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CBCS practice test questions and answers already graded A+ 2025/2026
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CBCS practice test questions and answers already graded A+ 2025/2026
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CBCS practice testA beneficiary of a Medicare/Medicaid crossover claim submitted with the aid of a participating
company is chargeable for which of the following percentage?
40%
20%
10%
zero% - ANS-0%
A biller will electronically publish a declare to the service through which of the subsequent?
-Electronic remittance recommendation (response from insurance)
-Direct statistics access
-Electronic fund transfer
-Charge data access - ANS-Direct facts entry
A CBCS can ensure appropriate coverage coverage for an outpatient process by using first the
usage of which of the subsequent techniques?
- Predetermination (finals step to determine coverage compensation and patient duty)
- Precertification (first step to decide if the patient has insurance)
- Preaudit (evaluate of claim before adjudication)
- Preauthorization ( coverage acclaim for the technique) - ANS-Precertification (first step to
determine if the patient has coverage)
- Predetermination (finals step to decide insurance repayment and affected person duty
- Preaudit (review of declare before adjudication)
- Preauthorization ( insurance approval for the technique)
A CBCS has 4 past-due fees: $400 this is 10 weeks late; $800 that is 6 weeks overdue; $one
thousand this is 4 weeks past due; and $2000 this is 8 weeks overdue. Which of 1 should be
sent to series first?
-$four hundred
-$800
-$a thousand
- $2000 - ANS-$2000 (the biggest amount first)
A CBCS is making ready a declare from a provider from a collection exercise.. The CBCS
should enter the rendering provider's NPI into which of the following blocks on the CMS-1500?
- 17b (referring issuer NPI)
- 24J
- 31 (companies signature)
- 25 (federal tax identity number) - ANS-24J
- 17b (referring provider NPI)
- 31 (carriers signature)
- 25 (federal tax identity quantity)
A CBCS is reviewing a CMS-1500 claim shape. The project of the advantages field has been
checked "yes". The take a look at field suggests which of the following?
,- The company receives payment without delay from payer
- The payer sends repayment for service to the affected person
- The payer can pay the issuer a set quantity for each enrolled person task of benefit container
- The company can collect complete price from the patient - ANS-The provider receives
payment directly from payer
A CBCS wishes to realize how a great deal Medicare paid on a claim before billing the
secondary coverage. To which of the following should the specialist refer?
-Assignment of advantages
-Medicare precis observe (how a good deal the provider was billed and what sort of the patient
has to pay)
-Remittance recommendation
-Coordination of benefits - ANS-remittance recommendation
A CBCS should upload modifier -50 to codes whilst reporting which of the subsequent?
- A bilateral procedure
- A unilateral procedure
- Multiple technique
- Reduces offerings - ANS-A bilateral procedure
A CBCS ought to enter the prior authorization wide variety on the CMS-1500 claim form in which
of the following blocks?
- 21A (prognosis code)
- 24 D (techniques and offerings)
- 23 (previous authorization)
- 24E (federal tax identity) - ANS-23 (previous authorization)
- 21A (diagnosis code)
- 24 D (processes and services)
- 24E (federal tax id)
A CBCS ought to robotically examine which of the subsequent to determine the variety of
awesome claims?
- Accounts payable record
- Aging file
- Remittance recommendation
- Explanation of benefits - ANS-getting old report
A CBCS should remember that the economic record source this is generated via the company's
workplace is called a _______ .
- Chargemaster
- Fee schedule
- Encounter shape
- Patient ledger account - ANS-Patient ledger account (records of affected person's financial file)
A CBCS submitted a claim to Medicare electronically. No mistakes were located by using the
billing software program or clearinghouse. Which of the following describes this claim?
- Pending declare
- Clean declare
- Tertiary declare (processed by using both number one and secondary insurance)
- Physically easy declare (no staples, no highlighters) - ANS-easy
,A declare can be denied or rejected for which of the following motives?
- All records is uppercase
- Block 25 consists of the EIN of the rendering provider
- The patient's DOB is in eight digit format
- Block 24 D consists of the diagnosis code - ANS-Block 24 D consists of the prognosis code
(must be in 21)
A declare is denied because the service changed into no longer covered by using the insurance.
Upon confirmation of no errors at the claim, which of the following describes the system with the
intention to comply with the denial?
- The declare might be submitted with a new CPT code
- The declare will not be resubmitted and the affected person could be despatched a bill
- The claim will be resubmitted with a modifier on the CPT code
- The declare will now not be resubmitted, however the claim might be appealed. - ANS-The
declare will now not be resubmitted and the affected person could be despatched a invoice
A claim is denied because of termination of coverage. Which of the following actions must the
CBCS take next?
- Follow up with the company to decide modern-day system code, diagnostic code and provider
variety for resubmission
- Follow up with the affected person to decide current number one care provider for
resubmission
- Follow up with the issuer to determine modern patient's popularity and include a billing records
for resubmission
- Follow up with the affected person to decide modern name, address, and insurance carrier for
resubmission - ANS-Follow up with the affected person to decide modern-day call, deal with,
and coverage carrier for resubmission
A claim is submitted with a transposed insurance member ID wide variety and back to the
issuer. Which of the subsequent describes the fame that should be assigned to the declare with
the aid of the provider?
- Suspended
- Pending
- Denied
- invalid - ANS-invalid
A coroner's autoplay is created from which of the subsequent examinations?
- Suppression trying out
- Gross exam
- Diagnostic endoscopy
- Mohs micrographic examination - ANS-Gross exam
A structured child whose mother and father both have coverage coverage, comes to the
sanatorium. The CBCS uses the birthday rule to determine which coverage coverage is number
one. What is the birthday rule?
- The figure who has the birthdate closer to the child
- The determine whose birthday comes first inside the calendar 12 months
- The figure who is older
, - In the case of identical birthdates, the charge whose call is first alphabetically - ANS-the figure
whose birthday comes first in the calendar yr
A form that incorporates prices, DOS, CPT codes, ICD codes, prices and copayment
information is called which of the following?
- Encounter shape
- Itemized invoice
- Chargemaster
- Remittance recommendation - ANS-encounter shape
A husband and wife each have organization insurance through their employers. The spouse has
an appointment with her issuer. Which coverage ought to be used as primary for the
appointment?
- Husbands coverage
- Whoever is older
- Whoever has their birthday first within the calendar year
- Wife's insurance - ANS-wife's coverage
A Medicare non-taking part (non-PAR) company's accepted charge quantity is $two hundred for
a lobectomy and the deductible has been met. Which of the following quantities is the
proscribing price for this manner?
- $a hundred and sixty
- $200
- $170
- $230 (can acquire a max of 15% over the non-PAR Medicare schedule quantity) - ANS-$230 =
can gather a max of 15% over the non-PAR Medicare schedule mount
A nurse is reviewing a affected person's lab consequences previous to discharge and discovers
an extended glucose stage. Which of the subsequent health care providers must be alerted
before the nurse can continue with discharge making plans?
- The attending doctor
- The admitting medical doctor
- The nursing manager
- The physician assistant - ANS-attending medical doctor
A collaborating blue move/blue shield issuer receives an explanation of blessings for a patient
account. The charged amount became $one hundred. Blue shield allowed $80 and carried out
$forty to the affected person's annual deduction. Blue defend paid the stability at 80%. How lots
must the patient anticipate to pay?
-$eighty
-$56
-$40
-$48 - ANS-$forty eight
A affected person involves the hospital for an inpatient manner. Which of the subsequent group
of workers individuals is responsible for the preliminary affected person interview, acquiring
demographic and insurance statistics, and documenting the chief criticism?
- Nurse
- Insurance billing clerk
- Admitting clerk
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