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CBCS Exam Study Guide
- Which of the following is an example of electronic claim submission
ANS –
Claims submitted via a secure network - After a third-party payer validates a claim, which of the following takes placenext
ANS Claim ajudication - A Patient presents to the provider with chest pain and shortness of breath.After an unexpected ECG result, the providercalls a cardiologist and summarizes the patient’s symptoms. What portion of the HIPPA allows the provider to speak to the cardiologist prior to obtaining the patients consent
ANS Title II
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- When a patient has a condition that is both acute and chronic, how should it be reported
ANS Code both acute and chronic, sequencing the acute first. - Which of the following organizations identifies improper payments made onCMS claims
ANS Recovery Audit Contractor (RAC) - Which of the following is the third stage of the life cycle of a claim
ANS Claims adjudication - The destruction of lesions using cryosurgery would use which of the following treatments
ANS Cold treatment - Which of the following statements is true when determining patient financialresponsibility by reviewing the remittance advice
ANS Any coinsurance, copay- ments, and deductibles are the patients
responsibility
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- A claim is denied because the service was not covered by the insurance
company. Upon confirmation of no errors on the claim, which of the followingdescribes the process that will follow the denial
ANS The claim will not be re-sub- mitted and the patient will be sent a bill - Accepting assignment on the CMS-1500 claim form indicates that:
ANS the physician agrees to accept payment under the terms of the payers
program - A patient has met a Medicare deductible of 150. the patients coinsuranceis 20%. and the allowed amount is 600. Which of the following is the patient’sout of pocket expense
ANS 120
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