Certified Billing and Coding Specialist - Mock Exam 1 (2022) COMPLETE SOLUTIONS

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Certified Billing and Coding Specialist - Mock Exam 1 (2022) COMPLETE SOLUTIONS All are eligible under Medicare health insurance except: a) retiree of the Civil Service Retirement System b) person... s of 65 years or older, retired on Social Security benefits c) those diagnosed with end-stage renal disease (ESRD) d) All kidney donors - ✔✔d) All kidney donors Which provider/network must accept the payer's allowable amount as 100% payment for procedures or services provided? a) Out of Network provider b) Participating provider c) Non-participating provider d) Both a & b - ✔✔b) Participating provider _____ means the provider agrees to accept what the insurance company approves as payment in full for the claim. a) Assignment of benefits b) Fee schedule c) accept assignment d) Capitation - ✔✔c) accept assignment Charge a higher premium than HMO's in exchange for more flexibility and more options for the beneficiaries. There is no gatekeeper-physician and beneficiaries choose the provider from whom to seek services as long as the provider is within the network. a) PPO b) HMO c) Triple Plan Optiond) Prepaid health plan - ✔✔a) PPO Vaccine codes are found in what section of the CPT? a) E & M secion b) Laboratory section c) Medicine section d) Appendix C - ✔✔c) Medicine section Covers some other medical services that Part A doesn't cover, such as outpatient services, some of the services of physical and occupational therapists, and some home health care. a) Medicare Part A b) Medicare Part B c) Medicare Part C d) Medicare Part D - ✔✔b) Medicare Part B Under Medicaid, a low income individual losing employer health insurance coverage can be eligible under Medicaid. What law provides continuation of group health coverage that otherwise might be terminated? a) COBRA b) Stark Law c) OIG d) HIPAA - ✔✔a) COBRA For work related injuries, is it covered by private insurance even though patient is covered under Worker's Compensation Insurance? a) True b) False - ✔✔b) False Gate-keeper under managed care plan is also called the: a) Primary care physicianb) Referring physician c) Consultant d) Attending physician - ✔✔a) Primary care physician Assignment of benefits means that third party payer will: a) Pay the physician directly b) Pay the patient directly c) Pay claim 100% d) none of the above - ✔✔a) Pay the physician directly Insurance for active military personnel and their dependents. a) CHAMPVA b) Medicare c) Tricare d) BCBS - ✔✔c) Tricare Which of the following is not being paid by insurance because it is not included in the benefits list of insurance policy contract? a) preexisting condition b) medically necessary c) non-covered benefits d) not authorized services - ✔✔c) non-covered benefits Which would be assigned to report DMEPOS on insurance claim? a) CPT code b) HCPCS Level I codes c) HCPCS Level II codes d) HCPCS Level III codes - ✔✔c) HCPCS Level II codesWhich of the following is the "Payer of Last Resort"? a) Tricare b) Medicare c) Medicaid d) all of the above - ✔✔c) Medicaid those who qualify for Medicaid include all of the following except: a) Low income families with children b) Persons over 65 who are blind or have a permanent disability c) Persons who earn enough money to pay basic living expenses, but cannot afford high medical bills d) High income earners - ✔✔d) High income earners To avoid interfering with an individual's access to quality health care or the efficient payment for such health care, the Privacy Rule permits a covered entity to use and disclose protected health information, with certain limits and protections without individual's authorizations for the following purposes: a) Treatment, Payment, and Healthcare Operations b) Treatment, Pathology, and Outpatient Visits c) Trading, Payment, and Research d) None of the above. All disclosure need patient's authorization. - ✔✔a) Treatment, Payment, and Healthcare Operations Anti Self-referral law is also called: a) HIPAA b) False Claims act c) Stark Law d) CMS - ✔✔c) Stark Law A Certificate of Medical Necessity of DME must be attached to claim when billing DME to Medicare insurance. a) Trueb) False - ✔✔a) True When a Non-member physician treats an HMO patient, the service rendered is: a) Consultation b) Out of network c) Within network d) All of the above - ✔✔b) Out of network _____ is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed "medically necessary". a) Advance beneficiary notice b) Pre-authorization c) Certificate of medical necessity d) Coordination of benefits - ✔✔b) Pre-authorization Which of the following is not covered by Medicaid? a) Prenatal care b) Vaccines for children c) Elective cosmetic surgery d) Family planning and supplies - ✔✔c) Elective cosmetic surgery This is also known as fee-for-service. Services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. a) Traditional/Indemnity Insurance b) Worker's Compensation c) Liability Insurance d) Disability Insurance - ✔✔a) Traditional/Indemnity Insurance Disclosure refers to the way health information is.a) Handled by doctors. b) Given to an outside person or organization. c) Stored d) Organized - ✔✔b) Given to an outside person or organization. Business associates are also considered as covered entities if they function as a Provider, Health insurance, or Clearinghouse [Show More]

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