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Review for CPB Exam
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Exam of 8 pages for the course CPB at CPB (Review for CPB Exam)
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REVIEW FOR CPB EXAM QUESTIONSAND ANSWERS GRADEDA A+
x To report co-management, Which below must be true? - A. Co-management only applies to doctors in
the same clinic.
B. Two physicians must be performing the surgical procedure.
C. Two doctors must be managing the Post-op Care.
D. Non of the answers are correct.
Answer: D None of the answers are correct. The doctors must be in separate office/clinics. Co-
management refers to another provider providing the post-operative care for a surgical procedure. Co-
management is not for two surgeons. Co-management refers to office visits and standard aftercare. Two
doctors cannot be paid for the same date's for post-op care (different dates, yes).
What is a Certificate of Authority used for? - Certificate of Authority (COA) is issued by the state. It
licenses the operation of an HMO (Health Maintenance Organization.
What are the three components of the Medicare Allowable fee for a specific clinic? - The total RVUs, the
GPCI and the current year Malpractice RVU.
The work RVU, The Practice Expense RVU and the Malpractice RVU all add up to be the total RVU's for a
given service in either the office or hospital setting. The total RVUs, the GPCI and the current year
Medicare conversion factor are how the Medicare allowable for a given service is calculated.
Which is true concerning professional courtesy charges? - DDHS OIG is its 1991 Special Fraud Alert,
emphasized that the "routine" waiver of co-payments and/or deductibles is equivalent to misstating the
actual charge.
What is the time limit for filing notice of injury and claim for federal workers' compensation? - Three
years. A notice must be filed within three years of the date of injury. However, if a claim is not filed
within three years, compensation may still be paid if written notice of injury was given within 30 days, or
the employer had actual knowledge of the injury within 30 days after it occurred.
What is a good example of a "Carrier-Specific" Rule or Guideline? - MOD-50 or RT/LT on separate lines.
Carrier-Specific Rules or Guidelines are unique to a specific carrier, Medicare (10 Jurisdictions) or private
carrier (Blue-Cross/Blue Shield). Examples include MOD-50 versus RT/LT usage, billing an E & M with a
minor procedure. Most all carriers will follow the Medicare lead on NCCI edits, Bilateral Surgery
Modifiers and 1997 E & M Guidelines. These should not vary by carrier except in the most non-standard
cases.
, What is the difference between a rejection and a denial? - A rejection is most often from the
clearinghouse, before the claim gets to the carrier where you will get a specific denial code on the EOB.
In general, the clearinghouse will reject claims for global issues like NCCI edits whereas the carrier denial
can be by plan and is specific to each carrier.
What is Medical Necessity (for reimbursement)? - Matching of ICD-10 codes to a CPT code that support
reimbursement (not as a screening). Services are not reimbursed if medical necessity is not supported.
How is modifier GA used? - When a patient signs an Advanced Beneficiary notice (ABN); append the
code to the service provided. MOD-GA when a service may not be covered by Medicare. Don't use
modifier GA on the 92015 refraction code.
A Medicare Participating Provider is? - A provider who accepts assignment for Medicare Claims.
Accepting Medicare Assignment means the provider will accepts what Medicare pays and not bill the
patient for the difference between what the services costs and what Medicare pays.
PAR provider: - Signs an agreement with the Fiscal Intermediary.
OCE Edits include which of the following? What does OCE mean? - Age Edits; Outpatient Code Editor.
Both age and sex edits are correct but OCE means Outpatient Code Editor.
Which item below is not an indication of complicance? - A. If the CPT code and modifiers are valid codes
and the carrier pays
B. Only certified coders are hired
C. Using an EMR system
D. All of the answers are correct.
Answer: D All of the answers are correct
None of these guarantee compliance. Most EMR systems will consistently up-code E & M visits. The
documentation must match the code reported.
Which of the following would NOT be allowed under HIPAA? - A.. Giving out the patient's hospital room
number to someone who is not a family member.
B. Faxing information to a provider without marking out confidential information.
C. Emailing confidential patient information.
D. None of the answers are correct.
Answer: D None of the answers are correct
All are allowed, however, the provider must follow the "minimum necessary standard" rules. Also the
physician must use "reasonable and appropriate safeguards" to protect the communication.
Which of the following does not need to provide a HIPAA notice? - A. A correctional institution that is a
covered entity
B. Health care clearinghouse
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