Download Medical Billing and Coding Exam Questions with Confirmed Answers and more Exams Medical Records in PDF only on Docsity!
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AMCA BILLING & CODING TEST WITH CONFIRMED
ANSWERS
1.What type of insurance allows treatment virtually anywhere with a high deductible that policy
holders are willing to pay?
a. COBRA
b. EPO
c. PPO
d. HMO: C
2.Veterans with service related disabilities are eligible for case under which of the following
programs:
a. CHAMPUS
b. Medicare
c. CHAMPVA
d. TRICARE: C
3. is usually sponsored and partially paid by an employer.
a. TRICARE
b. Private Insurance
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c. Group Health Insurance
d. Worker's Aide: C
4. are used to report encounters for circumstances other than a
disease or injury in the ICD-10-CM.
a. A codes
b. V codes
c. Z codes
d. E codes: C
5.The abbreviation PMPM stands for:
a. Per member per month
b. Provider membership per management
c. Provider management provider manual
d. Pre menstrual after midnight: A
6.Schedule of benefits means:
a. Coordination of benefits
b. HMO
c. Medical service covered under the insured's policy
d. Managed care organization: C
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b. The billing and coding specialist is responsible for any errors made by the medical staff
c. The physician is responsible for any errors made by the medical staff
d. The person who has been employed for the longest period of time is responsible for any
errors made by the medical staff: C
11.HIPAA, stands for which of the following?
a. Health Insurance Portability and Accountability Act
b. Health Insurance Privacy Assessment and Agreement
c. Health Insurance Privacy and Agreements
d. Health Insurance Practices and Agreements: A
12.Information given by a patient to medical personnel that cannot be dis- closed without
consent constitutes:
a. Judgment
b. Duty of care
c. Privileged communication
d. Negligence: C
13.Why is a superbill/encounter form an important document in the office?
a. It is used when considering purchasing medical billing software
b. It has information needed for vendors
c. It ensures the correct spelling of the patient's name
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d. It ensures the correct patient data information and procedure codes: D
14.Which of the following facilities does not use CMS-1500 forms?
a. ASC (Ambulatory Surgery Center)
b. Nursing Home
c. Acute care
d. Dialysis clinic: D
15. Physicians usually submit claims for patients and receive payments direct- ly for the payers.
The policy holder authorizes this by signing and dating a:
a. Accept assignment
b. Schedule of benefits
c. Assignment of benefits
d. Encounter form: C
16. Under the HIPAA Privacy Rule, providers do not need specific authorization in order to
release a patients PHI for TPO purposes. What does TPO stand for?
a. Treatment, patient protection, operations
b. Treatment, payment and health care operations
c. Type of payment, patient and observation
d. Type of insurance, payment, and health care operations: B
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20.If a health plan member receives medical services from a provider who does not participate in
the plan, the cost for the member is typically:
a. Lower
b. Negotiable
c. Higher
d. The Same: C
21.The tertiary insurance pays:
a. After the first and second payer
b. After the receipt of the claim
c. After the patient has paid the co-insurance
d. After the payer: A
22.A certification number for a procedure is the result of which transaction and process?
a. Claims status
b. Coordination of benefits
c. Referral and authorization
d. Health care payments and remittance advice: C
23.Which of the following is one of the sections in the CPT Coding Manual?
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a. Encounters
b. Vaccinations
c. Pharmacy
d. Pathology and Laboratory: D
24.A late effect may be indicated in documentation by the use of the expres- sion(s):
a. Primary or secondary
b. Missile, puncture, with foreign body
c. Due to an old—due to a previous
d. Malignant: C
25.Multigravida is a term associated with:
a. Arthritis
b. Glaucoma
c. Bronchitis
d. Pregnancy: D
26.What insurance company is the payer of last resort?
a. Blue Cross and Blue Shield
b. Workers Compensation
c. Medicaid
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b. Colporrhaphy
c. Hysterectomy
d. Salpingectomy: C
31.If the patient is treated for both an acute and chronic condition, each of which has a separate
code, how should the codes be listed?
a. Acute code, chronic code
b. Chronic code, acute code
c. V code, condition code
d. Acute code, V code: A
32.A new patient is one who has not received services from the physician or any other physician in
that group for:
a. 3 years
b. 1 year c. 2 years d. 90 days: A
33.The abbreviation for PFSH is:
a. Present, family and social history
b. Past, family and/or social history
c. Patient, family and/or systems history
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d. Past, family and systems history: B
34.The three key factors in selecting E/M codes are:
a. Time, severity of presenting problem and history
b. History, examination and time
c. History, examination and medical decision making
d. Past history, history of present illness and chief complaint: C
35.When a panel code from the Pathology and Laboratory section is report- ed:
a. 50% of the listed tests must have been performed
b. 90% of the listed tests must have been performed
c. All the listed tests must have been performed
d. All of the listed tests must have been performed on the same day: C
36.What is the Medicare Coverage Gap also know as the "donut hole"?
a.The amount of out of pocket costs after a certain amount of money has been spent from Medicare
on prescription drugs
b. It is the gap in coverage from month to month
c. It is out of pocket costs associated with a hospital stay
d. It is a specific part of Medicare coverage that can be subscribed to: A
37.CPT is what level of Healthcare Common and Procedure coding system?
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40.Medicare Part A covers:
a. Physician services
b. MACs
c. Hospital services
d. Prescription drugs: C
41.A payer's initial processing of a claim screens for:
a. Utilization guidelines
b. Medical edits
c. Claim attachments
d. Basic errors in claim data or missing information: D
42.A claim may be downcoded because:
a. The claim does not list a charge for every procedure code
b. The claim is for non-covered services
c. The documentation does not justify the level of service
d. The procedure code applies to a patient of the other gender: C
43.Payers should comply with the required:
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a. Insurance aging report
b. Remittance advice
c. Claim turnaround time
d. Retention schedule: C
44.What is a capitated payment?
a. This is when a provider can only see specific patients with specific insur- ance
b. This is when a physician can only charge a specific amount of money
c. This is a regular payment received by the physician
d.This when a physician has a contract with an insurance company to be paid whether he sees the
patient or not: D
45.The patient aging report is used to:
a. Collect overdue accounts from patients
b. Enter write-offs to a patient's account
c. Enter payments into the patient billing system
d. Track overdue claims from payers: D
46.A deviated septum dur to a nasal fracture could be considered a:
a. Allergic effect
b. Early effect
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50.To indicate that something lies nearer the surface, use the term:
a. Distal
b. Superficial
c. Deep
d. Proximal: B
51.The definition of fraud would be:
a. submitting a claim with incorrect patient information
b. Unintentionally making a coding error
c. Providing poor quality care to the patient
d. Intentionally upcoding in order to increase payment: D
52.In order to find a code using the ICD-10-CM manual, the first step is to look up in the
index?
a. main term
b. nonessential modifier
c. manifestation
d. sub term: A
53.A lab report cannot be used for coding purposes because:
a. they are not reviewed by a physician before inclusion in the record
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b. Pathologists are not physicians
c. They are not part of the health record
d. They are diagnostic tests: A
54.Which one of the following instructional notes suggests that a second code may be
required?
a. Code also
b. Includes
c. See also
d. See: A
55.Which CPT modifier should the billing and coding specialist attach to a consultation code when
the service performed is required by a third party-pay- er r governmental regulatory body?
a. -59 (Distinct Procedural Services)
b. -32 (Mandated Services)
c. -22 (Unusual Procedural Services)
d. -26 (Professional Component): B
56.What do the letters NOS (not otherwise specified) indicate?
a. Equals unspecified
b. Encloses synonyms, alternative words or explanatory phrases
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a. Diabetes, hypertension
b. Shortness of breath, cough, pain, diabetes, hypertension
c. Pneumonia, diabetes, hypertension
d. Pneumonia, diabetes, hypertension shortness of breath cough, pain: B
60.In the following question, identify the term for the first-listed diagnosis in the following
encounter or visit. Established patient presented to clinic with exacerbation of Crohn's disease. Patient's rheumatoid arthritis stable.
a. Arthritis
b. Crohn's disease
c. Rheumatoid arthritis
d. Established patient: B
61.Identify the term for first-listed diagnosis in the following encounter or visit.
Initial office visit fir patient requiring management of COPD and CHF.
a. Established patient
b. Initial visit
c. COPD and CHF
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d. Pain management: C
62.The UB-04 is used for primarily what type of patient visit?
a. Clinic
b. Hospital inpatient
c. Urgent care
d. Emergency room: B
63.The term malignant refers to:
a. Site of origin or where the tumor originated
b. Site to which a malignant tumor has spread
c. Used to describe a cancerous tumor that grows worse over time
d. Malignancy that is located within the original site if development: C
64.Which of the following terms refers to a cancerous neoplasm in its original location?
a. Ca in situ
b. Benign
c. Malignant primary
d. Malignant secondary: A
65.In accordance to the Health Insurance Portability and Accountability Act (HIPAA), which of the
following organizations considers health plans, health care providers and clearinghouses as covered entities?
