CBCS Practice Exam #3 Questions and Answers 2024, Exams of Nursing

Download CBCS Practice Exam #3 Questions and Answers 2024 and more Exams Nursing in PDF only on Docsity! 1 CBCS Practice Exam #3 Questions and Answers 2024 A patient presents to the provider with chest pain and shortness of breath. After an unexpected ECG result, the provider calls a cardiologist and summarizes the patient's symptoms. What portion of HIPAA allows the provider to speak to the cardiologist prior to obtaining the patient's consent? - answers-Title II A physician is contracted with an insurance company to accept the allowed amount. The insurance company allows $80 of a $120 billed amount, and $50 of the deductible has not been met. How much should the physician write off the patient's account? - answers-$40 Which of the following sections of the medical record is used to determine the correct Evaluation and Management code used for billing and coding? - answers-History and physical A billing and coding specialist is reviewing a CMS-1500 claim form. The assignment of benefits box has been checked yes. The checked box indicates which of the following? - answers-The provider receives payment directly from the payer. Which of the following do physicians use to electronically submit claims? - answers-Clearinghouse Which of the following should the billing and coding specialist include in an authorization to release information? - answers-The entity to whom the information is to be released Which of the following describes the content of a medical practice aging report? - answers-An overview of the practice's outstanding claims HIPAA transaction standards apply to which of the following entities? - answers-Health care clearinghouses When a physician documents a patient's response to symptoms and various body systems, the results are documented as which of the following? - answers-Review of systems Which part of Medicare covers prescriptions? - answers-Part D Which of the following indicates a claim should be submitted on paper instead of electronically? - answers-The claim requires an attachment. 2 Medicare enforces mandatory submission of electronic claims for most providers. Which of the following providers is allowed to submit paper claims to Medicare? - answers-A provider's office with fewer than 10 full-time employees Which of the following is the correct term for an amount that has been determined to be uncollectable? - answers-Bad debt Which of the following statements is correct regarding a deductible? - answers-The deductible is the patient's responsibility. Which of the following statements is true regarding the release of patient records? - answers-Patient access to psychotherapy notes may be restricted. Why does correct claim processing rely on accurately complete encounter forms? - answers-They streamline patient billing by summarizing the services rendered for a given date of service. When posting payment accurately, which of the following items should the billing and coding specialist include? - answers-Patient's responsibility A dependent child whose parents both have insurance coverage comes to the clinic. The billing and coding specialist uses the birthday rule to determine which insurance policy is primary. Which of the following describes the birthday rule? - answers-The parent whose birthdate comes first in the calendar year Which of the following actions should the billing and coding specialist take to effectively manage accounts receivable? - answers-Collect copayment from the patient at the time of service. If a patient has osteomyelitis, he has problems with which of the following areas? - answers-Bones and bone marrow Which of the following is used by providers to remove errors from claims before they are submitted to third-party payers? - answers-Clearinghouse A provider receives a reimbursement from a third-party payer accompanied by which of the following documents? - answers-Explanation of benefits Which of the following is the appropriate diagnosis for a patient who has an abnormal accumulation of fluid in her lower leg that has resulted in swelling? - answers-Edema 5 Which of the following is an example of a violation of an adult patient's confidentiality? - answers-Patient information was disclosed to the patient's parent without consent. When coding on the UB-04 form, the billing and coding specialist must sequence the diagnosis codes according to ICD guidelines. Which of the following is the first listed diagnosis code? - answers-Principal diagnosis Which of the following steps would be part of a physician's practice compliance program? - answers-Internal monitoring and auditing A physician ordered a comprehensive metabolic panel for a 70-year-old patient who has Medicare as her primary insurance. Which of the following forms is required so the patient knows she may be responsible for payment? - answers-Advanced Beneficiary Notice Which of the following is the advantage of electronic claim submission? - answers-Claims are expedited Which of the following information is required to include on an Advanced Beneficiary Notice (ABN) form? - answers-The reason Medicare may not pay Which of the following documents is require to disclose an adult patient's information? - answers-A signed release from the patient A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which of the following documents? - answers-A billing worksheet from the patient account Which of the following modifiers should be used to indicate a professional service has been discontinued prior to completion? - answers-53 Which of the following is considered the final determination of the issues involving settlement of an insurance claim? - answers-Adjudication Which of the following parts of the body system regulates immunity? - answers-Lymphatic system The physician bills $500 to a patient. After submitting the claim to the insurance company, the claim is sent back with no payment. The patient still owes $500 for the year. This amount is called which of the following? - answers-Deductible In an outpatient setting, which of the following forms is used as a financial report of all services provided to patients? - answers-Patient account record 6 Which of the following is a private insurance carrier? - answers-Blue Cross/Blue Shield On the CMS-1500 claim form, Blocks 1 through 13 include which of the following? - answers-The patient's demographics A patient has met a Medicare deductible of $150. The patient's coinsurance is 20%, and the allowed amount is $600. Which of the following is the patient's out-of-pocket expense? - answers-$120 Which of the following billing patters is a best-practice action? - answers-Documenting the patient's chief complaint, history, exam, assessment, and plan for care Behavior plays an important part of being a team player in a medical practice. Which of the following is an appropriate action for the billing and coding specialist to take? - answers-Communicating with the front desk staff during a team meeting about missing information in patient files A billing and coding specialist should enter the prior authorization number on the CMS-1500 claim form in which of the following blocks? - answers-23 Which of the following is the primary information used to determine the priority of collection letters to patients? - answers-The age of the account Which of the following is the initial step in processing a workers' compensation claim? - answers-First report of injury Block 17b on the CMS-1500 claim form should list which of the following information - answers-Referring physician's national provider identifier (NPI) number Which of the following is allowed when billing procedural codes? - answers-Billing using two-digit CPT modifiers to indicate a procedure as performed differs from its usual five-digit code A billing and coding specialist should add modifier -50 to codes when reporting which of the following? - answers-A bilateral procedure Which of the following information should the billing and coding specialist input into block 33a on the CMS-1500 claim form? - answers-NPI A participating Blue Cross/Blue Shield (BC/BS) provider receives an explanation of benefits for a patient account. The charged amount was $100. BC/BS allowed $80 7 and applied $40 to the patient's annual deductible. BC/BS paid the balance at 80%. How much should the patient expect to pay? - answers-$48 Which of the following situations constitutes a consultation? - answers-Services rendered by a physician whose opinion or advice is requested by another physician or agency. In 1995 and 1997, which of the following introduced documentation guidelines to Medicare carriers to ensure that services paid for have been provided and were medically necessary? - answers-CMS Which of the following is a correct entry of a charge of $150 in Block 24F of the CMS-1500 claim form? - answers-150 00 Which of the following statements is true when determining patient financial responsibility by reviewing the remittance advice? - answers-Any coinsurance, copayments, or deductibles can be collected from the patient Which of the following blocks on the CMS-1500 claim form is required to indicate a workers' compensation claim? - answers-10a Which of the following is one of the purposes of an internal auditing program in a physician's office? - answers-Verifying that the medical records and the billing record match Which of the following is an example of electronic claim submission? - answers-Claims submitted via a secure network When an electronic claim is rejected due to incomplete information, which of the following actions should the medical billing specialist take? - answers-Complete the information and re-transmit according to the third-party standards The provision of health insurance policies that specifies which coverage is considered primary or secondary is called which of the following? - answers-Coordination of benefits For which of the following time periods should the billing and coding specialist track unpaid claims before taking follow-up action? - answers-30 days The standard medical abbreviation "ECG" refers to a test used to assess which of the following body systems? - answers-Cardiovascular The "><" symbol is used to indicate new and revised text other than which of the following? - answers-Procedure descriptors