.png){kind=logo}
PDF Download
FREE AND STUDY GAMES ABOUT CBCS EXAM QUESTIONS
Actual Qs and Ans Expert-Verified Explanation
This Exam contains:
-Guarantee passing score -100 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation Question 1: Which of the following is the provision of health insurance policies that specifies which coverage is primary or secondary?
Answer:
Coordination of Benefits (COB): This provision in a health insurance policy determines which plan is responsible for paying first when a patient has coverage under more than one plan.Question 2: A billing and coding specialist is preparing an accounts receivable aging report.The specialist should expect the report to include which of the following?
Answer:
Outstanding balances organized by date Question 3: A new patient presents for an urgent care encounter. Which of the following code sets should be used to report this encounter?
Answer:
Office or other outpatient services Question 4: Which of the following pieces of guarantor information is required when establishing a patient's financial record?
Answer:
Phone number - A guarantor is the person responsible for a patient's bill if they cannot pay themselves.Their phone number is crucial for contacting them regarding payment arrangements.
Question 5: A billing and coding specialist is determining the level of service for an office visit for a new patient. Which of the following codes represents a moderate level of medical decision-making?
Answer:
99204 evaluation and management of a new patient's office or other outpatient visit, requiring a medically appropriate history and/or examination, and a moderate level of medical decision-making.Question 6: A claim is submitted with a transposed insurance member ID number and returned to the provider. Which of the following describes the status that will be assigned to the claim by the third-party payer?
Answer:
Invalid - An invalid claim means the claim has a critical error that prevents it from being processed.Question 7: A billing and coding specialist is reviewing a patient's encounter progress note.Which of the following modifiers indicates the patient received general anesthesia from a surgeon?
Answer:
-47 Anesthesia by a surgeon Question 8: On a remittance advice form, which of the following is responsible for writing off the difference between the amount billed and the amount allowed by the agreement?
Answer:
Provider Question 9: HIPAA transaction standards apply to which of the following entities?
Answer:
health care clearinghouses.Question 10: A billing and coding specialist is collecting demographic information from a patient. Which of the following pieces of information should the specialist expect the Medicaid eligibility verification system (MEVS) to provide?
Answer:
Dates of coverage - (MEVS) verifies a patient's eligibility for Medicaid.
Question 11: A patient has a resection of the intestines with anastomosis through the abnormal walls. Which of the following is a type of anastomosis?
Answer:
Ileostomy is a type of surgical procedure that creates an opening from the ileum to the outside of the body through the abdominal wall. This opening, called a stoma, allows intestinal waste to pass out of the body into a collection bag.
Question 12: Which of the following is the third stage of a claim's life cycle?
Answer:
Adjudication - The third stage of a claims life cycle Question 13: When a patient has a condition that is both acute and chronic, how should it be coded?
Answer:
Code both the acute and chronic conditions, sequencing the acute condition first. - with separate codes for both the acute and chronic aspects of the condition, with the acute condition sequenced first Question 14: A billing and coding specialist is reviewing a remittance advice from Medicare and notices that the amount paid for a procedure is less than the contracted amount. Which of the following is a potential reason for the reduced amount of payment?
Answer:
The claim indicated an incorrect place of service.Question 15: When should a billing and coding specialist initiate the collection of the information needed to process a patient's insurance claim form?
Answer:
When the patient contacts the provider's office and schedules an appointment.Question 16: A patient has a breast biopsy w/the placement of a clip. After the biopsy is determined to be malignant, the patient elects for a mastectomy during the global period of the biopsy. Which of the following modifiers should be use to report the mastectomy?
Answer:
-58 Staged or related procedure by the same physician or qualifying healthcare professional during postoperative period.
Question 17: Medigap coverage is offered to Medicare beneficiaries by which of the following?
Answer:
private third-party payers.Question 18: Anesthesia codes from the CPT® manual require which of the following on the claim form?
Answer:
Physical status modifiers are appended to anesthesia codes to indicate the patient's health condition before surgery, which influences the complexity of the procedure and the corresponding reimbursement.Question 19: A billing and coding specialist is preparing a claim for an appendectomy and reports it with two units. The claim is then denied. Which of the following coding edits should the specialist have reviewed prior to submitting the claim?
Answer:
An appendectomy is a procedure that only involves one appendix, so billing it with two units is considered medically unlikely. A "Medically Unlikely Edit (MUE)" is a software rule that checks for codes that are billed with an implausible number of units.Question 20: A billing and coding specialist is preparing a claim for a provider. The operative note indicates the surgeon performed a CABG. The specialist should identify that CABG stands for which of the following?
Answer:
Coronary Artery Bypass Graft. This is a surgical procedure where a surgeon uses a healthy blood vessel (like a vein from the leg) to create a new pathway around a blocked coronary artery. This restores blood flow to the heart muscle.Question 21: A specialist is determining (COB) for a pt who has health insurance coverage from both parents. The pt's father's birthday is May 18, 1982 and their mother's birthday is May 18,
- Which of the following statements is correct for determining coverage?
Answer:
The parent whose insurance policy went into effect most recently will be the primary insurer.Question 22: A patient who recently received care from an endocrinologist is being referred to an infectious disease specialist. Which of the following types of referral does the patient need from the endocrinologist?
.png)