Certified Billing and Coding Specialist - Mock Exam 1 (2022) COMPLETE SOLUTIONS

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Certified Billing and Coding Specialist - Mock Exam 1 (2022) COMPLETE SOLUTIONS All are eligible under Medicare health insurance except: a) retiree of the Civil Service Retirement System b) persons of 65 years or older, retired on Social Security benefits c) those diagnosed with end-stage renal disease (ESRD) d) All kidney donors - ✔✔d) All kidney donors Which provider/network must accept the payer's allowable amount as 100% payment for procedures or services provided? a) Out of Network provider b) Participating provider c) Non-participating provider d) Both a & b - ✔✔b) Participating provider _____ means the provider agrees to accept what the insurance company approves as payment in full for the claim. a) Assignment of benefits b) Fee schedule c) accept assignment d) Capitation - ✔✔c) accept assignment Charge a higher premium than HMO's in exchange for more flexibility and more options for the beneficiaries. There is no gatekeeper-physician and beneficiaries choose the provider from whom to seek services as long as the provider is within the network. a) PPO b) HMO c) Triple Plan Optiond) Prepaid health plan - ✔✔a) PPO Vaccine codes are found in what section of the CPT? a) E & M secion b) Laboratory section c) Medicine section d) Appendix C - ✔✔c) Medicine section Covers some other medical services that Part A doesn't cover, such as outpatient services, some of the services of physical and occupational therapists, and some home health care. a) Medicare Part A b) Medicare Part B c) Medicare Part C d) Medicare Part D - ✔✔b) Medicare Part B Under Medicaid, a low income individual losing employer health insurance coverage can be eligible under Medicaid. What law provides continuation of group health coverage that otherwise might be terminated? a) COBRA b) Stark Law c) OIG d) HIPAA - ✔✔a) COBRA For work related injuries, is it covered by private insurance even though patient is covered under Worker's Compensation Insurance? a) True b) False - ✔✔b) False Gate-keeper under managed care plan is also called the: a) Primary care physicianb) Referring physician c) Consultant d) Attending physician - ✔✔a) Primary care physician Assignment of benefits means that third party payer will: a) Pay the physician directly b) Pay the patient directly c) Pay claim 100% d) none of the above - ✔✔a) Pay the physician directly Insurance for active military personnel and their dependents. a) CHAMPVA b) Medicare c) Tricare d) BCBS - ✔✔c) Tricare

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