CBCS CBCS Full Exam Simulation 2

Question 1

Which of the following best describes a coordination of benefits (COB) situation?

Accepted Answer

A patient is covered by two or more insurance plans, requiring determination of which pays first

Answer

A patient has both Medicare Part A and Part B coverage

Answer

A provider participates in both Medicare and Medicaid programs

Answer

A patient switches insurance carriers mid-year

Question 2

Under Medicare Secondary Payer (MSP) rules, in which situation is Medicare the secondary payer?

Accepted Answer

When an employee aged 70 is covered by their employer's group health plan

Answer

When a patient is over age 65 with no other insurance

Answer

When a patient is on Medicare and Medicaid simultaneously

Answer

When a patient has a Medicare Supplement (Medigap) policy

Question 3

What is an Advance Beneficiary Notice (ABN) in Medicare billing?

Accepted Answer

A notice required when a provider believes Medicare may not pay for a service

Answer

A notice sent to patients explaining their Medicare Part D coverage

Answer

An annual notice sent to all Medicare beneficiaries about their benefits

Answer

A notice sent to new Medicare enrollees about their rights

Question 4

What is a National Provider Identifier (NPI)?

Accepted Answer

A unique 10-digit identifier assigned to healthcare providers under HIPAA

Answer

A state-issued license number for healthcare providers

Answer

A CMS-assigned billing number used only for Medicare claims

Answer

A number assigned to each health plan by the federal government

Question 5

Which of the following is a function of a healthcare clearinghouse?

Accepted Answer

Translating claims between non-standard formats and HIPAA-standard formats for transmission to payers

Answer

Processing medical claims on behalf of patients directly

Answer

Negotiating reimbursement rates between providers and payers

Answer

Credentialing providers for participation in insurance networks

Question 6

What type of audit involves OIG investigators posing as patients or providers to gather evidence of fraud?

Accepted Answer

Undercover investigation

Answer

Comprehensive Error Rate Testing (CERT)

Answer

Recovery Audit Contractor (RAC) audit

Answer

Zone Program Integrity Contractor (ZPIC) review

Question 7

Which code set is used to report durable medical equipment (DME) and supplies on a Medicare claim?

Accepted Answer

HCPCS Level II codes

Answer

CPT codes

Answer

ICD-10-PCS codes

Answer

Revenue codes

Question 8

What does the 'clean claim' concept mean in medical billing?

Accepted Answer

A claim that contains all required information and can be processed without further information from the provider

Answer

A claim that has been scrubbed to remove duplicate charges

Answer

A claim that has been paid in full with no outstanding balance

Answer

A claim for which all clinical documentation has been reviewed