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CPB Exam Top Questions with accurate answers, Graded A+. Verified. When a provider chooses not to participate in the Medicare program and does not accept assignment on claims, the maximum amount the provider can charge is _______ percent of the approved fee schedule amount for non-participatin...

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  • February 8, 2023
  • 41
  • 2022/2023
  • Exam (elaborations)
  • Questions & answers

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  • the maximum amount the
  • cpb exam top questions with accurate answers
  • graded a verified when a provider chooses not to participate in the medicare program and does not accept assignment on claims

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CPB Exam Top Questions with accurate
answers, Graded A+. Verified.

When a provider chooses not to participate in the Medicare program and does not accept assignment
on claims, the maximum amount the provider can charge is _______ percent of the approved fee
schedule amount for non-participating providers.



A. 115

B. 100

C. 50

D. 25 - ✔✔-A



When a physician intentionally bills procedures to Medicaid that he did not perform he is in violation of
which Act?



A. Truth in Lending Act

B. Federal Claims Collection Act

C. False Claims Act

D. Health Insurance Portability and Accountability Act - ✔✔-C



Joe and Mary are a married couple and both carry insurance from their employers. Joe was born on
February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary
insurance for their children for billing?



A. Joe, because he is the male head of the household.

B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd.

C. Mary, because her birth year is before Joe's birth year.

D. Joe, because his birth month and day are before Mary's birth month and day. - ✔✔-D

,Question 2

Which type of managed care insurance allows patients to self-refer to out-of-network providers and pay
a higher co-insurance/copay amount?

I. HMO

II. PPO

III. EPO

IV. POS

V. Capitation



A. II

B. IV

C. II and IV

D. II, III, and V - ✔✔-C



When a nonparticipating provider files a claim for a patient to BC/BS, how is the payment processed?



A. The payment is sent to the patient and the patient must pay the provider.

B. The payment is sent to the provider if the provider agrees to accept assignment.

C. The payment is sent to the provider regardless if he accepts assignment.

D. The claim is not paid because the provider is not participating in the plan. - ✔✔-A



A patient covered by a PPO is scheduled for knee replacement surgery. The biller contacts the insurance
carrier to verify benefits and preauthorize the procedure. The carrier verifies the patient has a $500
deductible which must be met. After the deductible, the PPO will pay 80% of the claim. The contracted
rate for the procedure is $2,500. What is the patient's responsibility?



A. $400

B. $500

C. $900

D. $1,600 - ✔✔-C

,Which of the following TRICARE options is/are available to active duty service members?



A. TRICARE Select

B. TRICARE Prime

C. TRICARE For Life

D. TRICARE Young Adult - ✔✔-B



A Medicare card will list which of the following:



I. Effective date of coverage

II. Home address

III. Telephone Number

IV. Entitled to Part A and/or Part B

V. When coverage ends

VI. Name of Primary Care Physician



A. I - VI

B. I, IV

C. I-III, VI

D. I, II, IV, V - ✔✔-B



In which of the following scenarios is Medicare the secondary payer?



I. A 65 year-old patient who is collecting her deceased spouse's Medicare benefits and has a
supplemental insurance

II. A 72 year-old patient who participates in the group health insurance of his employer

III. A 66 year-old patient is injured at work and the employer does not offer health insurance as a benefit
of employment

, IV. A 55 year-old patient who is on disability through Social Security and qualifies for Medicaid and
Medicare



A. I-IV

B. II and III

C. I and IV

D. None - ✔✔-B



When a patient has Medicare primary and AARP as Medigap, what is entered on the CMS-1500 claim
form in item 9d for the Insurance Plan Name or Program Name for Medicare to cross over the claim?



A. Plan name followed by "MEDIGAP"

B. Plan Payer ID followed by "MEDIGAP"

C. COBA Medigap claim-based identifier (ID)

D. Leave blank - ✔✔-C



Which guidelines must all billing personnel be knowledgeable about in order to ensure compliance with
Medicaid programs?



A. Federal guidelines

B. State guidelines

C. Both A and B

D. None - ✔✔-C



Which of the following services is covered by Early and Periodic Screening, Diagnostic, and Treatment
(EPSDT)?



A. Family planning

B. Obstetric care

C. Pediatric checkups

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