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

COB applies when a patient has coverage under more than one insurance plan, requiring the determination of primary vs. secondary payer responsibility.

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

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.

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

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.

Question 4

What is a National Provider Identifier (NPI)?

Accepted Answer

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

Answer

The NPI is a unique 10-digit number required by HIPAA to identify covered healthcare providers in standard transactions.

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

Clearinghouses act as intermediaries that translate non-standard electronic claims into HIPAA-compliant formats and check claims for errors before sending them to payers.

(CBCS) Certified Billing and Coding Specialist Practice Test

(CBCS) Certified Billing and Coding Specialist Practice Test

CBCS CBCS Full Exam Simulation 2