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Medical Billing and Coding Practice Test, Exams of Advanced Education

University of WitwatersrandAdvanced Education

A practice test for medical billing and coding professionals. It covers a wide range of topics related to the medical billing and coding process, including insurance claims, coding compliance, claim submission, patient privacy, and medical terminology. The questions test the reader's knowledge of various aspects of the billing and coding workflow, such as identifying the appropriate claim form, applying coding guidelines, handling denials and appeals, and ensuring compliance with hipaa regulations. The document could be useful for students or professionals preparing for a certification exam or looking to review and reinforce their understanding of medical billing and coding best practices.

Typology: Exams

2024/2025

Available from 09/22/2024

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NAH PRACTICE TEST EXAM
which of the following is considered the final determination of the issues involving
settlement of an insurance claim? - adjudication : is the process of putting an insurance
claim through a series of edits for final determination.
a form that contains charges, DOS,CPT codes,ICD codes, fees, and copayment
information is called which of the following? - encounter form: an encounter form is a
form that contains charges, DOS,CPT codes,ICD codes, fees and copayment
information.
a patient comes to the hospital for an inpatient procedure.Which of the following hospital
staff members is responsible for the initial patient interview, obtaining demographic and
insurance information, and documenting the chief complaint? - admitting clerk : these
duties are the responsibility of the admitting clerk.
which of the following privacy measures ensures protected health information (phi)? -
using data encryption software on office workstation .
which of the following planes divides the body into left and right ? - sagittal
which of the following provisions ensures that an insured's benefits from all insurance
companies do not exceed 100 of allowable expanses ? - coordination of benefits
which of the following actions should be taken first when receiving a delinquent claim ? -
verify the age of the account
which of the following is the advantage of electronic claim submission? - claims are
expedited ; submitting claims electronically is faster than submitting paper claims.
which of the following components of an explanation of benefits expedites the process
of a phone appeal ? - check number
the standard medical abbreviation "ECG" refers to a test used to assess which of the
following body system? - cardiovascular system
which of the following actions by a billing and coding specialist would be considered
fraud? - billing for services not provided
the "><" symbol is used to indicate new and revised text other than which of the
following? - procedure description
on the cms-1500 claim form, blocks 14 through 33 contain information about which of
following? - the patient's condition and provider's information
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NAH PRACTICE TEST EXAM

which of the following is considered the final determination of the issues involving settlement of an insurance claim? - adjudication : is the process of putting an insurance claim through a series of edits for final determination. a form that contains charges, DOS,CPT codes,ICD codes, fees, and copayment information is called which of the following? - encounter form: an encounter form is a form that contains charges, DOS,CPT codes,ICD codes, fees and copayment information. a patient comes to the hospital for an inpatient procedure.Which of the following hospital staff members is responsible for the initial patient interview, obtaining demographic and insurance information, and documenting the chief complaint? - admitting clerk : these duties are the responsibility of the admitting clerk. which of the following privacy measures ensures protected health information (phi)? - using data encryption software on office workstation. which of the following planes divides the body into left and right? - sagittal which of the following provisions ensures that an insured's benefits from all insurance companies do not exceed 100 of allowable expanses? - coordination of benefits which of the following actions should be taken first when receiving a delinquent claim? - verify the age of the account which of the following is the advantage of electronic claim submission? - claims are expedited ; submitting claims electronically is faster than submitting paper claims. which of the following components of an explanation of benefits expedites the process of a phone appeal? - check number the standard medical abbreviation "ECG" refers to a test used to assess which of the following body system? - cardiovascular system which of the following actions by a billing and coding specialist would be considered fraud? - billing for services not provided the "><" symbol is used to indicate new and revised text other than which of the following? - procedure description on the cms-1500 claim form, blocks 14 through 33 contain information about which of following? - the patient's condition and provider's information

which of the following includes procedures and best practices for correct coding? - coding compliance plan : the coding compliance plan contain rules, procedure, and best practices to ensure accurately coding when completing a CMS-1500 paper claim form. Which of the following is an acceptable action for billing and coding specialist to take? - use Arial size font : the billing specialist should use Arial, Pica ,or Ocr size 10-,11-, or 12- point font for paper claims. A participating Blue Cross/ Blue Shield (BC/BS) provider receives an explanation of benefits for a patient amount. The charged amount was $100.00 BC/BS allowed $ and applied $40 to the patient's annual deductible .BC/BS paid the balance at 80%.How much should the patient expect to pay? - 48 : the patient will pay $40 deductible and 20% of $40 balance. which of the following indicates a claim should be submitted on paper instead of electronically? - the claim requires an attachment. ( the billing and coding specialist should submit a paper form if the claim requires an attachment). According to HIPPA standards, which of the following identifies the rendering provider on the CMS-1500 claim form in Block 24J? - NPI Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim form for procedures, services, or supplies? - 24D ( Block 24D is for procedures, services, or supplies) which if the following terms describes when a plan pays 70% of the allowable amount and the patient pays 30%? - coinsurance ( is a percentage of the cost for covered services that is approved by the insurance company) A provider charged $500 to a claim that had an allowable amount of $400. In which of the following columns should the billing and coding specialist apply the non-allowed charge? - Adjustment column of the credits : is where adjustments are recovered. Which of the following is a HIPAA compliance guideline affecting electronic health records? - The electronic transmission and code set standards require every provider to use Healthcare transaction, code set, and identifiers. Patient: Jane Austin, Social Security No: 555-22-1111; Medicare ID No: 555-33-2222A; DOB: 05/22/1945. Claim information entered: Austin, Jane; Social Security No: 555-22- 1111; Medicare ID No.: 555-33-2222A; DOB: 052245. What is the reason the claim was rejected? - The DOB is entered incorrectly. Why does correct claim processing rely on accurately completed encounter forms? - they streamline patient billing by summarizing the services rendered for a given date of service.

A patient is upset about a bill she received .Her insurance company denied claim. Which of the following actions is an appropriate way to handle the situation? - inform the patient of the reason of the denial. 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 a provider to speak to the cardiologist prior to obtaining the patient's consent? - title ii: Title II deals with administrative simplification.Which include communication with parties involved in the patient's care.The patient signs an agreement and a copy of HIPAA standards upon becoming a pt. 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? - Advanced Beneficiary Notice ( a form that is required for medicare recipients). which of the following describes the reason for a claim rejection because of Medicare NCCI edits? - Improper code combination (Medicare NCCI edits will trigger a claim rejection for improper code combination) which of the following is the purpose of running an aging report each month? - it indicates which claims are outstanding. (an aging report indicates the status of outstanding claims that need to be paid). Which of the following should the billing and coding specialist include in an authorization to realize Information? - the entity to whom the information is to be released. (the receiving entity must be included in the authorization) which of the following information is required on a patient account record? - name and adress of guarantor. which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? - UB-04 (this is the form used to bill hospital inpatient claims). an insurance claims register (aged insurance report) facilitates the following? - follow up of insurance claims by date (an aged insurance report is run by date. it can be sorted by date of service or date of submission. when posting payment accurately, which of the following items should the billing and coding specialist include? - patients responsibility could include a copayment ,deductible or coinsurance.

which of the following should the billing and coding specialist complete to be reimbursed for the provider's services? - CMS- As of April 1, 2014, what is the maximum number of diagnoses that can be reported on the CMS-1500 claim form before a further claim is required? - 12 (the cms-1500 is a paper form and can accept 12 diagnoses before a future claim is required) which of the following describes an obstruction of the urethra? - urethralagia which of the following options is considered proper supportive documentation for reporting CPT, and ICD codes for surgical procedure? - operative report ( surgical procedures are required to be supported by an operative report) which of the following describes a delinquent claim? - the claim is overdue for payment. All dependents 10 years of age or older are required to have which of the following for TRICARE? - military identification which of the following types of claims in 120 days old? - delinquent HIPAA transcation standards apply to which of the following entities? - health care clearinghouse ( Entites covered by HIPAA regulation include health care clearinghouses, providers of health care services , and health care third-party payers who submit transactions electronically.) which of the following actions should be taken when a claim is billed for a level four office list and paid at a level three? - submit an appeal to the carrier with the supporting documentation. when submitting a clean claim with a diagnosis of kidney stones, which of the following procedure name is correct? - Nephrolithiasis All e-mail correspondence to a third-party payer containing patient's protected health information (PHI) should be? - encrypted the billing and coding specialist should first divide the evaluation and management code by which of the following? - place of service in which of the following department should a patient be seen for psoriasis? - Dermatology A nurse is reviewing a patient's lab results prior to discharge and discovers an elevated glucose level.which of the following health care providers should be alerted before the nurse can proceed with discharge planning? - the attending physician

which of the following is the verbal or written agreement that gives approval to some action, situation, or statement, and allows the release of patient information? - consent agreement A claim can be denied or rejected for which of the following reasons? - block 24D contains the diagnosis code.. on the CMS-1500 claim form,Blocks 1 through 13 include which of the following? - the patient's demographics To be compliant with HIPAA, which of the following positions should be assigned in each office? - privacy officer which of the following information should the billing and coding specialist input into Block 33A on the CMS-1500 claim form? - national provider identification number Urine moves from the kidneys to the bladder through which of the following parts of the body? - ureters. which of the following sections of the medical record is used to determine the correct Evaluation and Management code used for billing and coding? - history and physical ( the evaluation and management code for the patient's current condition can be found in the history and physical section). on a Remittance Advice form, Which of the following is responsible for writing off the difference between the amount billed and the amount allowed by the agreement? - Provider ( the provider is responsible for writing off the difference between the amount billed and the amount allowed.) 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. - the parent whose birthdate comes first in the calendar year. which of the following statements is correct regarding a deductible? - the deductible is the patient's responsibility Which of the following claims is submitted and then optically scanned by the insurance carrier and converted to an electronic claim? - paper claim (a paper claim is submitted on paper and requires optical scanning to convert to electronic form) A patient who has a primary malignant neoplasms of the lung should be referred to which of the following specialist? - pulmonary oncologist

which of the following statement is true regarding the release of patient records? - patient access to psychotherapy notes may be restricted ( patients can not access psychotherapy notes or information complied for lawsuits.) which of the following is the primary function of the heart? - pumping blood in the circulatory system. A deductible of $100 is applied to a patient's remittance advice. The provider requests the account personnel write it off. Which of the following terms describes this scenario?

  • Fraud which of the following medical terms refers to the sac that encloses the heart? - pericardium 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? - $ ( that is the difference between the amount billed and amount allowed.The physician should write of $40)