Certified Patient Account Technician Exam! Trivia Quiz
Are you reading to tackle the certified patient account technician exam! For you to hold this position, you need to ensure you have a deeper understanding of how to store patient files, extract them, and also handle any issues patients will have when it comes to billing. How about you take this quiz and be a step closer to ace your exams.
Questions and Answers
- 1.
The Uniform Bill is also known as:
- A.
UB04
- B.
UB92
- C.
CMS1500
- D.
Both A & C
Correct Answer
A. UB04Explanation
The Uniform Bill is also known as UB04 because it is a standardized form used by hospitals and other healthcare facilities to submit claims for reimbursement to insurance companies. It replaced the previous version known as UB92. CMS1500, on the other hand, is a different form used for physician and outpatient services. Therefore, the correct answer is UB04, as it refers to the specific form used for hospital claims.Rate this question:
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- 2.
The UB04 contains how many data elements:
- A.
78
- B.
81
- C.
92
- D.
150
Correct Answer
B. 81Explanation
The UB04 form contains 81 data elements. This means that there are 81 specific pieces of information that can be recorded on the form. These data elements are used to capture important details about a patient's healthcare services, such as their diagnosis, treatment, and costs. Having 81 data elements ensures that a comprehensive range of information can be collected and documented accurately for billing and administrative purposes.Rate this question:
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- 3.
Condition codes are found in which fields:
- A.
39-41
- B.
66-74
- C.
31-34
- D.
18-28
Correct Answer
D. 18-28Explanation
Condition codes are found in the fields 18-28.Rate this question:
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- 4.
Revenue codes are found in which fields:
- A.
42-49
- B.
31-34
- C.
66-74
- D.
18-28
Correct Answer
A. 42-49Explanation
Revenue codes are found in fields 42-49.Rate this question:
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- 5.
Occurrence codes are found in which fields:
- A.
18-28
- B.
31-34
- C.
39-41
- D.
42-49
Correct Answer
B. 31-34Explanation
Occurrence codes are found in fields 31-34.Rate this question:
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- 6.
A UB04 code that identifies a specific accommodation, ancillary service or billing calculation:
- A.
Condtion code
- B.
Occurrence code
- C.
Value code
- D.
Revenue code
Correct Answer
D. Revenue codeExplanation
A revenue code is a UB04 code that identifies a specific accommodation, ancillary service, or billing calculation. It helps in categorizing the services provided by healthcare facilities and determining the charges associated with them. Revenue codes are used for billing purposes and play a crucial role in accurately documenting and tracking financial transactions in the healthcare industry. They ensure that the correct charges are applied and that the billing process is transparent and standardized.Rate this question:
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- 7.
A UB04 code which identifies the condition(s) relating to the bill that may affect payer processing:
- A.
Condtion code
- B.
Occurrence code
- C.
Value code
- D.
Revenue code
Correct Answer
A. Condtion codeExplanation
A condition code is a UB04 code that identifies any specific condition(s) related to the bill that may impact the processing by the payer. These codes are used to provide additional information about the patient's condition or treatment that may affect the reimbursement or coverage. By including a condition code, healthcare providers can ensure that the payer has all the necessary information to accurately process the claim.Rate this question:
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- 8.
A UB04 code used to identify values of monetary nature:
- A.
Condition code
- B.
Occurrence code
- C.
Value code
- D.
Revenue code
Correct Answer
C. Value codeExplanation
Value code is a UB04 code used to identify values of monetary nature in healthcare billing. This code is used to indicate specific dollar amounts related to services provided, such as charges, payments, or adjustments. It helps in accurately capturing and reporting financial information for reimbursement purposes.Rate this question:
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- 9.
A UB04 code used which identifies the specific date defining a significant event relating to the bill that may affect payment processing:
- A.
Condition code
- B.
Occurrence code
- C.
Value code
- D.
Revenue code
Correct Answer
B. Occurrence codeExplanation
Occurrence code is a UB04 code that is used to identify a specific date defining a significant event relating to the bill that may affect payment processing. This code helps in providing additional information about the occurrence of a particular event, such as the date of admission, discharge, or surgery. It is essential for accurate billing and payment processing as it helps in determining the appropriate reimbursement for the services provided.Rate this question:
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- 10.
The type of bill code is how many digits:
- A.
2
- B.
3
- C.
4
- D.
5
Correct Answer
B. 3Explanation
The type of bill code consists of three digits.Rate this question:
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- 11.
The type of bill code is found in what field locator:
- A.
5
- B.
6
- C.
2
- D.
4
Correct Answer
D. 4Explanation
The correct answer is 4. This suggests that the type of bill code is found in field locator 4.Rate this question:
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- 12.
The first digit in the type of bill indicates:
- A.
Frequency
- B.
Type of facility
- C.
Bill Classification
- D.
None of the above
Correct Answer
B. Type of facilityExplanation
The first digit in the type of bill indicates the type of facility. This means that the first digit in the bill number represents the specific type of healthcare facility where the bill originated from. It helps in categorizing and identifying the source of the bill, making it easier for administrative purposes and tracking.Rate this question:
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- 13.
The third digit in the type of bill indicates:
- A.
Frequency
- B.
Type of facility
- C.
Bill Classification
- D.
None of the above
Correct Answer
A. FrequencyExplanation
The third digit in the type of bill indicates the frequency. This means that it represents how often a particular bill is being issued or generated. It helps in categorizing and organizing bills based on their frequency, making it easier for record-keeping and analysis purposes.Rate this question:
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- 14.
Type of bill code 131 indicates:
- A.
Skilled nursing, Outpatient, Interim- first claim
- B.
Hospital, outpatient, non payment zero claims
- C.
Hospital, inpatient, admit through discharge claim
- D.
Hospital, outpatient, admit through discharge claim
Correct Answer
D. Hospital, outpatient, admit through discharge claimExplanation
The type of bill code 131 indicates a claim for a hospital outpatient visit that includes both the admission and discharge of the patient. This means that the patient was admitted to the hospital for treatment or observation and then discharged after receiving the necessary care. The code is used to accurately categorize and process the claim for reimbursement purposes.Rate this question:
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- 15.
Type of bill code 227, the third digit 7 indicates:
- A.
Final claim for a home health PPS episode
- B.
Interim- last class
- C.
Replacement of prior claim
- D.
Late charge only
Correct Answer
C. Replacement of prior claimExplanation
The correct answer is "Replacement of prior claim." In the type of bill code 227, the third digit 7 indicates that the claim is a replacement of a prior claim. This means that a previous claim for the same patient and episode was submitted, but it was incorrect or incomplete, so it needs to be replaced with a corrected claim.Rate this question:
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- 16.
Type of bill code 333, the second digit 3 indicates:
- A.
Outpatient
- B.
Inpatient Part B
- C.
Swing Bed
- D.
Inpatient part A
Correct Answer
A. OutpatientExplanation
The correct answer is Outpatient. In the type of bill code 333, the second digit 3 indicates that the bill is for an outpatient service. This means that the patient received medical treatment or services in a healthcare facility but did not require an overnight stay. Outpatient services can include consultations, diagnostic tests, minor surgeries, and other procedures that do not require hospitalization.Rate this question:
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- 17.
Hospital, swing bed, Interim- first claim:
- A.
251
- B.
182
- C.
145
- D.
262
Correct Answer
B. 182Explanation
The given sequence of numbers represents the number of patients in a hospital's swing bed on different days. The numbers 251, 145, and 262 are higher than the previous numbers, indicating an increase in the number of patients. However, the number 182 is lower than the previous number, suggesting a decrease in the number of patients. Therefore, the number 182 is the correct answer as it breaks the pattern of increasing numbers.Rate this question:
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- 18.
CWF is the acronym for:
- A.
Common working field
- B.
Constant working file
- C.
Conditional working file
- D.
Common Working File
Correct Answer
D. Common Working FileExplanation
CWF stands for Common Working File. This term is commonly used in various industries to refer to a shared or centralized database or system that is accessible by multiple users or departments. The Common Working File allows for efficient collaboration, data sharing, and real-time updates, ultimately improving productivity and streamlining processes.Rate this question:
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- 19.
The CWF contains all of the following except:
- A.
Part A & B deductible information
- B.
Date of Birth
- C.
Date of service
- D.
Benefit periods and days remaining in the current benefit period
Correct Answer
C. Date of serviceExplanation
The CWF (Common Working File) is a database that contains important information about a patient's Medicare coverage. It includes details such as Part A & B deductible information, date of birth, benefit periods, and days remaining in the current benefit period. However, it does not include the specific date of service, which refers to the date on which a particular medical service was provided to the patient.Rate this question:
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- 20.
MSP is the acronym for:
- A.
Medicaid secondary payer
- B.
Medicare seasonal payer
- C.
Miscellaneous secondary payer
- D.
Medicare secondary payer
Correct Answer
D. Medicare secondary payerExplanation
The correct answer is Medicare secondary payer. MSP refers to Medicare secondary payer, which is a provision that requires certain types of insurance to pay before Medicare pays for healthcare services. This provision is designed to ensure that Medicare is not the primary payer when other insurance coverage is available.Rate this question:
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- 21.
A claim that contains complete and necessary information, but the information is illogical or incorrect is:
- A.
Clean claim
- B.
Incomplete claim
- C.
Invalid claim
- D.
None of the above
Correct Answer
C. Invalid claimExplanation
An invalid claim refers to a statement that contains all the necessary information but is illogical or incorrect. This means that the claim may have all the required details but fails to make sense or is factually incorrect. Therefore, it cannot be considered as a valid or accurate claim.Rate this question:
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- 22.
A clean claim is one which:
- A.
If investigated does not require contact with the provider
- B.
Will pass all front end edits
- C.
Is processed electronically
- D.
All of the above
Correct Answer
D. All of the aboveExplanation
A clean claim is one that meets all the requirements for processing without any issues. It does not require any further investigation or contact with the healthcare provider. Additionally, it will pass all front-end edits, meaning it meets all the necessary criteria for electronic processing. Therefore, the correct answer is "All of the above" as all the statements mentioned are true for a clean claim.Rate this question:
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- 23.
The medicare Part A deductible for days 1-60 is:
- A.
$1000.00
- B.
$1132.00
- C.
$1200.00
- D.
$1500.00
Correct Answer
B. $1132.00Explanation
The correct answer is $1132.00. This is the deductible amount for the first 60 days of Medicare Part A coverage. It means that if a person is admitted to the hospital, they will be responsible for paying the first $1132.00 of their medical expenses before Medicare coverage begins.Rate this question:
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- 24.
The Medicare Part A Lifetime Reserve Days deductible for days 91-150 is:
- A.
$275.00 per day
- B.
$350.00 per day
- C.
$566.00 per day
- D.
$1132.00 per spell of illness
Correct Answer
C. $566.00 per dayExplanation
The Medicare Part A Lifetime Reserve Days deductible for days 91-150 is $566.00 per day. This means that for each day of hospitalization during this time period, the patient is responsible for paying $566.00 out of pocket before Medicare coverage kicks in. This deductible applies to the lifetime reserve days, which are additional days of hospitalization that Medicare covers after the standard 90-day benefit period has been exhausted.Rate this question:
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- 25.
The blood deductible for Medicare Part A & B is:
- A.
1 unit per year
- B.
2 units per year
- C.
3 units per year
- D.
4 units per year
Correct Answer
C. 3 units per yearExplanation
Medicare Part A and B have a blood deductible of 3 units per year. This means that Medicare beneficiaries are responsible for paying for the first 3 units of blood they receive each year before Medicare coverage kicks in. This deductible applies to both inpatient and outpatient blood transfusions.Rate this question:
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- 26.
Which of the following tasks is typically performed by a Certified Patient Account Technician (CPAT)?
- A.
Clinical diagnosis of patients
- B.
Surgical procedures on patients
- C.
Handling medical billing and insurance claims
- D.
Conducting laboratory tests on patient samples
Correct Answer
C. Handling medical billing and insurance claimsExplanation
A Certified Patient Account Technician (CPAT) is trained to handle tasks related to medical billing and insurance claims processing, ensuring accurate and timely reimbursement for healthcare services provided to patients.Rate this question:
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- 27.
What form provides a complete listing or detailed account of every service posted to a patient account:
- A.
Data mailer
- B.
Superbill
- C.
Itemized Statement
- D.
Both B & C
Correct Answer
C. Itemized StatementExplanation
An itemized statement provides a complete listing or detailed account of every service posted to a patient account. It includes a breakdown of each service or procedure along with the corresponding charges. This statement is often used for billing and reimbursement purposes, as it allows patients and insurance companies to review and verify the services provided and the associated costs. The itemized statement ensures transparency and accuracy in the billing process, making it an essential document in healthcare financial management.Rate this question:
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- 28.
An invoice used to document the services ordered or rendured during a patient visit:
- A.
Data mailer
- B.
Superbill
- C.
Itemized statement
- D.
Both B & C
Correct Answer
B. SuperbillExplanation
A superbill is a type of invoice that is used to document the services ordered or rendered during a patient visit. It includes detailed information about the services provided, such as the procedures performed, the diagnosis codes, and the costs associated with each service. This document is typically used by healthcare providers to communicate with insurance companies for reimbursement purposes. The superbill helps ensure accurate billing and record-keeping for both the healthcare provider and the patient.Rate this question:
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- 29.
A system generated free form statement that is used to communicate the status of a patients account:
- A.
Data Mailer
- B.
Superbill
- C.
Itemized Statement
- D.
Both B & C
Correct Answer
A. Data MailerExplanation
The correct answer is "Data Mailer." A data mailer is a system-generated statement that is used to communicate the status of a patient's account. It is typically sent to the patient or their insurance company and contains detailed information about the services provided, charges incurred, and any payments made. This statement helps in keeping the patient informed about their account balance and facilitates the billing and payment process.Rate this question:
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- 30.
Medicare is a secondary payer to which of the following:
- A.
Federal Black Lung
- B.
Workers Compensation
- C.
Automobile medical, no fault or liability insurance
- D.
All of the above
Correct Answer
D. All of the aboveExplanation
Medicare is considered a secondary payer to Federal Black Lung, Workers Compensation, and Automobile medical, no fault or liability insurance. This means that if an individual has coverage through any of these sources, Medicare will only pay for their healthcare expenses after these primary payers have paid their share. Therefore, Medicare will not be the primary payer in these situations, but rather a secondary payer.Rate this question:
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- 31.
If ESRD (End Stage Renal Disease) is the only reason a patient was entitled to Medicare, the coverage with end in the following time frames:
- A.
24 months after they no longer require maintenance dialysis
- B.
36 months after the month of a successful kidney transplant
- C.
Employer group health plans with greater than 20 employees
- D.
12 months after they no longer require maintenance dialysis
Correct Answer
A. 24 months after they no longer require maintenance dialysisExplanation
The correct answer is 24 months after they no longer require maintenance dialysis. This means that once a patient with ESRD (End Stage Renal Disease) no longer needs regular dialysis treatments, their Medicare coverage will end after 24 months. This indicates that Medicare coverage for ESRD patients is provided for a specific period of time after the patient's condition improves or changes.Rate this question:
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- 32.
When a person with VA benefits (Veterans Administration) and Medicare recieves healthcare, they can use both benefits:
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
A person with VA benefits and Medicare cannot use both benefits simultaneously. Generally, if a person is eligible for both VA benefits and Medicare, they can choose to use either one for their healthcare needs. However, it is important to note that there are certain situations where VA benefits and Medicare may work together to provide coverage for specific services or treatments.Rate this question:
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- 33.
Working aged means a person is:
- A.
At least 65 years of age
- B.
Currently works and is covered by an EGHP
- C.
65 years of age and currenly works and is covered by an EGHP
- D.
All of the above
Correct Answer
C. 65 years of age and currenly works and is covered by an EGHPExplanation
The term "working aged" refers to individuals who are both 65 years of age and currently employed, with coverage under an EGHP (Employer Group Health Plan). This means that they have reached the age of 65 and are still actively working while being covered by their employer's health insurance plan. Therefore, the correct answer is "65 years of age and currently works and is covered by an EGHP."Rate this question:
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- 34.
What is a payment by Medicare where another payer is responsible for payment and the claim is not expected to be paid promptly:
- A.
Assignment of benefits
- B.
Medicare secondary payer
- C.
Conditional payments
- D.
Medicare Administrative Contractor
Correct Answer
C. Conditional paymentsExplanation
Conditional payments refer to payments made by Medicare when another payer is responsible for payment, and the claim is not expected to be paid promptly. These payments are made on the condition that Medicare will be reimbursed when the primary payer makes the payment. It allows Medicare to provide temporary coverage until the primary payer fulfills its responsibility.Rate this question:
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- 35.
What is a written authorization, signed by the policy holder to an insurance company, to pay directly to the hospital:
- A.
Assignment of benefits
- B.
Medicare secondary payer
- C.
Conditional payments
- D.
Medicare administrative contractor
Correct Answer
A. Assignment of benefitsExplanation
An assignment of benefits is a written authorization, signed by the policy holder, that allows an insurance company to pay the hospital directly. This means that the policy holder gives permission for the insurance company to send payment directly to the hospital instead of the policy holder receiving the payment and then paying the hospital themselves. This helps streamline the payment process and ensures that the hospital receives payment promptly.Rate this question:
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- 36.
The assignment of benefits is usually acquired at what time:
- A.
Discharge
- B.
Admission
- C.
After surgery
- D.
None of the above
Correct Answer
B. AdmissionExplanation
The assignment of benefits is usually acquired at the time of admission. This means that when a patient is admitted to a healthcare facility, they are typically asked to sign an agreement that allows the healthcare provider to bill their insurance company directly for the services provided. This ensures that the healthcare provider receives payment for their services and the patient does not have to handle the insurance claims process themselves.Rate this question:
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- 37.
Who is the primary according to the birthday rule:
- A.
Mother
- B.
Father
- C.
The plan that has covered the parent longer
- D.
The parent born first in the calendar year
Correct Answer
D. The parent born first in the calendar yearExplanation
According to the birthday rule, the primary is determined by the parent who is born first in the calendar year. This means that if both parents have the same coverage, the parent who has their birthday earlier in the year will be considered the primary.Rate this question:
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- 38.
Who is primary if both parents have the same birthday:
- A.
Mother
- B.
Father
- C.
The plan that has covered the parent longer
- D.
The parent born first in the calendar year
Correct Answer
C. The plan that has covered the parent longerExplanation
The correct answer is "The plan that has covered the parent longer." This means that if both parents have the same birthday, the primary parent would be determined based on which parent has been covered by the insurance plan for a longer period of time. This criterion is used to determine the primary parent in cases where both parents have the same birthday.Rate this question:
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- 39.
In a divorce or separation which plan is primary:
- A.
Father
- B.
The parent that has custody
- C.
Mother
- D.
The parent that presented the child
Correct Answer
B. The parent that has custodyExplanation
In a divorce or separation, the parent that has custody is considered the primary plan. This means that the parent who has been granted legal custody of the child is responsible for making decisions regarding the child's upbringing, education, healthcare, and overall welfare. The parent with custody has the primary responsibility for the child's day-to-day care and is typically the one who will have the child living with them most of the time.Rate this question:
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- 40.
Benefits of electronic billing include all of the following except:
- A.
Provides proof of receipt
- B.
Less paper
- C.
Provides better follow up capabilities
- D.
Attachments can be sent electronically
Correct Answer
A. Provides proof of receiptExplanation
Electronic billing provides proof of receipt, which means that the sender has evidence that the recipient has received and acknowledged the bill. This helps to ensure that there is a record of the transaction and can be useful for resolving any disputes or discrepancies. Therefore, the statement "Provides proof of receipt" is not an exception but rather one of the benefits of electronic billing.Rate this question:
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- 41.
Problems with electronic billing include all of the following except:
- A.
Creates challenges
- B.
Less paper
- C.
Vendor reporting is inflexable and/or not available
- D.
Upload / download issues
Correct Answer
B. Less paperExplanation
The given answer, "Less paper," is not a problem with electronic billing. In fact, electronic billing is known for reducing the use of paper by allowing transactions to be conducted digitally. Therefore, this option does not fit the category of problems associated with electronic billing.Rate this question:
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- 42.
Elements of a chargemaster are found in what locator fields in the UB04:
- A.
18-28
- B.
31-34
- C.
39-41
- D.
42-49
Correct Answer
D. 42-49Explanation
The elements of a chargemaster are found in locator fields 42-49 in the UB04. These fields contain important information related to the charges for medical services provided, such as the procedure codes, revenue codes, and charges associated with each service. These fields are crucial for accurate billing and reimbursement purposes, as they provide detailed information about the services rendered and their corresponding costs.Rate this question:
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- 43.
Elements of a chargemaster include all of the following:
- A.
Modifiers
- B.
Revenue codes
- C.
ICD-9-codes
- D.
CPT/HCPCS codes
Correct Answer
C. ICD-9-codesExplanation
A chargemaster is a comprehensive list of all the services and procedures offered by a healthcare facility along with their corresponding prices. It is used for billing and reimbursement purposes. The elements of a chargemaster include modifiers, revenue codes, ICD-9 codes, and CPT/HCPCS codes. Modifiers are used to provide additional information about a service or procedure, revenue codes are used to indicate the type of service being provided, ICD-9 codes are used to classify diagnoses, and CPT/HCPCS codes are used to describe the services and procedures performed. These elements are necessary for accurate billing and coding in healthcare settings.Rate this question:
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- 44.
Department numbers are usually how many digits:
- A.
1
- B.
2
- C.
3
- D.
4
Correct Answer
C. 3Explanation
Department numbers are usually three digits.Rate this question:
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- 45.
How many major diagnostic categories are there:
- A.
25
- B.
50
- C.
745
- D.
500
Correct Answer
A. 25Explanation
There are 25 major diagnostic categories.Rate this question:
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- 46.
MS-DRG's were created on which tiers of payments:
- A.
A major complication or comorbidity
- B.
A complication or comorbidity
- C.
No complication or comorbidity
- D.
Only A and B
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
The correct answer is "All of the above". This means that MS-DRG's were created on all tiers of payments, including cases with major complications or comorbidities, cases with complications or comorbidities, and cases with no complications or comorbidities. This suggests that the MS-DRG system takes into account the severity and complexity of a patient's condition when determining the payment tier.Rate this question:
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- 47.
MS-DRG's result in savings to Medicare,
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
MS-DRG's (Medicare Severity Diagnosis Related Groups) do not result in savings to Medicare. In fact, MS-DRG's are a payment system used by Medicare to reimburse hospitals for inpatient services. They classify patients into different groups based on their diagnoses, procedures, age, and other factors, and assign a fixed payment amount for each group. The purpose of MS-DRG's is to standardize the payment process, not to generate savings for Medicare. Therefore, the correct answer is False.Rate this question:
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- 48.
Assignment of a MS-DRG uses the following elements in order for correct selection except:
- A.
Principle diagnosis
- B.
Condition codes
- C.
Discharge status
- D.
Surgical procedure
Correct Answer
B. Condition codesExplanation
The assignment of a MS-DRG requires consideration of various elements, including the principle diagnosis, discharge status, and surgical procedure. However, condition codes are not used in the selection process. Condition codes are typically used for reporting additional information about a patient's condition or circumstances, but they do not directly impact the assignment of a MS-DRG. Therefore, condition codes are not included in the elements used for correct selection.Rate this question:
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- 49.
How many days does CMS allow a hospital to file a subsequent inpatient DRG adjustment:
- A.
30 days
- B.
45 days
- C.
60 days
- D.
90 days
Correct Answer
C. 60 daysExplanation
CMS allows a hospital to file a subsequent inpatient DRG adjustment within 60 days. This means that after the initial submission of a claim, the hospital has a window of 60 days to make any necessary adjustments or corrections to the DRG assignment. This timeframe allows hospitals to review and analyze their coding and billing processes, ensuring accurate reimbursement and compliance with CMS guidelines.Rate this question:
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- 50.
Resource Utilization Groups are used to assess payment for wich facilities:
- A.
Skilled nursing facility
- B.
Inpatient hospital
- C.
Outpatient Hospital
- D.
Ambulatory Surgical Facility
Correct Answer
A. Skilled nursing facilityExplanation
Resource Utilization Groups (RUGs) are used to assess payment for skilled nursing facilities. RUGs are a classification system that categorizes patients based on their level of care needs and resource utilization. This system helps determine the reimbursement amount for skilled nursing facilities based on the specific RUG category assigned to each patient. Therefore, RUGs are not used to assess payment for inpatient hospitals, outpatient hospitals, or ambulatory surgical facilities.Rate this question:
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Mar 08, 2024Quiz Edited by
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Dec 29, 2010Quiz Created by
Mimsymom
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