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CPB Exam Study Guide
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CPB Exam Study Guide
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CPB EXAM STUDY GUIDE QUESTIONSWITH CORRECT DETAILED ANSWERS
kWhat is the drawback of an HMO? - A. Providers have an incentive to keep treatment cost at a
minimum.
B. The HMO administrators determine what services are reimbursed and what is not.
C. The provider is now a gatekeeper to the patient's medical care.
D. All of the answers are correct
Answer: D All of the answer are correct
The healthcare carrier refused to accept MOD-RT and MOD-LT and only accepted MOD-50. What does
this mean? - A. This is an example of a carrier-specific rule for a bilateral procedure (performed on both
sides of the body, right and left.
B. This is considered an error on the carrier's part
C. This would never happen
D. Without additional information this means nothing
Answer: A- This is an example of a carrier-specific rule for a bilateral procedure (performed on both sides
of the body, right and left. In other words a carrier can require MOD-50 over MOD-RT and LT even
though technically they are the same.
What is not in the Medicare PFSRVU database? - A. Global Days
B. Bilateral surgery modifier
C. RVU's
D. Medical Necessity
Answer: D- Medical Necessity
What are the characteristics of the emergency room visit? - A. It applies equally to new and established
patients
B. The Emergency Department must be available 24 hours a day
C. Both answers are correct
D. None of the answers are correct
Answer: C- Both answers are correct
These codes are used only for the emergency room encounters.
,Which would be most likely not be covered under a corporate Family Medical Leave Act (FMLA)? - A.
Birth of child
B. Provide care for a sick spouse
C. An employees with a serious health condition
D. Vacations
Answer: D- Vacations
A PPO is a: - A. Preferred Provider Organization, there is no gatekeeper
B. Provider Patient Organization, there is a gate keeper
C. Prospective Payment Option System where charges are diagnosis based
D. Provider Payment Option System where charges are diagnosis-based
Answer: A- Preferred Provider Organization, there is no gatekeeper like an HMO
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. None of the answers are correct
Answers: D- non 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 ( e. g.,
cataract surgery). Co-management is not for two surgeons. Co-management refers to office visits and
standard aftercare. Two doctors cannot be paid for the same dates for Post-OP Care (different dates,
yes).
How does the CPT Professional Edition define a new patient? - A. A new patient is one who has not
received any professional services from the physician or another physician of the same specialty who
belongs to the same group practice, within the past two years.
B. A new patient is one who has not received any professional services from the physician or another
physician of the same specialty who belongs to the same group practice, within the past three years.
C. A new patient is one who has received professional services from the physician or another physician
of the same specialty within the last two years for the same problem
D. A new patient is one who has received hospital services but has never been seen in the clinic by the
reporting physician.
Answer: B. A new patient is one who have not received any professional services from the physician or
another physician of the same specialty who belongs to the same group practice, within the past three
years.
, If a doctor or supplier "accepts" (Medicare) assignment then: - A. The client is only responsible for paying
20 percent of the amount set by Medicare, even if that amount is less than what the doctor or provider
normally charges.
B. The client is responsible for paying 100% percent of the amount set by Medicare.
C. The client is only responsible for paying 20 percent of the amount set by Medicare, or what the doctor
or provider normally charges, whichever is less.
D. The doctor or provider is limited to charging the client an additional 15 percent of the Medicare
amount, This is called a limiting charge.
Answer: A- The Client is only responsible for paying 20 percent of the amount set by Medicare, even if
that amount is less than what the doctor or provider normally charges.
Medicare Part-A is: - A. Billed on the UB-04 Form
B. Submitted for Facility Fees
C. A mandatory program
D. All of the answers are correct
Answer: D- All the answers are correct
At 65 everyone must enroll in Medicare Part-A. Part-B is voluntary. The professional fees for the surgeon
are submitted on the CMS-1500 form.
Which statement could be found in a medical carrier contract? - A. That all their contracted patients
must receive their most favorable pricing ( No other carrier can be lower, especially Medicare)
B. That is the claim is not filed within the "Timely Filing Period" then they cannot bill the patient (if the
carrier refuses payment).
C. For children they must provide specific services such as immunizations, hearing or vision tests, or
other required services.
D. All of the answers are correct.
Answer: D All of the answers are correct
Contracts can have a very unique and specific payment and compliance requirements.
What is the official medicare appeals process? - A. Medicare has five levels of appeals
B. Medicare has seven levels of appeals
C. Medicare has levels of appeals
D. There is no official Medicare appeals process.
Answer: A- Medicare has five levels of appeals
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