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Certified Billing and Coding Specialist
Primary diagnosis - When coding for outpatient and professional services and procedures, a billing and coding specialist must sequence the diagnosis codes according to ICD-10-CM guidelines. Which of the following describes the first listed diagnosis code on a claim? Coinsurance - Which of the following terms describes the amount the patient must pay for a service when they have an insurance plan benefit that pays 70% of the allowed amount and the patient is responsible for 30% of the allowed amount? Remove all information other than what pertains to the patient - A billing and coding specialist is contacted by a patient who requests a copy of the remittance advice for a recently adjudicated claim. Which of the following actions should the specialist take? -80 - A billing and coding specialist is billing for services provided by an assistance surgeon. Which of the following modifiers should the specialist use? Date of birth - A billing and coding specialist is reviewing a claim edit report and identifies a rejection for missing patient demographic information. Which of the following missing pieces of patient demographic information would cause a rejection from the clearinghouse? Pathology and Laboratory - Which of the following sections of the CPT manual lists the code for WBC with differential, automated? Any coinsurance, copayments, or deductibles should be collected from the patient - Which of the following statements is true when determining patient financial responsibility by reviewing the remittance advice?
The referring providers national provider identifier (NPI) - Which of the following should be included on a claim form that is sent from a specialist to a managed health care organization? Greater than 120 days - A billing and coding specialist is analyzing the health of a practice's revenue cycle using an aging report. Which of the following categories of the report should contain the lowest percentage of accounts receivable? Electronic remittance advice (ERA) - Which of the following is an electronic form that is used to post reimbursements? TRICARE - A billing and coding specialist is collecting demographic information for a patient who lives in Hawaii and is an active-duty service member. The specialist should identify that the insured has which of the following types of insurance? Privacy officer - Which of the following positions is required in a provider's office to comply with HIPAA regulations? To ensure the patient understands how much they are responsible to pay - A patient's portion of the bill should be discussed with the patient before a procedure is performed for which of the following reasons? Part C - A patient is covered by Medicare through managed care. Which of the following parts of Medicare includes this coverage? Charged amount - Payment amount - Adjustment amount = Patient responsibility - A billing and coding specialist is posting payments from an explanation of benefits (EOB). Which of the following equations determines how patient responsibility is calculated? Include an attachment to the claim -
A billing and coding specialist is coding a consultation in the providers office. The provider documented that a detailed examination was performed. Which of the following evaluation and management (E/M) codes should the specialist report? Complex - A billing and coding specialist is coding a laceration repair and needs to determine the type of closure. The specialist queries the provider, who confirms retention sutures were used. The specialist should code which of the following types of closure? Review the operative report - A billing and coding specialist is coding a claim for a provider who performed a hysterectomy and needs to determine whether the procedure was done by an excisional or laparoscopic procedure. Which of the following actions should the specialist take to determine the correct CPT procedure code? 99203 - A billing and coding specialist is processing a claim for a new patient who came to the office for a sore throat. The provider diagnosed the patient with tonsilitis and wrote a prescription for antibiotics. Which of the following codes should the specialist use? The modifier is not valid with the procedure - A billing and coding specialist is reviewing a denied claim for a 19-year-old patient's hysterectomy (58150-26). Which of the following is the reason for the denial? Garnishment - A billing and coding specialist is preparing a small claims court case against a patient for a delinquent account in the amount of $6,500. Which of the following is a court order that allows payments on unsecured debt to be made directly from a defendant's paycheck? Life insurance policy - Which of the following requires an authorization to release protected health information (PHI)? Operative report -
Which of the following is proper supportive documentation for reporting CPT and ICD-10-CM codes for the removal of a skin lesion? The patients third party payer should be contacted to obtain a new preauthorization - A patient is preauthorized to receive vitamin B12 injections from January 1 to May 31. On June 2, the provider prescribes an additional 6 months of injections. In order for the patient to continue with coverage of care, which of the following should occur? Cough, chest congestion, and low-grade fever - A patient was seen in an outpatient clinic for a cough, chest congestion, and a low-grade fever and was given the diagnosis of possible pneumonia. How should a billing and coding specialist code this encounter using ICD-10-CM? E10.22 - A billing and coding specialist is reviewing the encounter form for a patient who has type 1 diabetes mellitus and stage III chronic kidney (CKD). Which of the following diagnosis codes should be assigned? The electronic transmission and code set standards require every provider to use the health care transactions, code sets, and identifiers - Which of the following is a HIPAA compliance guideline affecting health records? Title II: Administrative Simplification - A patient presents to a provider with chest pain and shortness of breath. After an unexpected EKG result, the provider calls a cardiologist and summarized the patient's symptoms. Which of the following is a portion of HIPAA that allows the provider to speak to the cardiologist prior to obtaining the patients consent? O24.410 - A patient Is in the third trimester of pregnancy and has developed gestational diabetes mellitus that is diet controlled. Which of the following codes should a billing and coding specialist assign to this patient? Medical decision making -
A patient had an x-ray for a fractured arm. The documentation does not indicate if the x ray was performed on the right or left arm. Which of the following actions should a billing and coding specialist take? -P1 - Which of the following physical status modifiers should a billing and coding specialist use for anesthesia services performed as a health 4-year-old patient? Checking claims against payer edits for missing, incomplete, or invalid information - A billing and coding specialist is training a new specialist about submitting claims to a clearinghouse. Which of the following describes the process completed by the clearinghouse before submitting claims to a third-party payer? Billing for services not provided to obtain higher reimbursement - Which of the following actions by a billing and coding specialist is an example of fraud? Review the scrubber report - A billing and coding specialist is submitting a batch of claims to the clearinghouses and receives a report stating that three claims were rejected. Which of the following actions should the specialist take? The ICD-10-CM code for tonsilitis was listed with the CPT code for an appendectomy - A billing and coding specialist is reviewing a remittance advice for a claim that was denied for medical necessity. Which of the following is an example of this type of error? Medicine section - A patient undergoes hemodialysis. The code for this procedure is found in which of the following areas of the CPT manual? Z51.11 Chemotherapy - A patient has a history of breast cancer that has metastasized to the liver and is undergoing chemotherapy today for the liver cancer. Which of the following ICD-10-CM codes should be sequenced first? Review of systems -
A provider documents a patient's response to questions about various parts of the body, A billing and coding specialist should identify that this information is included in which of the following sections of the note? Aging report - Which of the following documents should a billing and coding specialist use to ensure that all payers are sending reimbursement within 45 days of claim submission? Precertification - Which of the following processes is used to verify patient benefits and insurance coverage for an outpatient procedure? Encryption - Which of the following security features is required during transmission of protected health information and medical claims to third party payers? Fraud - A billing and coding specialist is reviewing a remittance advice that has a deductible of $ indicated for one of the claims. The provider asks the specialist to write it off. Which of the following describes this scenario? Health care clearinghouses - Which of the following is a covered entity affected by HIPAA security rules? Seventh character - Based on coding guidelines, which character in an ICD-10-CM diagnosis code provides information about the encounter for care? NCD - A billing and coding specialist is verifying coverage for a Medicare beneficiary. Which of the following determines Medicare coverage of services on a national level? When a third-party payer transfers data to allow coordination of benefits for a claim - Which of the following describes the term "crossover" as it relates to Medicare?
Part D - A billing and coding specialist is posting a payment received from Medicare. The specialist should identify that which part of Medicare covers prescription costs? Remark code - A billing and coding specialist is reviewing an electronic remittance advice (ERA). Which of the following gives additional information about the denial of reimbursement? National Correct Coding Initiative (NCCI) - A billing and coding specialist is evaluating code assignments for a batch of claims. Which of the following should the specialist consult as a resource to check for proper code assignment based on procedure to procedure (PTP) code pair edits and medically unlikely edits (MUEs)? Recovery Audit Contractors (RACs) - Which of the following identifies improper payments made for CMS claims? Scrubbing claims, translating them to a standard format, then sending them to various third-party payers - A billing and coding specialist is submitting claims through a clearinghouse. The specialist should identify that which of the following actions is performed by the clearinghouse? Subpoena duces tecum - Which of the following is a valid type of authorization used to release medical information to the judicial system? Denied - A patient's employer has not submitted a premium payment for the company's commercial insurance plan. Which of the following is the claim status the provider will receive for any claims sent to the third-party payer? Redetermination - A billing and coding specialist is appealing a Medicare denial. Which of the following is the first step in the appeals process?
A provider accepts assignment for a patient who has a $10 copayment and has already met $100 of their $150 deductible. The office charge is $100, and the allowed amount is $70. How much should the provider's office adjust off the patients account? Professional component - Which of the following describes a CPT modifier that is used to indicate a provider supervised and interpreted a radiology procedure? Professional component - Which of the following describes a CPT modifier that is used to indicate a provider supervised and interpreted a radiology procedure? Within 1 year from the date of service - Which of the following is the filing limit for claim submission for an outpatient service with TRICARE? 58558 - A billing and coding specialist is coding a procedure note for a patient who had a diagnostic hysteroscopy that resulted in a hysteroscopic cervical biopsy. Which of the following codes should the specialist use? 6 - How many behavior classifications are included in the Table of Neoplasms in the ICD-10-CM? Bad debts - A billing and coding specialist is preparing a list of delinquent accounts over 300 days old that have received telephone calls, letters, and have been referred to a collection agency with no results. Which of the following is the term that describes accounts receivable that are deemed to be "uncollectable"? As an annual percentage rate -
Medicare Part A - A billing and coding specialist in an internal medicine practice is assisting a patient who is already collecting social security but will be turning 65 in the next year and has questions about what Medicare will cover. The specialist should know that which of the following is the Medicare benefit the patient will be enrolled in automatically? Claims adjustment reason codes - Which of the following is used to communicate why a claim line item was denied or paid differently than it was billed? E11.319, Z79.4 - A patient who is insulin-dependent is diagnosed with diabetic retinopathy. According to ICD- 10-CM coding guidelines. In which of the following orders should the codes be reported on the claim form? CPT codes - Which of the following are used to code provider and outpatient services?
