CBCS Full Exam Simulation Flashcards
8 cards from real CBCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 8 CBCS Full Exam Simulation flashcards as text
A patient is seen in the emergency department for chest pain. No definitive diagnosis is established. For outpatient coding, what is the correct approach?
Answer: Code the sign or symptom of chest pain (R07.9)
For outpatient coding, when no definitive diagnosis is established, the sign or symptom (chest pain) is coded — not a suspected diagnosis.
Medicare uses which system to pay physicians for their professional services?
Answer: Resource-Based Relative Value Scale (RBRVS) via MPFS
Medicare pays physicians based on the Resource-Based Relative Value Scale (RBRVS), implemented through the Medicare Physician Fee Schedule.
A billing specialist discovers that a claim was submitted with an incorrect CPT code. The claim has already been paid. What is the correct action?
Answer: Submit a corrected claim or refund the overpayment to the payer
Discovered billing errors must be corrected by submitting a corrected claim and refunding any overpayment — failing to do so can constitute fraud.
What information is required on a CMS-1500 claim form in Box 21?
Answer: Diagnosis codes (ICD-10-CM codes)
Box 21 on the CMS-1500 claim form is used to report ICD-10-CM diagnosis codes.
What does HIPAA require regarding the transmission of electronic claims?
Answer: Covered entities must use standardized transaction formats (X12 837) for electronic claims submission
HIPAA requires covered entities to use standardized X12 transaction formats, including the 837 for electronic claims submission.
Which of the following is a compliance risk related to the False Claims Act?
Answer: Knowingly submitting a claim for services not rendered or medically unnecessary
Knowingly submitting false claims to federal healthcare programs is the central offense prohibited by the False Claims Act.
A physician orders a hemoglobin A1c test for a diabetic patient's routine monitoring. What code set is used to report this lab service?
Answer: CPT (85018 or 83036)
Lab services such as hemoglobin A1c are reported using CPT codes from the Pathology and Laboratory section.
What is a Remittance Advice (RA), and how is it used in medical billing?
Answer: An electronic or paper document sent by the payer explaining claim payment or denial details
A Remittance Advice is sent by the payer explaining how a claim was processed, including payments made, adjustments, and denial reasons.