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CBCS Practice Test Questions with
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After a third-party payer validates a claim, which of the following takes place next? - ANSWER>>Claim adjudication When a patient has a condition that is both acute and chronic, how should I be reported? - ANSWER>>Code both acute and chronic sequencing the acute first Which of the following acts applies to the Administrative Simplification guidelines? - ANSWER>>Health Insurance Portability and Accountability Act (HIPAA) After reading a providers notes about a new patient, a coding specialist decides to code for a longer length of time than the actual office visit. Which of the following describes the specialist's action? - ANSWER>>Fraud A biller will electronically submit a claim to the carrier via which of the following? - ANSWER>>Direct Data Entry Which of the following is the purpose of running an aging report each month? - ANSWER>>It indicates which claims are outstanding
Which of the following is a type of claim that will be denied by the thirdparty payer? - ANSWER>>incomplete claim Which of the following actions should the billing and coding specialist take to prevent fraud and abuse in the medical office? - ANSWER>>Internal monitoring and auditing Which of the following is a verbal or written agreement that gives approval to release protected health information (PHI)? - ANSWER>>consent Which of the following is a requirement of some Third-party payers before a procedure is performed? - ANSWER>>Preauthorization form Which of the following is the function of the respiratory system? - ANSWER>>Oxygenating blood cells The destruction of lesions using cryosurgery would use which of the following treatments? - ANSWER>>cold treatment Z codes are used to identify which of the following? - ANSWER>>immunizations Which of the following types of health insurance plans best describes a government-sponsored benefit program? - ANSWER>>TRICARE Prime The star Symbol in the CPT code book is used to indicate which of the following? - ANSWER>>Telemedicine
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? - ANSWER>>Tittle II Which of the following is an example of a violation of adult Patients confidentiality? - ANSWER>>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 code according to the ICD guidelines. Which of the following is the first listed diagnosis code? - ANSWER>>Principal diagnosis Which of the following steps would be part of a physicians practice compliance program? - ANSWER>>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 that the patient knows she may be responsible for the payment? - ANSWER>>Advance beneficiary notice Which of the following is the advantage of electronic claim submission? - ANSWER>>Claims are expedited
Which of following information is required to include on an advance beneficiary notice (ABN) form? - ANSWER>>The reason Medicare may not pay Which of the following documents is required to disclose in adult patients information? - ANSWER>>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?
- ANSWER>>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? - ANSWER>>-53 This modifier is used by the physician to indicate that a procedure was begun but discontinued prior to its completion Which of the following is considered the final determination of the issues involving Settlement of an insurance claim? - ANSWER>>adjudication The process of putting an insurance claim through a series of edits for final determination 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. The amount is called which of the following? - ANSWER>>Deductible Which of the following parts of the body system regulates immunity? -
On the CMS-1500 claim form, blocks 1 through 13 include which of the following? - ANSWER>>The patient's demographics A patient has met a Medicare deductible of $150. The patient coinsurance is 20% and the allowed amount is $600. Which of the following is the patients out of pocket expense? - ANSWER>>$ Since the patient's deductible has been met the patient responsibilities 20% of the allowed amount which of the following billing patterns is a best-practice action? - ANSWER>>Documenting the patient's chief complaint, history, exam, assessment, and plan for care Behavior plays in 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? - ANSWER>>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? - ANSWER>>Block 23 Which of the following is the primary information used to determine the priority of collection letters to patients? - ANSWER>>The age of the account Which of the following is the initial step in processing a Worker's
Compensation claim? - ANSWER>>First report of injury Box 17 B on the CMS-1500 claim form should List which of the following information? - ANSWER>>Referring physician's national provider identifier (NPI) number Which of the following is a loud wind billing procedural codes? - ANSWER>>Billing using two digit CPT modifiers to indicate a procedure as performed differs from its usual five digit code A patient has an emergency appendectomy While on vacation. The claim is rejected due to the patient obtaining service out of pocket. Which of the following information should be included in the claim appeal? - ANSWER>>The patient was out of town during the emergency A billing and coding specialist should add modifier - 52 codes when reporting which of the following? - ANSWER>>Bilateral procedure Which of the following information should the billing and coding specialist input into block 33A on the CMS-1500 claim form? - ANSWER>>National Provider Identification Number A participating Blue Cross Blue Shield provider receives an explanation of benefits for a patient account. The charge amount was $100. Blue Cross Blue Shield allowed $80 and applied $40 to the patient's annual deductible. Blue Cross Blue Shield paid the balance at 80%. How much should the patient expect to pay? - ANSWER>>$
Which of the following is an example of electronic claim submission? - ANSWER>>Claims submitted via a secure network When electronic claim is rejected due to incomplete information, which of the following actions should the medical billing specialist take? - ANSWER>>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? - ANSWER>>Coordination of benefits For which of the following time periods should be billing and coding specialist track unpaid claims for taking follow up action? - ANSWER>> days Excepting assignment on the CMS 1500 claim form indicates which of the following? - ANSWER>>The physician agrees to except payment under the terms of the payers program The standard medical abbreviation "ECG" Refers to a test used to assess which of the following body systems? - ANSWER>>Cardiovascular system Which of the following claims would appear on an aging report? - ANSWER>>A claim that is delinquent for 60 days
When submitting claims, which of the following is the outcome if block 13 is left blank? - ANSWER>>The third-party payer reimburses the patient and the patient is responsible for reimbursing the provider. Which of the following was developed to reduce Medicare program expenditures by Detecting an appropriate codes and eliminating and proper coding practices? - ANSWER>>NCCI The national correct coding initiative was implemented in 1996 to detect an appropriate codes and illuminate improper coding practices Which of the following organizations identifies improper payments made on a CMS claim? - ANSWER>>Recovery audit contractor (RAC) Which of the following is the portion of the account balance the patient must pay after services are rendered in the annual deductible is met? - ANSWER>>coinsurance Which of the following describes the status of a claim that does not include required pre-authorization for a service? - ANSWER>>Denied A billing and Coding Specialist needs to know how much Medicare paid on a claim before billing the secondary insurance. To which of the following should the specialist refer? - ANSWER>>remittance advice Which of the following medical terms refers to the sac that encloses the heart? - ANSWER>>pericardium
A patient who has an HMO insurance plan needs to see a specialist for a specific problem. From which of the following should the patient obtain a referral? - ANSWER>>Primary care provider Which of the following standardized formats are used in the electronic filling of claims? - ANSWER>>HIPAA standard transactions A provider surgically punctures through the space between the patients ribs using an aspirating needle to withdraw fluid from the chest cavity. Which of the following is the name of this procedure? - ANSWER>>Pleurocentesis On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the following? - ANSWER>>The patient's condition and the provider's information Which of the following blocks on the CMS-1500 claim form is used to accept assignment of benefit? - ANSWER>>Block 27 The explanation of benefits states the amount billed was $80. The allowed amount is $60, and the patient is required to pay a $20 copayment. Which of the following describes the insurance check amount to be posted? - ANSWER>>$ The allowed amount is $60 and the patient is required to pay $ copayment. The difference in cost is $40, which would be the insurance check.
Which of the following should a billing and coding specialist use to submit a claim with supporting documents? - ANSWER>>Claims attachment When reviewing an established patients insurance card, the billing and coding specialist notices a minor change from the existing card on file. Which of the following actions should the billing and coding specialist take?
- ANSWER>>Photocopy both sides of the new card Which of the following accurately describes code symbols found in the CPT manual? - ANSWER>>A product pending FDA approval is indicated as a lightning bolt symbol Which of the following Medicare policies determines if a particular item or services is covered by Medicare? - ANSWER>>National coverage determination (NCD) Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - ANSWER>>Operative report Which of the following is an example of a remark code from an explanation of benefits document? - ANSWER>>Contractual allowance Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? - ANSWER>>UB- 04
When coding a front torso burn, which of the following percentages should be coded? - ANSWER>>18% Which of the following is true regarding Medicaid eligibility? - ANSWER>>Patient eligibility is determined monthly Which of the following describes a key component of an evaluation and management service? - ANSWER>>history Which of the following is considered fraud? - ANSWER>>The billing and coding specialist unbundles a code to receive higher reimbursement Which of the following is an example of Medicare abuse? - ANSWER>>Charging excessive fees Which of the following privacy measures ensures protected health information (PHI)? - ANSWER>>Using data encryption software on office workstations Which of the following organizations fights waste, fraud, and abuse is Medicare and Medicaid? - ANSWER>>Office of Inspector General Which of the following parts of the Medicare Insurance program is managed by private, third-party insurance providers that have been approved by Medicare? - ANSWER>>Medicare Part C
A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? - ANSWER>>Aging report A patients employer has not submitted a premium payment. Which of the following claim statutes should the provider receive from the third-party payer? - ANSWER>>Denied Which of the fowling forms does a third-party payer require for physician services? - ANSWER>>CMS- 1500 Which of the following reports is used to arrange the accounts receivable from the date of service? - ANSWER>>Aging report Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim form for procedures, services, or supplies? - ANSWER>>Block 24D Which of the following provisions ensures that an insureds benefits from all insurance companies do not exceed 100% of all allowable medical expenses ? - ANSWER>>Coordination of benefits A physicians office fee is $100 and the Medicare part B allowed amount is $85. Assuming the beneficiary has not met his annual deductible, the office should bill the patient for which of the following amounts? - ANSWER>>$
ANSWER>>
On a CMS-1500 claim form, which of the following information should the billing and coding specialist enter into block 32? - ANSWER>>Service Facility location information Which of the following best describes medical ethics? - ANSWER>>Medical standard of conduct A patient has AARP a secondary insurance. In which of the following blocks on the CMS-1500 claim form should this information be entered? - ANSWER>>Block 9 A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by first using which of the following process? - ANSWER>>Precertification When a third-party payer request copies of patient information related to a claim, the billing and coding specialist must make sure which of the following is included in the patient's file? - ANSWER>>Signed release of information form In the Anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? - ANSWER>>add-on codes
A provider performs an examination of a patient's knee joint via small incisions and an optical device. Which of the following terms describes this procedure? - ANSWER>>Arthroscopy Which of the following describes the term "crossover" as it relates to Medicare? - ANSWER>>When an insurance company transfers data to allow coordination of benefits of a claim Which of the following qualifies as an exception to the HIPAA privacy rule?
- ANSWER>>Psychotherapy notes A patient has laboratory work done in the emergency department after an inhalation of toxic fumes from a faulty exhaust fan at her place of Employment. Which of the following is responsible for the charges? - ANSWER>>Workers compensation If both parents have full coverage for a dependent child, which of the following is considered to be the primary insurance holder? - ANSWER>>The parent whose birthday comes first in the calendar year is the primary insurance holder Which of the following describes the organization of an aging report? - ANSWER>>By date Which of the following actions by the billing and coding specialist Prevents fraud? - ANSWER>>Performing periodic audits
