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CBCS Exam Study Guide
- What is the filing limit for claim submission for an outpatient service with
TRICARE?: Within 1 year from the date of service - A patient’s employer has not submitted a premium payment for the company’s commercial insurance plan. Which claim status should the provider
receive from the third-party payer?: Denied - What prohibits a provider from referring Medicare patients to a clinical
laboratory service in which the provider has a financial interest?: Stark Law - What is issued to active duty uniformed service personnel for access to
TRICARE benefits?: common access card
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- A billing and coding specialist is posting payments from an explanation
of benefits (EOB). What equation determines how patient responsibility is
calculated?: Charged amount – Payment amount – Adjustment amount = Patient
responsibility - What describes the term “crossover” as it relates to Medicare?: When a
third-party payer transfers data to allow coordination of benefits for a claim - How many behavior classifications are included in the Table of Neoplasmsin the ICD-10-CM?: 6
- A billing and coding specialist is appealing a Medicare denial.What is the
first step in the appeals process?: Redetermination - What modifier indicates that a patient has signed a Medicare Advance
Beneficiary Notice (ABN)?: -GA
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