CBCS CBCS Full Exam Simulation 3

Question 1

What is the purpose of a National Correct Coding Initiative (NCCI) edit?

Accepted Answer

To prevent improper bundling or unbundling of CPT codes on the same claim

Answer

To identify incorrect ICD-10-CM diagnosis sequencing

Answer

To audit providers for upcoding of E/M services

Answer

To determine DRG assignments for inpatient claims

Question 2

A patient has primary coverage through UnitedHealthcare and secondary coverage through Aetna. After UnitedHealthcare pays, a balance remains. What should the biller do?

Accepted Answer

Submit a COB claim to Aetna as the secondary payer with the primary EOB attached

Answer

Bill the patient for the remaining balance immediately

Answer

Write off the remaining balance as a contractual adjustment

Answer

Resubmit the claim to UnitedHealthcare with a higher charge

Question 3

What is the Stark Law, and how does it affect medical billing?

Accepted Answer

A law prohibiting physicians from referring patients to entities in which they have a financial interest

Answer

A law requiring all medical billing to be performed by certified billers

Answer

A law mandating disclosure of billing errors within 30 days of discovery

Answer

A law regulating the collection of patient copayments

Question 4

What is the purpose of a Medicare Summary Notice (MSN)?

Accepted Answer

An explanation sent to Medicare beneficiaries showing what Medicare paid and patient responsibility for claims processed in a period

Answer

A summary of Medicare benefits sent to providers after a claim is processed

Answer

An annual notice sent to Medicare beneficiaries reviewing their annual coverage options

Answer

A billing statement sent by the physician's office to Medicare patients

Question 5

A coder assigns CPT code 99215 for a new patient office visit that was actually a Level 2 service. This is an example of:

Accepted Answer

Upcoding

Answer

Unbundling

Answer

Downcoding

Answer

DRG shifting

Question 6

Which of the following is a valid use of CPT modifier -26?

Accepted Answer

When a physician provides only the professional interpretation of an X-ray performed at a hospital radiology department

Answer

When a physician performs a reduced surgical service

Answer

When two surgeons perform the same procedure together

Answer

When a service is provided by a physician assistant

Question 7

What is the purpose of the 'timely filing' requirement in medical billing?

Accepted Answer

To require claims to be submitted within a payer-defined deadline after the date of service

Answer

To ensure claims are submitted before the patient's deductible is met

Answer

To mandate that secondary claims be filed within 24 hours of primary payment

Answer

To require providers to post payments within 30 days of receipt

Question 8

What does the OIG Work Plan help billing specialists understand?

Accepted Answer

Areas of compliance risk that the OIG has identified for audit and investigation in the coming year

Answer

How to properly sequence ICD-10-CM codes for complex cases

Answer

Which CPT codes have been revised or deleted for the upcoming year

Answer

How Medicare fee schedules will change in the next calendar year