FREE MEDICAL AND STUDY GAMES ABOUT CBCS EXAM

PDF Download

FREE MEDICAL AND STUDY GAMES ABOUT CBCS EXAM

WORDS Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -44 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation

Question 1: Case Manager

Answer:

a review of clinical services being provided.

Question 2: Registered Nurse

Answer:

(RN) legally authorized/registered to practice after passing exam given by state board, nurse examiners, or similar regulatory authority; liaison between patient, provider, medical assistant (MA), and often billing and coding specialist.

Question 3: Licensed Practical Nurse

Answer:

(LPN) able to perform functions similar to an RN, BUT under the direct supervision of an RN; can work in hospitals or other specialized settings such as nursing homes, providers offices, or home health care.Question 4: Providers, facilities, and prescription drugs within a boarder, contracted network of the insurance company.

Answer:

Tier 2

Question 5: Accounts Receivable Department

Answer:

department that keeps track of what third-party payers the provider is waiting to hear from and what patients are due to make a payment.

Question 6: (Least expensive) generic or not covered by a patent

Answer:

Tier 1

Question 7: Documentation

Answer:

the record of clinical observations and care a patient receives at a health care facility.

Question 8: Rendering Provider

Answer:

the person or company (laboratory or other facility) who rendered the care.

Question 9: Abuse

Answer:

practices that directly or indirectly result in unnecessary costs to the Medicare program.

Question 10: Regulatory Compliance

Answer:

When a business follows state, federal, and International laws and regulations relevant to its operations.

Question 11: Referring Physician

Answer:

refers patients for services or supplies they cannot provide.

Question 12: Gatekeeper

Answer:

person who coordinates care in a managed care plan. Usually the PCP in an HMO plan. Provider who determines the appropriateness of the health care service, level of health care professional called for, and setting for care.

Question 13: Providers, facilities, and prescription drugs not on the formulary.

Answer:

Tier 4

Question 14: E Codes

Answer:

External Cause of Injury codes (ICD-9 specific)- used to classify environmental events, circumstances, and conditions, such as the cause of injury, poisoning, and other adverse events.

Question 15: Referring Provider

Answer:

the physician or other licensed health care professional who requests a service for a patient.

Question 16: Prescription with non-preferred brand name

Answer:

Tier 3

Question 17: Not on formulary

Answer:

Tier 4

Question 18: Disclosure

Answer:

communicating confidential patient information to others in accordance with legal guidelines, given to an outside person or organization.

Question 19: Providers, facilities, and prescription drugs out of the network.

Answer:

Tier 3

Question 20: Medical Administrative Assistant

Answer:

responsible for providing administrative support to providers an other health care professionals; perform general office tasks and are able to perform basic billing and coding functions, formerly known as secretaries and receptionists.

Question 21: Fraud

Answer:

making false statements of representation of material facts to obtain some benefit or payment for which no entitlement would otherwise exist.

Question 22: Unbundling

Answer:

using multiple codes that describe different components of a treatment instead of using a single code that describes all steps of the procedure.

Question 23: Upcoding

Answer:

assigning a diagnosis or procedure code at a "higher level then the level that the document supports, such as coding.

Question 24: Medical Assistant

Answer:

(MA) performs administrative and clinical tasks to keep office running smoothly; can perform basic function of medical billing and coding; work closely with providers, patients, administrative staff, and other health care professionals like RNs.

Question 25: Claim Scrubber

Answer:

software that reviews a claim prior to submission for correct and complete data, such as accurate gender in alignment with diagnosis/procedure or medical necessity.

Question 26: Supervising Provider

Answer:

the physician monitoring a patient's care.

Question 27: Non-generic with preferred brand name

Answer:

Tier 2