CBCS - Certified Billing and Coding Specialist Payer Types and Policies Questions and Answers

Question 1

A 68-year-old patient covered by traditional Medicare receives medically necessary inpatient care at a skilled nursing facility (SNF) following a qualifying three-day hospital stay.
Which part of Medicare is responsible for covering the SNF charges?

Accepted Answer

Medicare Part A

Answer

Medicare Part B

Answer

Medicare Part C

Answer

Medicare Part D

Question 2

A 72-year-old patient has both Medicare and a state Medicaid plan. The patient receives services from a physician who accepts both types of insurance. How should the claim be processed?

Accepted Answer

The claim should be submitted to Medicare first, and Medicaid will be the secondary payer.

Answer

The claim should be submitted to Medicaid first, and then to Medicare.

Answer

The patient can choose which insurance will be billed as primary.

Answer

The claim should be split and submitted to both Medicare and Medicaid simultaneously.

Question 3

Which of the following is a defining characteristic of most Health Maintenance Organization (HMO) plans?

Accepted Answer

It requires patients to select a Primary Care Physician (PCP) to manage their care.

Answer

It offers the same level of coverage for both in-network and out-of-network providers.

Answer

Patients can see any specialist without a referral.

Answer

It operates exclusively on a fee-for-service model for all provider payments.

Question 4

A patient with a Preferred Provider Organization (PPO) plan chooses to see a specialist who is not in the PPO network. Which of the following outcomes is most likely?

Accepted Answer

The patient will likely have a higher coinsurance or copayment and a separate, higher deductible for out-of-network services.

Answer

The insurance plan will deny the claim entirely because the provider is out-of-network.

Answer

The patient's services will be covered at the same rate as an in-network provider.

Answer

The patient must first get a referral from their PCP for the services to be covered.

Question 5

A patient is treated for an acute injury that occurred at their workplace. The patient provides their commercial health insurance card at check-in. What is the correct procedure for the billing specialist?

Accepted Answer

Open a workers' compensation claim and bill that carrier directly.

Answer

Bill the patient's commercial health insurance as primary and list the employer as secondary.

Answer

Advise the patient to pay out-of-pocket and seek reimbursement from their employer.

Answer

Bill Medicare, as all workplace injuries are covered under federal programs.

Question 6

A primary care physician's practice has a contract with an insurance company where it receives a flat payment of $30 per month for each patient assigned to the practice, regardless of how many times the patient is seen or what services are provided. This payment model is known as:

Accepted Answer

Capitation

Answer

Fee-for-service

Answer

Bundled payment

Answer

Retrospective payment

A 68-year-old patient covered by traditional Medicare receives medically necessary inpatient care at a skilled nursing facility (SNF) following a qualifying three-day hospital stay.Which part of Medicare is responsible for covering the SNF charges?

A 68-year-old patient covered by traditional Medicare receives medically necessary inpatient care at a skilled nursing facility (SNF) following a qualifying three-day hospital stay.
Which part of Medicare is responsible for covering the SNF charges?