Study Software for the Certified Professional Coder (CPC®) Exam
Sample Certifed Professional Coder (CPC) Questions
1.
In order to
create and process claims faster, investing in
electronic medical billing software is suggested.
What other main benefits does electronic
billing software provide to your practice?
Choose one of the following.
A.
It aids in
internally auditing your claims in order to reduce
the amount of claims that are denied and returned to
your office.
B.
This
will help your practice save money, by reducing the
number of office staff you have.
C.
This
will cut costs on mailing expenses.
D.
Submitting claims electronically, guarantees that no
claims are ever denied.
Answer: A
Explanation:
Electronic billing means that your claims are
submitted and processed a lot faster, providing you
the opportunity to correct denied claims and
resubmit them before manual claims ever begin the
processing stage.
2.
It is best to
find a practice management system that works for you
and your practice.
Haphazardly dictating notes can send
insurance carriers the wrong message.
What prompts can aid your office in this
process?
Choose one of the following.
A.
Complete
documentation of every visit the patient has ever
made.
B.
Putting ICD-9 codes next to your modifiers.
C.
Health maintenance prompts.
D.
Prompts located in HIPPA documents.
Answer: C
Example:
Health maintenance prompts assist you in staying on
top of your patient’s progress. Be sure you have a
similar plan in place for your documentation.
3.
When
preparing your documentation, your notes and all
details should be complete.
Why is it important that each progress note
be able to stand alone to support the billed
service? Choose one of the following.
A.
Because this
will enable you to update your charge capture
documents.
B.
So
you can keep your physician’s license.
C.
So
that you can ensure that your employees are working
quickly and efficiently.
D.
To
keep your office from being vulnerable to audits.
Answer: D
Explanation: The guidelines clearly require specific
steps be performed and documented for billing
purposes.
By not maintaining complete documentation,
your practice could once again be vulnerable to
audits.
4.
You should
periodically monitor your documentation and billing
patterns to see if they support each other.
In the event they do not, what should you do?
Choose one of the following.
A.
Periodically
benchmark your claim history, and periodically audit
your documentation to see if the claims support each
other.
B.
Install a
practice management software solution at your
practice so that these claims don’t need to be
processed by hand.
C.
Review your charge capture documents.
D.
Train your office throughout the year on regulations
regarding billing.
Answer: A
Explanation: By monitoring you billing patterns, you
will notice and resolve these problem areas quickly
before they begin to affect your aging and before
they become bad debt. Review your office guidelines
on documentation as well as any new coding
regulations to find the error and rectify it
immediately.
5.
Your
appointment book is full and you are always seeing
patients but your aging report shows that the
services you are rendering are going unpaid.
One small detail that many practices
undervalue is: ______________________
Choose one of the following:
A.
Posting your
co-pay policy.
B.
Have an open
sign at the front door of your practice.
C.
Post
a sign with all insurances you accept at this time.
D.
Call
all of your patients the day before to remind them
of the appointment.
Answer: A
Explanation:
By posting the office collection policy for
co-pays and deductibles, your patients know that you
will require their payment at the time services are
rendered.
It is also a good idea to have your
collection policies on the patient statement as
well, so that they have a written copy of your
policies with every bill.
6.
A patient may
be covered by numerous insurance plans.
Because they have seen you many times changes
in their insurance may not prompt them to notify you
that their insurance has changed.
What can you implement to verify as to
whether or not you are a member of their new plan,
or if your status has expired?
Choose one of the following.
A.
Collect the
patient’s co-pay up front and they will tell you.
B.
Ask
the patient if you can make a copy of their
insurance card and keep it on file.
C.
Maintain Provider Registration/ Credentialing Files
D.
You
will receive a letter from the insurance carrier
once you have submitted their claim.
Answer. C
Explanation: By maintaining credentials and provider
status, you will be aware of an expiring or need for
renewal status.
If your client base continues to add
insurance carriers, even for secondary payment, you
will have contact information for contracting with
new insurance carriers to provide services to an
even wider range of patients, meaning greater
opportunity to expand your practice.
7.
In pediatric
cases, there may be instances in which both parents
are held equally responsible for the medical bills
for their children.
In this case, what can you do to prevent
their bills from going past due?
Choose one of the following.
A.
Mail the bill
in the child’s name.
B.
Mail
the bill to the mother only.
C.
Be
willing to create separate accounts.
D.
Mail
the bill to the father’s attorney as stated in the
divorce decree.
Answer: C
Explanation:
Be willing to create separate accounts.
If your practice continues to sending bills
to only one of the parents or the wrong insurance
carrier, the parent who gets the bill can quickly
find an account that is difficult to decipher and
quickly becomes past due.
The other parent, meanwhile, gets only
information that is filtered through their
ex-spouse, which can already be past due before an
opportunity to reconcile is available.
8.
Why should
your practice provide a line-item-billing statement?
A.
It will cause
insurance companies to deny the claims.
B.
It gives you
more room to write ICD-9 codes and modifiers.
C.
This
makes it easier for the patients to determine later
what specific charges account for a particular
balance that still may be due.
D.
It
will help you train your staff on writing better for
the purpose of documenting a patient’s visit.
Answer: C
Explanation:
Produce billing statements that are capable
of telling patients on a line-by-line basis, which
charges have been paid and which remains.
There are many software packages that will
allow you to customize the patient statement so that
their statements clearly define what charges have
been paid and what amount is outstanding.
9.
Many
practitioners would rather write off an account
before having to submit their claims for an appeal
process.
Why is that the case?
Choose one of the following.
A.
They have to
spend too much time training their staff on
maintaining proper documentation.
B.
They
don’t want to pay for any additional electronic
billing systems.
C.
Because of the amount of paperwork required, and the
added frustration of following the appeal.
D.
Because appealing a denial could take over one year.
Answer: C
Explanation:
Because so many physicians opt not to appeal
denials, errors in the insurance carriers’
processing can go undetected, costing providers lost
revenue.
Be sure that all claims that are submitted have
supporting documentation and are ready to be
transmitted to fight for your money.
10.
Why is
utilizing electronic billing so critical to your
practice?
Choose one of the following.
A.
No one may be
able to read the handwriting from your billing
department.
B.
You
can save money by not using so much paper.
C.
Generating claims takes significantly less time and
you will receive a confirmation code for all bills
submitted electronically.
D.
Turnaround time on paper claims can run anywhere
from three to six months.
Answer: C
Explanation:
By switching to electronic billing, your
office will operate seamlessly because the entire
patient billing information is contained within a
software program, instead of pulling paper files to
sort for the appropriate information.
11.
What is the
average cost of producing a hardcopy HCFA? Choose
one of the following.
Choose one of the following.
A.
$0.07 per
claim.
B.
$70.00 per claim.
C.
$8.00 per claim.
D.
11%
of the claim.
Answer: C
Explanation:
When you conduct a comprehensive cost
analysis, combining all the material and
non-material components (staff time), the cost to
produce a hardcopy HCFA form averages $8.00 per
claim.
12.
If you bill
500 patients per month at $8.00 per claim, you are
spending $4,000 a month just for submitting claims.
What does this break down to annually for submitting
claims?
Choose one of the following.
A.
$48,000 annually.
B.
$47,500 annually.
C.
$48,100 annually.
D.
$48,025 annually.
Answer: A
Explanation:
If you bill 500 patients per month at $8.00
per claim, you are spending $4000 a month. 4x12 =48,
therefore $4000x 12 months = $48,000 annually.
13.
What is the
turnaround time for Medicare to process an
electronic claim?
Choose from one of the following.
A.
5 -10 days.
B.
14
days.
C.
10-12 days.
D.
12-14 days.
Answer: B.
Explanation: Most insurance
companies are now mandating floor times for claims
received via hardcopy, including Medicare.
An electronic claim that is received by
Medicare is typically processed in 14 days.
14.
Submitting
claims electronically allows you to review your
claims before they are submitted as well as
receiving immediate feedback on any errors connected
with a claim.
If you submit claims hardcopy, you could wait
up to how many weeks to receive a denial for
clerical error?
Choose one of the following.
A.
2 weeks.
B.
4.5
weeks.
C.
8
weeks.
D.
10-12 weeks.
Answer: C
Explanation:
In addition to incurring the fixed cost of
submitting claims hardcopy, you allow the insurance
carrier to earn more interest on money that is due
to you. Submitting claims electronically allows you
to correct any errors with the claim and resubmit
without incurring the duplication of time and fixed
cost.
15.
There are
indications that your billing procedures may not be
working or your billing procedures are weak.
There are obvious signs such as no cash flow,
but take the time to review your billing procedures
to see if your office suffers from the following
problems:
Choose one of the following.
A.
Aging accounts receivable reports are not being
worked, and aging accounts are typically over 60
days old.
B.
Staff has over ordered medical supplies.
C.
Appointments are over booked.
D.
Your
office starts receiving additional magazines that
were not requested.
Answer: A
Explanation:
Your billing procedures should be evaluated
and corrections made to get your practice back on
track. Utilizing a medical billing software package
will assist your office in maintaining the
administrative function.
However, it takes staff training and
commitment to consistently achieve strong
receivables.
16.
Insurance
companies are earning interest on the money while
you wait for them to process your claims.
How long does it take insurance companies to
process a manual claim?
Choose one of the following.
A.
10-14 days.
B.
30
days.
C.
60
days.
D.
60-90 days.
Answer: C
Explanation:
Most insurance companies have mandatory floor
times for manual claims which equates to around a
60-day turnaround on claims.
17.
The standard
cost of submitting claims manually is around $8.00
per claim including forms, postage, envelopes, claim
preparation, staff time, stuffing the envelopes,
etc. If
the 268,000 providers are submitting their
26,800,000 claims manually, the cost of submitting
the claims once would be:
Choose one of the following.
A.
200,000,000
B.
202,001,000
C.
214,400,000
D.
214,000,001
Answer:
C
Explanation:
26,800,000x $8.00= $214,400,000 just for
submitting the claims once.
18.
If you remove
the cost of submitting claims manually from the
outstanding receivables and express this amount as a
percentage, you are losing: In other words-
670,000,000-$214,400,000=$455,600,000 remaining outstanding receivables.
So, you would calculate this to find your percentage:
$214,400,000/$670,000,000= ___________________.
Choose one of the following:
A.
31.5%
B.
42%
C.
32%
D.
52%
Answer: C. 32% of your generated income is being
allocated for claims submission.
Explanation:
$214,400,000 divided by $670,000,000 = 32%
19.
What one cost
can be eliminated in the claims process if you have
a denied claim that was submitted electronically?
Choose from one of the following.
A.
The
cost of first class mail.
B.
The
cost incurred by a long distance phone call to the
patient.
C.
You
do not incur the $8.00 per claim cost to resubmit
claims.
D.
The
cost of $0.07 per paper copy that is used for
claims.
Answer: C
Explanation:
You have already submitted your claim
electronically in the system, so you will get a
confirmation code for collection purposes, verifying
that the insurance company received your claim.
20.
Define COB.
Choose from one of the following.
A.
Coordination
of Benefits.
B.
Cautionary of Benefits.
C.
Collections on Benefits.
D.
Carryover of Benefits
Answer: A
Explanation:
Coordination of Benefits.
This was developed to prevent over insurance
or duplicate coverage.
This occurs when two or more insurers,
insuring the same person for the same or similar
group health insurance benefits, limit the total
benefits to an amount not exceeding the total
allowable amount.
21.
A)
Both husband
and wife are employed and eligible for group health
coverage and each covers the other as a dependent.
B) A
person is employed in two jobs, both of which
provide group health insurance coverage.
These two situations represent one of the
following:
A.
Double
Insurance
B.
Over
Insurance
C.
Denial of Benefits
D.
Coordination of Benefits
Answer: B
Explanation:
Over insurance occurs when a person is
covered under two or more group health care plans
and may collect total benefits that exceed actual
loss.
22.
Assess the
following statement: “To limit the total benefits an
insured can collect under both group plans to not
more than 100 percent of the allowable expenses.
Therefore, the insured is prevented from making a
profit on health insurance claims.
This is what concept?
Choose from one of the following:
A.
Medical Model
Concept
B.
Family Medicine Concept
C.
Historical Concept of COB
D.
Conceptual Analysis of COB
Answer: C
Explanation:
Under COB, the primary plan pays benefits up
to its limit then the secondary plan pays the
difference between the primary insurer’s benefits
and the total incurred allowable expenses
(historically 100 percent of allowable expenses), up
to the secondary insurer’s limit.
23.
In regards to
Coordination of Benefits, who determines which plan
pays benefits first?
Choose one of the following:
A.
National
Commission of Insurance Benefits
B.
National Medical Payments Association
C.
Authority of the COB
D.
National Association of Insurance Commissioners
Answer: D
Explanation:
Each state of may choose to enact COB
regulations based on the National Association of
Insurance Comissioners guidelines and mode language
to facilitate consistent claim administration. The
order may differ from state to state depending on
NAIC rules.
24.
What is the
rule associated with determining which plan pays
benefits first?
Choose one of the following:
A.
The Order of
Benefits Determination
B.
The
Order of Insurance Rules
C.
The
Order of Coordination of Benefits
D.
The
Order of the Commission of Insurance Benefits
Answer: A
Explanation:
The plan that pays first is determined by the
Order of Benefits Determination Rules.
The order may differ from state to state
depending on which model of NAIC rules has been
adopted if any.
25.
If both
parents have the same birthday, the benefits of the
plan that covered one parent longer are determined
before those of the plan that covered the other
parent for a shorter period of time. This is known
as the :
Choose one of the following:
A.
The Aged
Parent Rule
B.
The
Ruling of Coordination of Benefits
C.
The
Birthday Rule
D.
The
Elder Parent Rule
Answer: C
Explanation: The benefits of the plan of the parent
whose birthday falls earlier in a year are determine
before those of the plan of the parent whose
birthday falls later in that year.
26.
The insurance
policy has no birthday rule in place, and there is a
secondary rule that could possibly be a determining
factor in paying benefits.
This rule is known as:
Choose one of the following:
A.
The Rule of
Thumb
B.
The
Gender Rule
C.
The
Rule of Higher Income
D.
The
Rule of Larger Deductibles
Answer:
B
Explanation:
If the plan does not have the Birthday Rule,
as previously discussed, but instead has a rule
based upon the gender of the parent, and if, as a
result, the plans do not agree on the Order of
Benefits, the rule based on gender will determine
the order of benefits.
27.
Ronnie and
Lisa have separate insurance policies that cover
their child.
Ronnie and Lisa are divorced, but Lisa has
custody of the child.
Which insurance policy is to pay for the
child’s health benefits first?
Choose one of the following:
A.
Ronnie’s plan will cover the child because he is the
primary wage earner.
B. The state will pay
for the child’s insurance.
C. Both plans are required to
each pay half of the child’s claims.
D. Lisa’s plan will cover the
child since she has custody of the child.
Answer: D
Explanation: If two or more plans
cover a person as a dependent child of separated or
divorced parents, then the plan of the parent who
has custody of the child will pay first.
28.
Falsifying
information on applications, medical records,
billing statements than this is considered fraud.
When collecting more than 20% co-insurance
from a patient at the time of the visit, this is
considered:
Choose one of the following:
A.
Money
Laundering
B.
Abuse
C.
Theft by Deception
D.
Malpractice
Answer: B
Explanation:
Providers found guilty of fraudulent or
abusive violations of Medicare law’s can be subject
to criminal prosecutions and penalties, civil
monetary penalties and other sanctions.
29.
A patient is
up front with you about their financial situation,
and they explain to you that they cannot pay you all
at once.
In an effort to help the patient and prevent wasting
time and money on collections you should:
Choose one of the Following:
A.
Offer the
patient a partial payment arrangement and have them
sign an agreement regarding their plan.
B.
Send
the patient the proper forms for worker’s
compensation.
C.
Call
them to let them know their wages will be garnished.
D.
Advise them to speak with welfare.
Answer: A
Explanation:
Partial payment is better than no payment at
all; communicate with your patients early on to see
if they are candidates for payment plans.
Make sure that any patient who will be paying
via a plan signs an agreement regarding their plan.
30.
Your patient
agrees to a payment plan, and then makes regular
payments.
They pay their balance off instead of leaving
you to take other measures like collections or
sending more letters.
You send them a thank you card.
Why is this important?
Choose one of the following:
A.
To show them
you have really nice handwriting.
B.
To
enclose additional business cards.
C.
To
reinforce your relationship with the patient.
D.
To
send them a referral sheet to fill out.
Answer: C
Explanation:
When you have a patient on a payment plan,
send them a thank you note when the balance is paid
in full.
This will reinforce your relationship with the
patient.
31.
You have a
wonderful staff that greets people upon arrival, and
the staff work every efficiently.
When the patient leaves, the last order of
business in addition to any new scheduling would be
asking for payment. The staff have a hard time doing
this, so you should probably do two of the
following:
A.
Provide
scripts for your staff when they speak with patients
regarding payments and post your payment policy,
asking each patient to sign it.
B.
Ask
for cash only so that the patient knows what to
expect, and have them sign the agreement.
C.
Have
the patient pay prior to the visit, and send them a
copy of the receipt for their records.
D.
Send
you staff to speaking class to help them gain
confidence, and have the patient sign a copy of your
financial policy in your practice.
Answer: A
Explanation:
Train your staff that browbeating and
threatening patients is counterproductive.
A professional tone in communications will
establish the authority of the practice, keep
patients talking to you and collect money.
If necessary, provide scripts for your staff
when they speak with patients regarding payments.
32.
Your office
has a co-pay of $15 per patient.
You see 15 patients a day which comes out to
$58,500 annually.
In order to ensure that your staff is able to
aggressively collect co-pays at the time of the
visit you can implement one of the following:
A.
Remind the
patient that if payment isn’t received same day,
that they can no longer return to your practice.
B.
Run
a contest to see how much your staff can charge
patients per day.
C.
Make
sure that you post a written collections policy, and
that all of your staff understands it.
D.
Send
the patient invoices every time they make a payment.
Answer: C
Explanation:
Your policy should cover that patients are
expected to pay their portion of the bill at the
time of service.
While most physician practices understand
this point, you need to stress the importance of
implementing this policy.
33.
In order to
make sure that the office addresses the collection
of any money in a uniform fashion, it is best for
you as the physician to:
Choose one of the following:
A.
Sign your
name to the collections policy.
B.
Tell
the patient yes if they ask you if they have to pay
today.
C.
Print a brochure that states your payment policy and
hand it out.
D.
Tell
the patient that they must pay fifty percent of the
balance for any office visit and procedure.
Answer: B
Explanation:
One of the most important things that
physician can do to assist in the collection process
is back the time-of-service payment and the staff.
The worse message a doctor can send a
conflicting message.
34.
You have a
patient that has set up a payment arrangement, and
they have not kept that arrangement.
They were offered a second arrangement, and
have not kept the second arrangement.
Your staff has come to you to let you know
that they have tried not just one arrangement, but
two payment arrangements to assist this patient.
What should you do to manage your practice better?
Choose one of the following:
A.
Set up a
third payment arrangement for this patient.
B.
Send
the patient to collections after the first payment
on the arrangement has been missed.
C.
Sue
the patient.
D.
Set
limits.
Answer: D
Explanation:
For risk management purposes, physicians can
review accounts before they are sent to collections,
but establish a time limit so that these outstanding
accounts are not held up in review.
35.
There are a
wide variety of ways to increase your practice’s
revenue. You are looking for ways to cut costs, but
there are some billing issues that can be addressed
that can more of a difference.
What changes can you make?
Choose one of the following:
A.
Hire one
biller, and one billing manager.
B.
Update your ICD-9 codes, and Review your denials.
C.
Color tabs your folders according to the nature of
the invoice.
D.
Have
one billing manager and a billing manager assistant
to double check her work.
Answer: B
Explanation:
If your practice is using outdated codes, or
not using the most current coding set, then you are
wasting time on resubmissions. You can learn from
your mistakes by reviewing your denials. You will
see if they were coding issues, and if they were all
from one carrier.
36.
You see that
your practice has been losing revenue, so you make
an assessment on what to look at first.
You are using electronic billing, and your
billing manager has been reviewing denials for
clerical errors. Everything on that end works out
perfect.
Your next step is to?
Choose one of the following:
A.
Ask the
billing manager how many patients bounce checks
every month.
B.
Sign
a contract to run commercials at three key times
throughout the day.
C.
Ask
full payment at the time services are rendered.
D.
Audit your records.
Answer: D
Explanation: Randomly choose patients and follow
them through your office, and make sure that their
insurance was verified, and that every chargeable
aspect of their care was billed.
37.
What is one
of the largest assets that your practice can have?
Choose one of the following:
A.
Your
receptionist.
B.
Your
nursing staff.
C.
Accounts Receivable.
D.
Your
Phlebotomists.
Answer: C
Explanation:
One of the largest assets to your practice is
accounts receivable.
Many practices overlook this asset, and fail
to manage it wisely.
The poor performance of your accounts
receivable department can literally sink your
practice.
38.
You find out
that your office manager has been receiving a large
amount of denials and rejections from various
carriers.
Your office manager proceeds to tell you that
they have tried to contact patients on various
accounts that have either non working numbers or
disconnected numbers.
Your manager sits up front at the check in
desk and observes.
She discovers that:
A.
None of the
patients are being asked if their information has
changed.
B.
There is an influx of self pay patients.
C.
The
receptionist doesn’t ask for any medical history.
D.
The
patients are asked if they are taking any new
vitamins.
Answer: A
Explanation:
Your receivables are impacted by your office
protocol, and how you collect information on your
patients.
The majority of claim rejections and denials
are a result of inadequate information maintained on
the patient.
39.
When an
insurer is dragging their feet on paying a claim,
you decide to use one critical law to your
advantage.
Choose one of the following:
A.
The
No pay Law.
B.
The
Slow pay law.
C.
The
Prompt Pay Law.
D.
The
Prompt Invoice Law.
Answer: C
Explanation: All states have a prompt pay law, and every state is
different.
If your contract with the insurer specifies
that more time is allowable, then find the time to
negotiate your contract.
40.
You have a
patient that has received statements every 30 days,
and now the billing has reached 90 days.
The patient still hasn’t paid and the debt is
$870.
You decide that before sending the patient to
collections you will try one more little known
strategy to get payment from the patient:
Choose one of the following:
A.
Your office
calls the patient at their workplace to confront
them.
B.
Your
office calls the patient’s cell phone and leave
repeated messages.
C.
You
send a final letter demanding payment in full.
D.
You
send the patient a notice that they will receive a
1099 C for income if they choose not to pay the
balance in full.
Answer: D
Explanation:
A physician can use a 1099 C form from the
IRS to notify the debtor (the non-paying patient),
that the cancellation of debt is being reported as
income to the patient unless payment in full is made
or other arrangements are made.
41.
Tracking
denials and logging the reasons for the denials is
key in being able to figure out how to fix them.
One of the main reasons for denials from the
carrier is:
Choose one of the following:
A.
The
patient wasn’t who they said they were.
B.
Coding mistakes.
C.
Using handwritten invoices.
D.
The
insurance carrier is not in the same state.
Answer: B
Explanation:
Denials caused by coding issues can include
bundled codes, a diagnosis that is inconsistent with
the procedure, and an invalid code or modifier.
42.
In an effort
to minimize the collections process for your
practice you decide to look into the way your office
is being run.
You find that plenty of patient information
is collected up front, but you undervalue reading
this one important clue that enters your office
every day. It is:
Choose one of the following:
A.
Reading the
patients mail they send you in response to your
requests.
B.
Patient surveys that have come back to you.
C.
Mail
from your insurance carriers.
D.
Letters from pharmaceutical reps.
Answer: A
Explanation:
Reading any patient mail that they send you
is important, because they may be sending you vital
information that you will need in order to get their
claim settled.
