Mock CPB Exam

The patient underwent office surgery on March 18, and the third-party payer determined the allowed charge to be $1,480. The patient paid the 20 percent coinsurance at the time of the office surgery. The physician and patient each received a check for $1,184, and the patient signed her check over to the physician. The overpayment was ______, and the physician must reimburse the third-party payer. a. $2,368 b. $296 c. $1,184 d. $1,480

$1,184

Dr. Smith is a participating provider (PAR) for the ABC Health Insurance Plan. Mary Talley is treated by Dr. Smith in the office, for which a $100 fee is charged. Calculate the PAR provider write-off amount when the PAR provider fee is $100; PAR allowable charge is $80; patient copayment is $20; and insurance payment is $60. The PAR provider write-off amount is ______ a. $20 b. $10 c. $40 d. $30

$20

Which code represents incision and drainage of pilonidal cyst? a. 10060 b. 10080 c. 11770 d. 11772

10080

Long-term acute care hospitals are defined by Medicare as having an average inpatient length of stay greater than ______ days. a. 30 b. 10 c. 15 d. 25

25

Which code represents revision of gastroduodenal anastomosis with reconstruction, with vagotomy? a. 43865 b. 43850 c. 43855 d. 43860

43855

Which code represents computed tomography, head or brain, without contrast material, followed by contrast material(s) and further sections? a. 70470 b. 70450 c. 70460 d. 76376

70470

The Medicare durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS) fee schedule reimburses DMEPOS either ______ percent of the actual charge for the item or the fee schedule amount, whichever is lower. a. 80 b. 20 c. 50 d. 100

80

Which code represents a new patient exam in which the physician documents a detailed history, detailed examination, and medical decision making of low complexity? a. 99203 b. 99204 c. 99214 d. 99213

99203

The ICD-10-CM Table of Drugs and Chemicals is an alphabetic index of medicinal, chemical, and biological substances that result in poisonings and adverse effects. The first column of the table lists generic names of drugs and chemicals with four columns for poisonings, one column for adverse effects, and one column for underdosing. Which column is reviewed to locate a code when the patient develops a pathologic condition that results from a drug or chemical substance that was properly administered or taken? a. Poisoning b. Underdosing c. Underdetermined d. Adverse Effect

Adverse Effect

Where is the first-listed diagnosis reported on the CMS-1500 claim? a. Block 24E b. Block 24D c. Block 21A d. Block 24A

Block 21A

Which code represents MRI without contrast followed with contrast, breast; unilateral? a. C8905 b. C8902 c. C8907 d. C8911

C8905

Which is a comprehensive health care program for which the Department of Veterans Affairs shares costs of covered health care services and supplies with eligible beneficiaries? a. CHAMPUS b. Medicare c. CHAMPVA d. TRICARE

CHAMPVA

Medicare requires providers to submit the ______ claim for payment of outpatient and office services. a. UB-04 b. CMS-1500 c. UB-02 d. CMS-1450

CMS-1500

Which insurance claim is submitted to receive reimbursement under Medicare Part B? a. UB-92 b. CMS-1450 c. CMS-1500 d. UB-04

CMS-1500

Provider services for inpatient care are billed on a fee-for-service basis, and service results in a unique and separate charge designated by a ______ or HCPCS level II service/procedure code. a. ICD-10-CM b. CPT c. ICD-9-CM d. ICD-10-PCS

CPT

Which coding system is used to report procedures and services on claims? a. CPT b. SNDO c. SNOMED d. ICD-10-CM

CPT

The Healthcare Common Procedure Coding System (HCPCS) consists of ______ codes. a. SNOMED and SNDO b. ICD-10-CM and ICD-10-PCS c. DSM and CDT d. CPT and national

CPT and national

What type of codes containing "emerging technology," are temporary codes assigned for data collection, and are still used by some third-party payers? a. Category II codes b. Category III codes c. Category I codes d. Category IV codes

Category III codes

Which act allows employees to continue health care coverage beyond the benefit termination date? a. Tax Equity and Fiscal Responsibility Act of 1982 b. Health Insurance Portability and Accountability Act of 1996 c. Omnibus Budget Reconciliation Act of 1981 d. Consolidated Omnibus Budget Reconciliation Act of 1985

Consolidated Omnibus Budget Reconciliation Act of 1985

Which code represents an Easy Care folding walker? a. E0143 b. E0105 c. E0148 d. E0144

E0143

Which code represents pillow for decubitis care? a. E0198 b. E0190 c. E0193 d. E0196

E0190

Diabetes insipidus is represented by which ICD-10-CM code? a. E13.9 b. E15 c. E23.7 d. E23.2

E23.2

To qualify for workers' compensation benefits, an employee must be injured while working within the scope of the job description, be injured while performing a service required by the employer, or develop a disorder that can be directly linked to employment, such as asbestosis or mercury poisoning. The worker does not have to be physically on company property to qualify for workers' compensation. Which is an example of an on the job injury that would qualify the employee for workers' compensation benefits? a. Employee is injured when picking up reports for the office at the local hospital. b. Employee develops pneumonia after working at the medical office all week. c. Employee faints at the grocery store and believes it is due to stress at work. d. Employee is injured in an accident during a trip to the bank to deposit personal checks.

Employee is injured when picking up reports for the office at the local hospital.

Atherosclerosis of native arteries of extremities with gangrene, bilateral legs is represented by which ICD-10-CM code? a. I70.263 b. I70.262 c. I70.268 d. I70.261

I70.263

Diagnosis pointer letters A-L are preprinted in Block 21 of the CMS-1500 claim to allow for entry of ______ codes, and they are reported in Block 24E. a. ICD-10-PCS b. HCPCS level II c. ICD-10-CM d. CPT

ICD-10-CM

Hospital inpatient ______ codes are submitted for reimbursement purposes. a. ICD-9-CM, CPT, and HCPCS level II b. ICD-10-CM, ICD-10-PCS, CPT, and HCPCS level II c. ICD-10-CM, CPT, and HCPCS level II d. ICD-10-CM and ICD-10-PCS

ICD-10-CM and ICD-10-PCS

Which classification system was developed by the World Health Organization (WHO) and used to collect data for statistical purposes? a. National Drug Codes b. Current Procedural Terminology c. International Classification of Diseases d. Healthcare Common Procedure Coding System

International Classification of Diseases

Chronic hepatic failure with coma is represented by which ICD-10-CM code? a. K72.91 b. K72.01 c. K72.11 d. K72.10

K72.11

Which code represents foot, abduction rotation bar, without shoes? a. L3170 b. L3150 c. L3140 d. L3160

L3150

The federal name for the Title 19 medical assistance program is ______. a. Medicare b. CHAMPUS c. Medicaid d. TRICARE

Medicaid

Which program added prescription medication coverage to the original Medicare plan, some Medicare cost plans, some Medicare private fee-for-service plans, and Medicare Medical Savings Account Plans? a. Medicare Part B b. Medicare Part D c. Medicare Part C d. Medicare Part A

Medicare Part D

Medicare beneficiaries can also obtain supplemental insurance to help cover costs not reimbursed by the original Medicare plan. This type of coverage is called ______. a. Medicaid b. Medigap c. Medicare PLUS d. PACE

Medigap

The Healthcare Effectiveness Data and Information Set (HEDIS) was developed by the ______ and created standards to assess managed care systems in terms of membership, utilization of services, quality, access, health plan management and activities, and financial indicators. a. Office of the Inspector General (OIG) b. Centers for Medicare and Medicaid Services (CMS) c. Joint Commission d. National Committee for Quality Assurance (NCQA)

National Committee for Quality Assurance (NCQA)

The Health Information Technology for Economic and Clinical Health Act was included in the American Recovery and Reinvestment Act of 2009 and amended the Public Health Service Act to establish the ______. a. Health Care Financing Administration b. Office of National Coordinator for HIT c. Centers for Medicare and Medicaid Services d. State Children's Health Insurance Program

Office of National Coordinator for HIT

Which program was implemented to find and correct improper Medicare payments paid to health care providers participating in fee-for-service Medicare? a. Hospital Inpatient Quality Reporting (Hospital IQR) b. Recovery Audit Contractor (RAC) c. Medicaid Integrity Program (MIP) d. Zone Program Integrity Contractor (ZPIC)

Recovery Audit Contractor (RAC)

Which requires providers to make certain written disclosures concerning all finance charges and related aspects of credit transactions (including disclosing finance charges expressed as an annual percentage rate)? a. Fair Credit Billing Act b. Truth in Lending Act c. Electronic Funds Transfer Act d. Equal Credit Opportunity Act

Truth in Lending Act

Institutional and other selected providers submit ______ claim data to payers for reimbursement of patient services. a. UB-02 b. CMS-1500 c. UB-92 d. UB-04

UB-04

An ambulatory surgical center (ASC) is a state-licensed, Medicare-certified supplier (not provider) of surgical health care services that must ______ on Medicare claims. a. assign benefits b. accept assignment

accept assignment

Which are the amounts owed to a business for services or goods provided? a. accounts payable b. allowed charges c. assignment of benefits d. accounts receivable

accounts receivable

Patients sign Block 13 of the CMS-1500 claim to instruct the payer to directly reimburse the provider. This concept is called ______. a. assignment of benefits b. accept assignment

assignment of benefits

Which of the following is an example of abuse? a. submitting claims for services and procedures knowingly not provided b. misrepresenting ICD-10-CM and CPT/HCPCS codes to justify payment c. billing noncovered services/procedures as covered services/procedures d. falsifying health care certificates of medical necessity plans of treatment

billing noncovered services/procedures as covered services/procedures

Which involves the development of patient care plans for the coordination and provision of care for complicated cases in a cost-effective manner? a. risk management b. utilization management c. quality management d. case management

case management

OSHA has special significance for those employed in health care because employers are required to obtain and retain manufacturers' Material Safety Data Sheets (MSDS), which contain information about ______ used on site. Training employees in the safe handling of these substances is also required. a. vaccinations and drugs b. possibly harmful agents only c. oral, IM, and IV medications d. chemical and hazardous substances

chemical and hazardous substances

Which is the percentage the patient pays for covered services after the deductible has been met and the copayment has been paid? a. deductible b. coinsurance c. premium d. copayment

coinsurance

Which type of automobile insurance pays for damage to a covered vehicle caused by hitting an object or being hit during an automobile accident? a. liability b. collision c. personal injury protection d. comprehensive

collision

General equivalency mappings are ______ of codes that can be used to roughly identify ICD-10-CM codes for their ICD-9-CM equivalent codes (and vice versa). a. crosswalks b. indexes c. registers d. details

crosswalks

The computer-to-computer transfer of data between providers and third-party payers (or providers and health care clearinghouses) in a data format agreed upon by sending and receiving parties is called electronic ______. a. flat file format b. remittance advice c. media claim d. data interchange

data interchange

The manual daily accounts receivable journal is also known as the ______, and it is a chronologic summary of all transactions posted to individual patient ledgers/accounts on a specific date. a. patient ledger b. superbill c. explanation of benefits d. day sheet

day sheet

The process of reporting ______ as numeric and alphanumeric characters on the insurance claim is known as coding. a. diagnoses and procedures/services b. health insurance claims identifiers c. national provider identifiers d. dates of service for procedures

diagnoses and procedures/services

The procedure or service provided is linked with the _________ that provided medical necessity for performing the procedure or service. a. supply b. diagnosis c. procedure d. service

diagnosis

CPT defines counseling as it relates to evaluation and management coding as a(n) ______ concerning areas that involve diagnostic results, impressions, recommended diagnostic studies, and so on. a. discussion with a patient and/or family b. order for further ancillary testing c. assessment that impacts patient care d. way to guarantee quality patient care

discussion with a patient and/or family

Which is a global concept that includes the collection of patient information documented by a number of providers at different facilities regarding one patient? a. electronic health record b. personal health record c. electronic medical record d. multidisciplinary health record

electronic health record

A military treatment facility (MTF) is a health care facility operated by the military that provides inpatient and ambulatory care to eligible TRICARE beneficiaries. Which is an example of ambulatory care? a. emergency department treatment b. acute care hospital stay c. overnight psychiatric evaluation d. rehabilitation requiring 30-day admission

emergency department treatment

Which term describes the cause or origin of disease? a. syndrome b. consequence c. manifestation d. etiology

etiology

Prolonged physician service with direct patient contact refers to ______ patient contact on an inpatient or outpatient basis. a. standby b. face-to-face c. unusual d. critical care

face-to-face

The Resource Based Relative Value Scale (RBRVS) system reimburses physicians' practice expenses using a ______. a. usual and reasonable payment basis b. prospective payment system c. guaranteed issue method d. fee schedule

fee schedule

TRICARE deductibles are applied to the government's ______ year, which runs from October 1 of one year to September 30 of the next. a. fiscal b. calendar c. consecutive d. sequential

fiscal

HIPAA defines abuse as involving actions that are ______ with accepted, sound medical, business, or fiscal practices, which directly or indirectly results in unnecessary costs to the program through improper payments. a. unvarying b. inconsistent c. recurrent d. compatible

inconsistent

Which type of HMO contracts health services that are delivered to subscribers by physicians who remain in their own office settings? a. independent practice association b. preferred provider organization c. triple-option plan d. point-of-service plan

independent practice association

ICD-10-PCS is an entirely new procedure classification system that was developed by CMS for use in ______ settings only, replacing Volume 3 of ICD-9-CM. a. provider office b. outpatient hospital c. skilled nursing facility d. inpatient hospital

inpatient hospital

Which typeface is used for ICD-10-CM tabular list exclusion notes and to identify manifestation codes, which are never reported as the first-listed diagnoses? a. bold b. italics c. all caps d. underline

italics

Which is a legal action that can be used to recover a debt and is usually a last resort for a medical practice? a. litigation b. mediation c. adjudication d. subrogation

litigation

Participating providers contract to participate in a BCBS plan's preferred provider network (PPN), which is a program that requires providers to adhere to ______ care provisions. a. retrospective b. hospital c. prospective d. managed

managed

Which includes health maintenance organizations and preferred provider organizations? a. high-risk pool b. managed care c. association health insurance d. indemnity insurance

managed care

Which is a condition that occurs as the result of another condition and for which the codes are always reported as secondary codes? a. manifestation b. syndrome c. symptom d. sign

manifestation

Diagnoses must be entered in the patient's record to validate ______ of procedures or services billed. a. frequency b. medical necessity c. documentation d. submission

medical necessity

The BCBS PPO plan is sometimes described as a subscriber-driven program, and BCBS substitutes the term subscriber or ______ for policyholder. a. payer b. provider c. patient d. member

member

When a child lives with both parents, and each parent subscribes to a different health insurance plan, the primary and secondary policies are determined by applying the birthday rule. The individual who holds the primary policy for dependent children is the spouse whose birth ______. a. month and day occur earlier in the calendar year b. year occurs earlier c. day occurs earlier in the month d. month, day, and year occur earlier

month and day occur earlier in the calendar year

Which term describes benign new growths or tumors, in which cell reproduction is out of control? a. malignancy b. cancer c. neoplasms d. tissues

neoplasms

A narrative clinic note is written in a(n) ______ format. a. catalogue b. itemized c. paragraph d. list

paragraph

Any information communicated by the ______ is considered privileged communication, and HIPAA provisions address the privacy and security of protected health information. a. patient to third-party payer b. provider to third-party payer c. third-party payer to provider d. patient to health care provider

patient to health care provider

Which is considered a nonphysician practitioner? a. pharmacist b. physician assistant c. provider d. nurse

physician assistant

First Report of Injury forms are completed by the ______ when treatment for a work-related illness or injury is sought. a. workers' compensation board b. state insurance fund or compensation board c. patient or patient's representative d. physician or other health care provider

physician or other health care provider

Who is required to personally sign the original and all photocopies of reports submitted to the workers' compensation board? a. patient or legal representative b. physician or other health care provider c. attorney representing the patient d. both the patient and physician

physician or other health care provider

The ______ of service refers to the physical location where health care is provided to patients. a. complexity b. place c. type d. level

place

Court decisions that establish a standard use legal decisions to serve as authoritative rules or patterns in future similar cases. The legal term for standard is ______. a. decision b. example c. precedent d. statute

precedent

The forerunner of what is known today as the BlueCross plan began in 1929 when Baylor University Hospital in Dallas, Texas, approached teachers in the Dallas school district with a plan that would guarantee up to 21 days of hospitalization per year for subscribers and each of their dependents, in exchange for a $6 annual premium. This was considered a ______ plan. a. postpaid b. retrospective c. traditional d. prepaid

prepaid

An advance beneficiary notice of noncoverage (ABN) is a written document provided to a Medicare beneficiary by a supplier, physician, or provider, and the ABN must be presented to the patient ______. a. at least one month before providing the service b. prior to providing the service or treatment c. on the day the service or treatment is provided d. after Medicare has denied payment for the service

prior to providing the service or treatment

Which is established in advance and based on reported health care charges from which a predetermined per diem rate is determined? a. prospective cost-based rate b. retrospective reasonable cost system c. prospective price-based rate d. site-of-service differential

prospective cost-based rate

Medicare calls its remittance advice a(n) ______. a. provider remittance notice b. explanation of benefits c. Medicare summary notice d. electronic remittance advice

provider remittance notice

A Medicare medical necessity denial is a denial of otherwise covered services that were found to be not ______. a. necessary and frequent b. cost effective and necessary c. in compliance with critical pathways d. reasonable and necessary

reasonable and necessary

Physician services standardized to measure the value of a service as compared with other services provided are called ______, and they consist of physician work, practice expense, and malpractice expense payment components. a. physician fee schedules b. price-based rates c. relative value units d. allowable charges

relative value units

Secondary insurance is the insurance plan that is billed after the primary insurance plan has paid its contracted amount and the provider's office has received a(n) ______ from the primary payer. a. encounter form b. remittance advice c. CMS-1500 claim d. explanation of benefits

remittance advice

Nonprofit corporations are charitable, educational, civic, or humanitarian organizations whose profits are ______. a. paid to the federal government as taxes b. returned to the nonprofit corporation c. distributed to shareholders and officers d. sent to beneficiaries who paid premiums

returned to the nonprofit corporation

A triangle located to the left of a code number identifies a code description that has been ______. a. reinstated or recycled since the last edition b. revised since the last edition of CPT c. deleted from CPT since its last edition d. added to CPT for new procedures and services

revised since the last edition of CPT

The Evaluation and Management section is located at the beginning of CPT because these codes describe ______. a. procedures performed by anesthesiologists b. encounters that have unusual circumstances c. health care rendered by nonphysicians only d. services most frequently provided by physicians

services most frequently provided by physicians

ICD-10-CM codes require up to ______ characters, are entirely alphanumeric, and have unique coding conventions, such as Excludes1 and Excludes2. a. five b. seven c. eight d. six

seven

Which punctuation is used in the ICD-10-CM index to identify manifestation codes and in the ICD-10-CM index and tabular list to enclose abbreviations, synonyms, alternative wording, or explanatory phrases? a. braces b. parentheses c. colons d. slanted brackets

slanted brackets

Mary Smith is working full time and enrolled in Medicare Part A at age 65. She decided not to enroll in Medicare Part B at that time because her employer group health insurance coverage reimburses for physician and other outpatient encounters. Mary is eligible to enroll in Medicare Part B anytime during a(n) ______ enrollment period, which is a set time when individuals can sign up for Medicare Part B if they did not enroll when they applied for Medicare Part A. a. initial b. beneficiary c. general d. special

special

When an unlisted procedure or service code is reported, a ______ must accompany the claim to describe the nature, extent, and need for the procedure or service along with the time, effort, and equipment necessary to provide the service. a. remittance advice b. CMS-1500 claim c. special report d. copy of the record

special report

TRICARE ______ are uniformed service personnel who are either active duty, retired, or deceased. a. patients b. sponsors c. beneficiaries d. providers

sponsors

Nonparticipating provider limiting charge information appears on the Medicare ______, which notifies Medicare beneficiaries of actions taken on claims. a. summary notice b. chargemaster c. remittance advice d. explanation of benefits

summary notice

Which is the financial record source document used by health care providers and other personnel in a physician's office setting to record treated diagnoses and services rendered to the patient during the current visit? a. superbill b. explanation of benefits c. CMS-1500 claim d. remittance advice

superbill

The primary care provider (PCP) is responsible for ______. a. providing nonessential health care services to all patients b. supervising and coordinating health care services for enrollees c. denying all referrals to specialists and inpatient hospital admissions d. being a gatekeeper to provide services at the highest possible cost

supervising and coordinating health care services for enrollees

Which serves as a system of checks and balances for labor and management? a. preferred provider organization b. medical underwriter c. health insurance exchange d. third-party administrator

third-party administrator

A new patient is one who has not received any professional services from the physician, or from another physician of the same specialty who belongs to the same group practice, within the past ______ year(s). a. four b. two c. one d. three

three

If a patient is covered by two different policies, the usual procedure for submitting a claim would be ______. a. to submit all claims to all payers at the same time b. a separate claim to each payer for each policy, submitted at the same time c. to submit to the primary payer first, followed by submitting to the secondary after primary payment is received d. one claim; the primary payer will submit a claim to the secondary payer

to submit to the primary payer first, followed by submitting to the secondary after primary payment is received

Which claims are organized by year and are generated for providers who do not accept assignment? a. clean claims b. unassigned claims c. open claims d. closed claims

unassigned claims

Which is the practice of submitting multiple CPT codes when just one code should have been submitted? a. jamming b. upcoding c. unbundling d. downcoding

unbundling

BlueShield plans were created as the result of a resolution passed by the House of Delegates at an American Medical Association meeting in 1938. This resolution supported the concept of ______ health insurance that would encourage physicians to cooperate with prepaid health care plans. a. voluntary b. mandatory c. commercial d. profit

voluntary