CPB

CPB Chapter 2 Glossary, Questions and answers, 100% Accurate, Rated A+ Accountable Care Organizations (ACO) - -A healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. Capitation - -Fixed payment remitted at regular intervals to a medical provider by a managed care organization for an enrolled patient. Carve-out - -A servi...

CPB - CHAPTER 8, Questions and answers, 100% Accurate, rated A+ What does the acronym NUCC stand for? a National Unified Claims Committee b National Uniform Criteria Committee c National Unified Claims Coordinators d National Uniform Claims Committee - -d National Uniform Claims Committee When a provider "accepts assignment" the difference between the charged amount and the allowed amount: a is billed to the patient. b can be submitted again for reconsideration. c is ...

CPB Board Study Questions and answers, 100% Accurate, Graded A+ When was the Code Of Conduct established? - -17 August 1955 under the Eisenhower Administration What Army Regulation covers the Code of Conduct? - -AR 350-30 If you become a prisoner of war, what information would you be required to give? - -Name, Rank, Service Number, Date of birth What Article of the Code of Conduct pertains to escape and evasion? - -Article 3 When was the Code of Conduct amended? - -May 1988 H...

CPB Final Exam Questions and answers, 100% Accurate, rated A+ Electronic data interchange - -EDI Treatment, payment and operations - -TPO Conditions of participation - -COP False claim act - -FCA Health information portability and accountability act - -HIPAA Preferred provider organization - -PPO Truth in lending act - -TILA Health maintenance organization - -HMO Release of information - -ROI Office of civil rights - -OCR Protected health information - -PHI ...

CPB Practice EXAM B Top exam Questions and answers, 100% Accurate, rated A What is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? A. Copayment B. Deductible C. Secondary Payment D. Coinsurance - -A deductible is the amount a policyholder pays for health care services before the health insurance begins to pay. Which type of insurance covers physicians and other he...

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 ...

CPB Final Exam Top Questions and answers. 100% Accurate. Graded A+ A practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice used x-rays of one patient to justify services on multiple other patients' claims. The office manager brought the civil suit. What type of case is this? - -Qui Tam In which of the following circumstances may PHI not be disclosed without the patient's authorization or permission? - -An office receives a call from the patient's husband as...

CPB PRACTICE EXAM A, Questions and answers, Rated A+. Verified. 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...

CPB PRACTICE EXAM C, Questions and answers, 100% Accurate. Approved. A 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance is primary? A. Mother's insurance plan B. Father's insurance plan C. The policy that has the best benefits D. Either mother's or father's insurance plan depending who brings the child in for medical care. - -The birthday rule states the ...

CPB Practice Exam Questions and answers, 100% Accurate. Verified. Managed care organization were created to manage benefits and to develop participating provider networks. Managed care can now be categorized according to six models. Which model below listed below is not considered managed care? A. Triple Option Plan (TOP) B. Integrated Delivery System (IDS) C. Health Maintenance Organization (HMO) D. Value-added Network (VAN) - -D. Value-added Network (VAN) Medicare Part ______ hel...