CBCS Full Exam Simulation Flashcards
8 cards from real CBCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 8 CBCS Full Exam Simulation flashcards as text
Which of the following best describes a coordination of benefits (COB) situation?
Answer: A patient is covered by two or more insurance plans, requiring determination of which pays first
COB applies when a patient has coverage under more than one insurance plan, requiring the determination of primary vs. secondary payer responsibility.
Under Medicare Secondary Payer (MSP) rules, in which situation is Medicare the secondary payer?
Answer: When an employee aged 70 is covered by their employer's group health plan
Under MSP rules, for active employees aged 65+ at companies with 20+ employees, the employer's group health plan is primary and Medicare is secondary.
What is an Advance Beneficiary Notice (ABN) in Medicare billing?
Answer: A notice required when a provider believes Medicare may not pay for a service
An ABN is a written notice given to Medicare fee-for-service beneficiaries before a service is provided that Medicare may deny as not medically necessary.
What is a National Provider Identifier (NPI)?
Answer: A unique 10-digit identifier assigned to healthcare providers under HIPAA
The NPI is a unique 10-digit number required by HIPAA to identify covered healthcare providers in standard transactions.
Which of the following is a function of a healthcare clearinghouse?
Answer: Translating claims between non-standard formats and HIPAA-standard formats for transmission to payers
Clearinghouses act as intermediaries that translate non-standard electronic claims into HIPAA-compliant formats and check claims for errors before sending them to payers.
What type of audit involves OIG investigators posing as patients or providers to gather evidence of fraud?
Answer: Undercover investigation
Undercover investigations involve OIG agents posing as patients or providers to detect healthcare fraud.
Which code set is used to report durable medical equipment (DME) and supplies on a Medicare claim?
Answer: HCPCS Level II codes
HCPCS Level II codes (alphanumeric codes beginning with letters A-V) are used to report DME, supplies, orthotics, prosthetics, and other items not in CPT.
What does the 'clean claim' concept mean in medical billing?
Answer: A claim that contains all required information and can be processed without further information from the provider
A clean claim is one that contains all required information and can be adjudicated by the payer without needing additional information from the provider.