cause code C) combination code D) manifestation code - ansb) external cause code Rationale: external cause codes are assigned to report where, how, and the circumstances surrounding an injury, poisoning, or adverse effect condition. Z-codes are used to report encounters for circumstances other than a disease or injury. Manifestation codes are additional codes that are reported in connection with other diagnostic codes. Transmission of claims via dsl, internet, magnetic tape, disk, or cd would be considered: A) attached claims submission B) interactive claims submission C) pushed claims submission D) electronic claims submission - ansd) electronic claims submission Rationale: dsl, internet, magnetic tape, disk, or cd are all considered to be electronic methods for claims submission. What is "qui tam"?

[Date] A) a provision in the false claims act which allows a private citizen to file a lawsuit in the name of the us government. B) a provision of the false claims act which allows the us government to file a lawsuit on behalf of a private citizen. C) a provision of hipaa that allows a patient the right to view their medical records D) a provision of hipaa that allows the us government to seize medical records at will. - ansa) a provision in the false claims act which allows a private citizen to file a lawsuit in the name of the us government. Rationale: the federal false claims act incorporated this concept allowing private citizens to file a lawsuit in the name of the us government in charging contractors and other entities receiving government funds with fraud and also allows for the citizen to share in the funds that are recovered in the lawsuit. What is a co-payment? A) an amount paid every month by the policyholder to maintain health insurance coverage B) a percentage of the allowed amount that the patient is responsible for. C) a flat amount paid to the healthcare provider when the policyholder is seen for an office visit. D) the adjusted amount based on the insurance policy requirement. - ansc) a flat amount paid to the healthcare provider when the policy holder is seen for an office visit.

[Date] What is a medigap policy? A) a policy that covers healthcare services that medicare does not cover. B) a policy that will not reimburse for out-of-pocket costs not covered by medicare C) a supplemental insurance offered by cms. D) a policy required by medicare. - ansa) a policy that covers healthcare services that medicare does not cover. What is linked by ncds and lcds? A) diagnosis codes to procedures or services that are determined to be payable for medicare patients B) diagnosis codes to procedures or services that are determined to be reasonable for medicare patients. C) diagnosis codes to procedure or services that are determined to be reasonable and medically necessary for medicare patients D) diagnosis codes to procedures or services that need to have a signed abn. - ansc) diagnosis codes to procedure or services that are determined to be reasoable and medically necessary for medicare patients Rationale: national and local coverage determinations (ncd & lcd) are continually being developed to link diagnoses and procedures based on medical necessity and reasonability. When an ncd/lcd review determines that a procedure or service is not reasonable or medically necessary, the provider is allowed to bill the patient only if an abn has been signed prior to providing the procedure or service.

[Date] What providers submit the ub-04 claim? I. Community mental health centers (cmhcs) Ii. Emergency department Iii. Hospice organizations Iv. Institution based ambulance companies V. Outpatient rehabilitation facilities Vi. Ambulatory surgery centers A) iii-vi B) iv, vi C) i, iii, iv, vi D) i-v - ansd) i-v Rationale: providers that submit the ub-04 claim are community mental health centers (cmhcs), hospitals (emergency department, inpatient, and outpatient services), hospice organizations, institution based ambulance companies, outpatient rehabilitation facilities, home healthcare agencies, psychiatric drug/alcohol treatment facilities, skilled nursing facilities, subacute facilities When a claim payment has been denied, the denial: A) is always found to be in error and a prompt appeal should be made: B) may be valid and should not be appealed.

[Date] C) should be analyzed and if it was denied in error, an appeal should be initiated. D) both b & c - ansd) both b & c Rationale: the denial should be analyzed prior to submitting an appeal to determine the reason for the denial. Some reasons for a denial could include billing for a procedure or service that was not medically necessary, or billing for a non covered benefit, or a pre-existing condition. Other possible reasons could be that the patient's coverage was terminated or the procedure required a pre-authorization that was not obtained. When an account has been determined (by the practice's policy) to be delinquent, the account should: A) be written off as a bad debt B) be closed and no further visits scheduled for the patient. C) be turned over to a collection agency. D) continue to be worked by the practice's billing office staff as time allows.

• ansc) be turned over to a collection Agency. Rationale: a medical practice should develop policies for handling delinquent accounts. The final step in delinquent account protocol would be to release the account to a collection agency who will continue the collection process until resolution.

[Date] When submitting a medigap policy, which option is an example of how the patient's id number should appear in item 9a of the cms-1500 claim form? A) 123456789 B) 123456789a C) mgap 123456789 D) aetna 123456789 medigap - ansc) mgap 123456789 Rationale: in item 9a enter medigap followed by the policy number and group number if applicable. These should be separated by spaces ie. Medigap 123456 222. Mg or mgap are also acceptable. Which of the following inofrmation is not required when requesting a prior authorization A) the ordering physician B) the amount of time needed to complete the procedure C) anticipated dates of surgery D) icd-10-cm codes - ansb) the amount of time needed to complete the procedure. Rationale: to obtain a prior authorization, the following inofrmation will be requested; the patient's name and id number, icd-10-cm codes, cpt/hcpcs level ii codes, the ordering physician, the schedule date for the procedure, and the site or facility where it will be performed. Which of the following scenarios would support billing incident-to services?

[Date] A) new patient seen by a mid-level provider who is an employee of the physician. B) established patient seen by a mid-level provider for follow-up for blood pressure check, physician is in the office suite. C) established patient seen by a mid-level provider for an established problem, the physician is performing hospital rounds. D) new patient to the practice, physician in exam room next door, mid-level provider is an employee of the physician. - ansb) established patient seen by a mid-level provider for follow-up for blood pressure.check, physician is in the office suite. Rationale: medicare's incident - to billing for mid-level providers allow for services to be billed under the physician's provider number when medicare patients are seen in collaboration with a physician. New patients must be seen by the physician to establish care. Physician must be readily available onsite in order to bill incident-to services. Which of the following statements is not true for the tob codes? A) digit 1 identifies the type of facility B) digit 2 identifies the type of facility C) digit 3 identifies the type of care provided D) digit 4 is the frequency code - ansa) digit 1 identifies the type of facility. Rationale: the tob (type of bill) is alphanumeric and describes three specific types of information after the leading "0". Digit 1 is the leading zero and

[Date] cms does not recognize this digit. Digit 2 identifies the type of facility, digit 3 classifies the type of care provided, and digit 4 is the frequency code which identifies the sequence of the bill for each episode of care Which of the following statements is true regarding medicaid? A) medicaid eligibility policies are the same for states of similar size and geographic region. B) medicaid eligibility is clear and consistent from state to state C) medicaid programs receive matching ffederal funding only if certain healthcare services are provided to eligible individuals. D) medicaid programs must provide medical assistance for all poor persons. - ansc) medicaid programs receive matching federal funding only if certain healthcare services are provided to eligble individuals. Medicaid programs must provide certain healthcare services to eligible individuals in order to receive matching federal funds known as federal medical assistance percentage (fmap). The percentage is determined on a year to year basis using a formula that compares the state's per capita average income with the national average. States with lower average income per capita receive a higher fmap. Which of the following statements is true regarding the non-par medicare allowed fee schedule? A) the non-par provider can bill the patient the difference between the charge and the medicare allowable.

[Date] B) the non-par limiting charge is 115% of the non-par medicare physician fee schedule C) the non-par physician fee schedule is 115% of the par medicare physician fee schedule D) the non-par limiting charge is 95% of the par medicare physician fee schedule. - ansb) the non-par limiting charge is 115% of the non-par medicare physician fee schedule. Rationale: per cms, the non-par limiting charge is 115% of the non-par medicare physician fee schedule. 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 - ansa) 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 permanently and totally disabled due to a service-related disability and their spouse and children.