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CPB Practice EXAM A Updated 2024/2025 Actual Questions and answers with complete solutions
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Which of the following TRICARE options is/are available to active duty service members? - AnswerTRICARE Prime A claim for CPT® codes 58260 and 58720 was filed to the patient's insurance. The claim was returned with 58260 paid and 58720 denied as inclusive. How should the claim be handled? - Answ...

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  • August 2, 2024
  • 9
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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CPB Practice E XAM A Which of the following TRICARE options is/are available to active duty service members? - Answer -
TRICARE Prime A claim for CPT® codes 58260 and 58720 was filed to the patient's insurance. The claim was returned with 58260 paid and 58720 denied as inclusive. How should the claim be handled? - Answer -A corrected claim should be filed with CPT® code 58262 A dermatologist performed an excision of a squamous cell carcinoma from the patients forehead with a 1.2 cm excised diameter. The excision site required an intermediate wound closure measuring 1.8 cm. What is/are the correct code(s)? - Answer -C. 11642, 120 51-51 A document provided to Medicare patients explaining their financial responsibility if Medicare denies a service is a(n): - Answer -Advance Beneficiary Notice A female patient who was involved in an auto accident presents to the emergency department (ED) for evaluation. She does not have any complaints. The provider evaluates her and determines there are no injuries. The provider informs the patient to come back to the ED or see her primary care physician if she develops any symptoms. How is the claim processed for this encounter? - Answer -The auto insurance is billed primary and the medical insurance is billed secondary A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate? - Answer -The code can only be reported for one unit of service on a single date of service A new patient presents for her annual exam and has no complaints. She is scheduled to see the physician assistant (PA). How should services be billed ? - Answer -Bill under the PA 55-year -old female presents to the office with ongoing history of type I diabetes which has been controlled with insulin. During the exam the physician notes that gangrene has set in due to the diabetic peripheral angiopathy on her left great toe. Patient is recommended to see a general surgeon for treatment of the gangrene on her left great toe. - Answer -E10.52 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 deductibl e, the PPO will pay 80% of the claim. The contracted rate for the procedure is $2,500. What is the patient's responsibility? - Answer -$900 A patient with an acute myocardial infarction is brought by ambulance to the emergency department. The patient is taken into the cardiac catheterization lab. Angioplasty and a stent was placed in the LAD. The patient's insurance requires preauthorization f or all surgical procedures. Which of the following statements is true for most payers? - Answer -Because this was an emergency, it is acceptable to obtain authorization following the surgery. According to CMS, which of the following services are included in the global package for surgical procedures? I. Surgical procedure performed II. E/M visits unrelated to the diagnosis for which the surgical procedure is performed III. Local infiltration, digital block, or topical anesthesia IV. Treatment for postoperative complication which requires a return trip to the operating room (OR) V. Writing Orders VI. Postoperative infection treated in the office - Answer -I, III, V, VI According to the LCD, how is an extracapsular cataract surgery with insertion of an intraocular lens for a drug induced cataract in the left eye reported? - Answer -66984, H26.32, T38.0X5A According to this clearinghouse rejections report, what action should be taken on the claims for Jerry McMahon, Date of Service 11/09/XX? - Answer -. C44.50 requires an additional character. Review the medical record for the correct sixth character, correct the claim in your system and re -file electronically. An example of an overpayment that must be refunded is _____________? - Answer -Duplicate processing of a claim CMS has a standard enrollment form in which the provider agrees to: I. Submit claims to Medicare II. Have authorization from the Medicare beneficiary to file claims III. Retain all source documentation and

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