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

NCCI edits identify pairs of CPT codes that should not be billed together because one is bundled into the other.

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

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.

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

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.

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

The Medicare Summary Notice is sent to beneficiaries explaining how their claims were processed, what Medicare paid, and what they may owe.

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

Assigning a higher-level code than is supported by documentation is upcoding — a compliance violation.

(CBCS) Certified Billing and Coding Specialist Practice Test

(CBCS) Certified Billing and Coding Specialist Practice Test

CBCS CBCS Full Exam Simulation 3