CPB Billing Regulations Exam Study Guide.
Medically Unlikely Edits (MUEs) - answernumber of units that can be reported for a service or
procedure on the same day
Medicare and Medicaid - answerMedicare pays first, and Medicaid pays last.
Medicare and TRICARE - answerTRICARE is secondary
Early a...
Medically Unlikely Edits (MUEs) - answer✔number of units that can be reported for a service or
procedure on the same day
Medicare and Medicaid - answer✔Medicare pays first, and Medicaid pays last.
Medicare and TRICARE - answer✔TRICARE is secondary
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) - answer✔Screening
Services/ Vision Services/ Dental Services/ Hearing Services/ Other necessary healthcare
services/ Diagnostic services/ Treatment
Prior Authorization - answer✔reported in Item 23;
Patient's name (as it appears on the insurance card)
Patient's date of birth
Insured's ID number
CPT®/HCPCS Level II code(s)
ICD-10-CM code(s)
Location where service is performed
Ordering physician
Date of service for the procedure if scheduled
incident-to - answer✔submit claim under the supervising physician
"those services that are furnished incident-to physician professional services in the physician's
office (whether located in a separate office suite or within an institution) or in a patient's home"
global package for surgical procedures - answer✔0-90 days as determined by the health plan:
Local infiltration, digital block, or topical anesthesia;
Writing Orders;
treatment in operation room;
postoperative follow-up care
global days - answer✔major surgeries - 90 days,
minor - 0-10 days
Medicare minor procedure: no pre-operative period; 10-day global period
fraud - answer✔making false statements or misrepresenting
facts to obtain an undeserved benefit or payment
from a federal healthcare program
eg. Billing for services not provided
abuse - answer✔action that results in unnecessary costs to a federal healthcare program, either
directly or indirectly
eg. Charging excessively
Equal Credit Opportunity Act - answer✔prohibits discrimination based on personal
characteristics
Fair Credit Reporting Act - answer✔protects information collected by consumer reporting
agencies
Truth in Lending Act - answer✔Requires lenders to disclose credit
terms and for the creditor to use uniform methods for
computing the cost of credit.
False Claims Act (FCA) - answer✔for claims to be brought up to seven years after the incident
but has been extended to 10 years in some cases.
report and return an overpayment within 60 days
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Brightstars. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.49. You're not tied to anything after your purchase.
