CBCS - Certified Billing and Coding Specialist Billing and Claims Submission Questions and Answers

Question 1

A physician's office needs to bill for a routine patient check-up provided in their clinic. Which standard claim form should be used to submit this professional service to the insurance payer?

Accepted Answer

CMS-1500

Answer

UB-04

Answer

ABN (Advanced Beneficiary Notice)

Answer

CMS-1490S

Question 2

A billing specialist submits a claim electronically. The clearinghouse report indicates the claim was not forwarded to the payer because it contained an invalid patient ID number. What is the status of this claim?

Accepted Answer

Rejected

Answer

Denied

Answer

Pending

Answer

Adjudicated

Question 3

A medical practice submits a claim for a service rendered on March 10, 2025. The payer's timely filing limit is 180 days from the date of service. The claim is submitted on October 1, 2025. What is the MOST likely outcome for this claim?

Accepted Answer

It will be denied for exceeding the timely filing limit.

Answer

It will be paid in full as submitted.

Answer

It will be rejected by the clearinghouse for a formatting error.

Answer

It will be paid at a reduced rate due to the delay.

Question 4

A large hospital system that employs hundreds of physicians applies for a National Provider Identifier (NPI) to use for billing purposes for the organization itself. Which type of NPI would this entity receive?

Accepted Answer

Type 2 (Organization)

Answer

Type 3 (Facility)

Answer

Type 1 (Individual)

Answer

Group Practice NPI

Question 5

A child is covered under health insurance plans from both parents. The mother's birthday is May 20th and the father's birthday is August 5th. According to the "birthday rule," which parent's plan is considered primary for the child's claims?

Accepted Answer

The mother's plan, because her birthday occurs earlier in the calendar year.

Answer

The father's plan, because his birthday is later in the year.

Answer

The plan of the parent who has had coverage for a longer period.

Answer

The plan of the parent whose name comes first alphabetically.

Question 6

When reviewing an Electronic Remittance Advice (ERA), a CBCS notices that a payment for a specific service has been reduced. Which of the following would provide the standardized, specific reason for this payment adjustment?

Accepted Answer

Claim Adjustment Reason Code (CARC)

Answer

CPT Code

Answer

National Provider Identifier (NPI)

Answer

Place of Service (POS) Code

A physician's office needs to bill for a routine patient check-up provided in their clinic.Which standard claim form should be used to submit this professional service to the insurance payer?

A physician's office needs to bill for a routine patient check-up provided in their clinic.
Which standard claim form should be used to submit this professional service to the insurance payer?