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
What is the purpose of a National Correct Coding Initiative (NCCI) edit?
Answer: To prevent improper bundling or unbundling of CPT codes on the same claim
NCCI edits identify pairs of CPT codes that should not be billed together because one is bundled into the other.
A patient has primary coverage through UnitedHealthcare and secondary coverage through Aetna. After UnitedHealthcare pays, a balance remains. What should the biller do?
Answer: Submit a COB claim to Aetna as the secondary payer with the primary EOB attached
After the primary payer pays, the biller submits a coordination of benefits claim to the secondary payer with the primary EOB to process the remaining balance.
What is the Stark Law, and how does it affect medical billing?
Answer: A law prohibiting physicians from referring patients to entities in which they have a financial interest
The Stark Law (Physician Self-Referral Law) prohibits physicians from referring Medicare/Medicaid patients to entities with which the physician has a financial relationship unless an exception applies.
What is the purpose of a Medicare Summary Notice (MSN)?
Answer: An explanation sent to Medicare beneficiaries showing what Medicare paid and patient responsibility for claims processed in a period
The Medicare Summary Notice is sent to beneficiaries explaining how their claims were processed, what Medicare paid, and what they may owe.
A coder assigns CPT code 99215 for a new patient office visit that was actually a Level 2 service. This is an example of:
Answer: Upcoding
Assigning a higher-level code than is supported by documentation is upcoding — a compliance violation.
Which of the following is a valid use of CPT modifier -26?
Answer: When a physician provides only the professional interpretation of an X-ray performed at a hospital radiology department
Modifier -26 (Professional Component) is used when the physician provides only the interpretation and report portion of a diagnostic service.
What is the purpose of the 'timely filing' requirement in medical billing?
Answer: To require claims to be submitted within a payer-defined deadline after the date of service
Timely filing limits require claims to be submitted to the payer within a specific timeframe after the date of service, or the claim will be denied.
What does the OIG Work Plan help billing specialists understand?
Answer: Areas of compliance risk that the OIG has identified for audit and investigation in the coming year
The OIG Work Plan outlines the specific areas the OIG plans to audit and investigate, helping providers proactively assess their own compliance risks.