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CBCS BILLING AND CODING NEWEST EXAM AND STUDY GUIDE ACTUAL EXAM WITH 450 UPDATED QUESTIONS AND ANSWERS (VERIFIED ANSWERS) [ALREADY GRADED A+] How are payments determined under Medicare's RBRVS? - by multiplying a code's relative value by constant dollar amount called the conversion fact...

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CBCS BILLING AND CODING NEWEST EXAM AND

STUDY GUIDE 2024-2025 ACTUAL EXAM WITH 450

UPDATED QUESTIONS AND ANSWERS (VERIFIED

ANSWERS) [ALREADY GRADED A+]


How are payments determined under Medicare's RBRVS? - by multiplying

a code's relative value by constant dollar amount called the conversion

factor (multiplier). The conversion factors are determined annually by the

CMS in cooperation with congress. The conversion factor varies according

to the type of service provided such as medical, surgical, non-surgical




How are services paid to physicians associated w/ Medicare Part B? -

services are paid according to a fee schedule which is based on the

relative value multiplied by the geographical adjustment and conversion

factors. All dr's in a given area are paid the same for same service

regardless of specialization. However, non par's are paid 5% less for

assigned claims. Non PAR's, not accepting assignment, can charge no

more than 115% of the participating allowance w/o facing possible

Medicare fines and penalties.

,2|Page




How do individuals that are not eligible for Social Security Obtain Medicare

Part A? - By paying a premium and they must enroll in Part B this is

however limited to applicants 65+ and US resident. A deductible is req for

each episode of illness and a co-insurance applies for hospitalizations of

more than 60 days




How do you know if an update has been made to the CPT manual? - **A

triangle- represents a change in the code description since the last edition.

The change may be minor or significant and it could be an addition,

deletion, or revision

**2 triangle symbols-represent changes in the text or definition between the

triangles

**A bullet-represents a new procedure or service code added since the

previous addition of the manual

**A plus sign-indicates add-on codes

**A circle w/ a line through it- represents exemption from use of modifier

,3|Page


How is a fee schedule determined? - UCR method, the usual, customary,

and reasonable- the carrier compare *the dr's most frequent charge for a

given service (the usual) *the average charge of all providers of similar

training/experience in a given geographical area (the customary) *the

actual charge submitted on a claim (must be reasonable to the provider)

*****the lowest amount is used as the basis for payment (the allowed

charge)




How is eligibility for Medicaid classified? - divided into 2 classifications

A) Categorically Needy: 1) families, pregnant women & children 2) Aged

and disabled persons 3) Persons receiving institutional or other long-term

care in nursing facilities (NF's) and intermediate care facilities (ICF's)

B) Medically Needy: 1) medically indigent low-income and families 2)low-

income persons losing employer health ins coverage (Medicaid purchase of

COBRA purchase)




How many chapters does the Tabular List(Volume 1) contain? - 17; based

on either body system or cause or type of disease

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How many edits does NCCI include? - 2: 1)Column 1/Column 2 (prev

called Comprehensive/Component) Edits




How many layers to the skin? - 3;1) Epidermis (thin, cellular membrane

layer that contains keratin)

2) Dermis (dense, fibrous, connective tissue that contains collagen)

3) Subcutaneous layer (thicker & fatter tissue)




How many parts to CPT Manual? - 3; the main text, the appendices and the

alphabetic index and is divided into 6 sections; these sections are

subdivided into




How many sections to the CPT Manual? - 8; each section begins w/

guidelines that provide specific coding rules for that section. Guidelines at

the beginning of the section are applicable to all codes in the section, while

notes that pertain to specific codes appear before or after such codes.

Guidelines usually contain definitions of terms, applicable modifiers,

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