CPB Practice Exam A. Questions &
Answers. 100% Accurate. Rated A+
The office policy for claims follow-up is to prioritize the insurance balance accounts past 90 days by
highest outstanding balance. Based on the A/R
...
CPB Practice Exam A. Questions &
Answers. 100% Accurate. Rated A+
The office policy for claims follow-up is to prioritize the insurance balance accounts past 90 days by
highest outstanding balance. Based on the A/R report provided, which payer type and aging category
would be one of the top priorities on which to focus collection efforts? - ✔✔-workers' compensation,
121+ days
Using the fee schedule and the payment policy provided, what is the expected reimbursement (including
patient responsibility) when a provider performs a nasal endoscopy and dilation of the left maxillary
sinus (31295) and a diagnostic nasal endoscopy of the right maxillary sinus (31233)? - ✔✔-$2475
Policy applies to all professional services performed in an office place of service: When a significant,
separately identifiable E/M service (appended with modifier 25) and any service that has a global period
indicator—as designated by CMS of 0, 10, 90 or YYY—is performed on the same day, the E/M service will
be reimbursed at 50% of the contracted allowable. When performed in a facility, both services are paid
at 100%.
When the E/M value is greater than the procedure, the reduction will be applied to the global procedure
code.
Based on the remittance advice and the payment policy provided, what action is required for this claim?
- ✔✔-D. The claim did not pay correctly. Both services should be paid at 100%. Contact the payer to
reprocess the claim for full payment.
Balloon Sinusplasty Medical Coverage Policy
According to the LCD, how is an extracapsular cataract surgery with insertion of an intraocular lens for a
drug induced cataract in the left eye reported? - ✔✔-66984, H26.32, T38.0X5A
I. Primary insurance
II. Primary insurance ID number
III. Relationship to the insured
IV. Place of service
V. Provider NPI
VI. CPT® code(s)
VII. Modifier
VIII. Diagnosis code correlation
IX. Units of service
X. Service Facility Location Information
(Robert Roberts) - ✔✔-VI , VIII and X
The provider performs an office visit with an expanded problem focused history, expanded problem
focused exam and low MDM to manage the patient's hypertension. The provider also destroys two
plantar warts. How is this reported? - ✔✔-99213-25, 17110
What is the correct HCPCS Level II code for Depo-Provera (medroxyprogesterone acetate) injection of
100 mg? - ✔✔-J1050 x 100
55-year-old female presents to the office with ongoing history of type I diabetes which has been
controlled with insulin. During the exam the physician notes that gangrene has set in due to the diabetic
peripheral angiopathy on her left great toe. Patient is recommended to see a general surgeon for
treatment of the gangrene on her left great toe. - ✔✔-E10.52
A dermatologist performed an excision of a squamous cell carcinoma from the patients forehead with a
1.2 cm excised diameter. The excision site required an intermediate wound closure measuring 1.8 cm.
What is/are the correct code(s)? - ✔✔-C. 11642, 12051-51
Procedures Performed: 1. Bilateral tympanotomy with insertion of ventilation tubes (69436 RVU 4.62) 2.
Adenotonsillectomy (42820 RVU 8.41) What is/.are the correct code(s) and proper billing sequence for
the following procedures performed by a physician? Procedures Performed: Bilateral tympanostomy
with insertion of ventilationg tubes (69436 RVU 4.63582) Adenotonsillectomy (42820 RVU 8.45321) -
✔✔-A. 42820, 69436
When you respond to a patient with "How may I help you, Mrs Jones?", the use of the patient's name: -
✔✔-C. Indicates to the caller you are interested and listening
Ms. Turner had surgery one month ago for hernia repair. She is still in the post-operative period and
comes in today to the see the same physician that performed the hernia repair surgery about a lump
that she has noticed on her tailbone. The physician performs an examination and the diagnosis is that
she has a pilonidal cyst which is unrelated to the surgery. Can the physician bill an E/M service for
today's visit during the post-operative period? - ✔✔-Yes, the E/M service can be reported with modifier
24 to indicate it is unrelated to the surgery.
CMS has a standard enrollment form in which the provider agrees to: I. Submit claims to Medicare II.
Have authorization from the Medicare beneficiary to file claims III. Retain all source documentation and
medical records IV. Submit claims within 60 days of the date of service V. Submit all claims with a group
NPI number VI. Research and correct claim discrepancies. - ✔✔-D. I, II, III, and VI
Incorrect entry of the patient demographics can have an affect on many areas of the practice. What
documents are necessary to verify demographics? I. Photo Identification II. Insurance card III. Credit card
information IV. Social Security card V. Patient completed demographic form - ✔✔-I, II, and V
What should a biller do when a claim is denied for not being submitted within the timely filing period? -
✔✔-Track the transmission date of the claim. If within the timely filing period, provide the information
to the payer to reprocess the claim.
Which of the following steps should be completed when filling an appeal?
I. Submit in the format required by the payer.
II. Review the reason for the denial and determine if the payer made an error.
III. Provide supporting documentation from an official source to support your reason for appeal.
IV. Keep a copy of the information submitted to the payer for the appeal.
V. Appeal the claim as soon as a denial is received.
VI. Appeal the claim as soon as you are certain the payer denied in error and the claim can not be
reprocessed. - ✔✔-C. I, II, III, IV, and VI
A patient with an acute myocardial infarction is brought by ambulance to the emergency department.
The patient is taken into the cardiac catheterization lab. Angioplasty and a stent was placed in the LAD.
The patient's insurance requires preauthorization for all surgical procedures. Which of the following
statements is true for most payers? - ✔✔-Because this was an emergency, it is acceptable to obtain
authorization following the surgery.
According to this clearinghouse rejections report, what action should be taken on the claims for Jerry
McMahon, Date of Service 11/09/XX? - ✔✔-. C44.50 requires an additional character. Review the
medical record for the correct sixth character, correct the claim in your system and re-file electronically.
Which of the following is an allowed collection policy after a patient files for bankruptcy? - ✔✔-Unpaid
insurance claims for dates of service occurring after the date of the bankruptcy can be collected.
Which statement is TRUE regarding the Fair Debt Collection Practices Act (FDCPA)? - ✔✔-Collectors are
not allowed to contact debtors at odd hours.
There is a written office policy to write off patients co-insurance and copayment amounts as a
professional courtesy. Is this appropriate? - ✔✔-No, it is cons
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