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NHA Billing and Coding practice test
(CBCS) Questions and
Answers (latest update)
The attending physician -question to the answer-A nurse is reviewing a patients lab results prior to discharge and discovers an elevated glucose level. Which of the following health care providers should be altered before the nurse can proceed with discharge planning? The patients condition and the providers information -question to the answer-On the CMS-1500 Claims for, blocks 14 through 33 contain information about which of the following? Problem focused examination -question to the answer-A provider performs an examination of a patient's throat during an office visit. Which of the following describes the level of the examination? Reinstated or recycled code -question to the answer-The symbol "O" in the Current Procedural Terminology reference is used to indicate which of the following? Coinsurance -question to the answer-Which of the following is the portion of the account balance the patient must pay after services are rendered and the annual deductible is met? Place of service -question to the answer-The billing and coding specialist should divide the evaluation and management code by which of the following? Cardiovascular system -question to the answer-The standard medical abbreviation "ECG" refers to a test used to access which of the following body systems? add on codes -question to the answer-In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances?
12 -question to the answer-As of April 1st 2014, what is the maximum number of diagnosis that can be reported on the CMS-1500 claim form before a further claim is required? Nephrolithiasis -question to the answer-When submitting a clean claim with a diagnosis of kidney stones, which of the following procedure names is correct? Verifying that the medical records and the billing record match -question to the answer-Which of the following is one of the purposes of an internal auditing program in a physician's office? The DOB is entered incorrectly -question to the answer-Patient: Jane Austin; Social Security # 555-22- 1111; Medicare ID: 555-33-2222A; DOB: 05/22/1945. Claim information entered: Austin, Jane; Social Security #.: 555-22-1111; Medicare ID No.: 555-33-2222A; DOB: 052245. Which of the following is a reason this claim was rejected? Operative report -question to the answer-Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? Verify the age of the account -question to the answer-Which of the following actions should be taken first when reviewing delinquent claims? Claim control number -question to the answer-Which of the following components of an explanation of benefits expedites the process of a phone appeal? Bloc 24D contains the diagnosis code -question to the answer-A claim can be denied or rejected for which of the following reasons? Privacy officer -question to the answer-To be compliant with HIPAA, which of the following positions should be assigned in each office?
Ureters -question to the answer-Urine moves from the kidneys to the bladder through which of the following parts of the body? Angioplasty -question to the answer-Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes which of the following procedures? To ensure the patient understands his portion of the bill -question to the answer-A patient's portion of the bill should be discussed with the patient before a procedure is performed for which of the following reasons? Performing periodic audits -question to the answer-Which of the following actions by the billing and coding specialists prevents fraud? Name and address of guarantor -question to the answer-Which of the following information is required on a patient account record? Invalid -question to the answer-A claim is submitted with a transposed insurance member ID number and returned to the provider. Which of the following describes the status that should be assigned to the claim by the carrier? CMS-1500 claim form -question to the answer-Which of the following should the billing and coding specialist complete to be reimbursed for the provider's services? The electronic transmission and code set standards require every provider to use the healthcare transactions, code sets, and identifiers. -question to the answer-Which of the following is HIPAA compliance guideline affecting electronic health records? Verification of coverage. -question to the answer-Which of the following is the purpose of precertification
The entity to whom the information is to be released -question to the answer- Which of the following should the billing and coding specialist include in an authorization to release information? Report the incident to a supervisor -question to the answer-Which of the following actions should the billing and coding specialist take if he observes a colleague in an unethical situation? Patient's responsibility -question to the answer-When posting payment accurately, which of the following items should the billing and coding specialist include? The parent whose birthdate comes first in the calendar year -question to the answer-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? Patient access to psychotherapy notes may be restricted -question to the answer- Which of the following statements is true regarding the release of patient records? Denied -question to the answer-A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer? Clearinghouse -question to the answer-Which of the following do physicians use to electronically submit claims? principal diagnosis -question to the answer-When coding on the UB-04 form, the billing and coding specialist must sequence the diagnosis codes according to the ICD guidelines. Which of the following is the first listed diagnosis code? Block 9 -question to the answer-A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500 claim form should this information be entered?
Assignment of benefits -question to the answer-Which of the following does a patient sign to allow payment of claims directly to the provider? Military identification -question to the answer-All dependents 10 year of age or older are required to have which of the following for TRICARE? Private 3rd party payers -question to the answer-Medigap coverage is offered to Medicare beneficiaries by which of the following? Follow up of insurance claims by date -question to the answer-An insurance claims register (aged insurance report) facilitates which of the following? Urethratresia -question to the answer-Which of the following describes an obstruction of the urethra? Admitting clerk -question to the answer-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? The patient demographics -question to the answer-On the CMS-1500 claim form, Blocks 1 through 13 include which of the following Pumping blood in the circulatory system -question to the answer-Which of the following is the primary function of the heart? Submit an appeal to the carrier with the supporting documentation -question to the answer-Which of the following actions should be taken when a claim is billed for a level four office visit and paid at a level three?
Delinquent -question to the answer-Which of the following types of claims is 120 days old? Aging report -question to the answer-Which of the following shows outstanding balances? Part D -question to the answer-Which part of Medicare covers prescriptions? Dermatology -question to the answer-In which of the following departments should a patient be seen for psoriasis? Patient information was disclosed to the patient's parent without consent. - question to the answer- Which of the following is an example of a violation of an adult patient's confidentiality? Improper code combinations -question to the answer-Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? History and physical -question to the answer-Which of the following sections of the medical record is used to determine the correct Evaluation and Management code used for billing and coding? Blue shield/ Blue cross -question to the answer-Which of the following is a private insurance carrier? National provider identification number -question to the answer-Which of the following information should the billing and coding specialist input into Block 33a on the CMS-1500 claim form? UB-04 -question to the answer-Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? Pulmonary oncologist -question to the answer-A patient who has a primary malignant neoplasm of the lung should be referred to which of the following
They streamline patient billing by summarizing the services rendered for a given date of service - question to the answer-Why does correct claim processing rely on accurately completed encounter forms? Sagittal -question to the answer-Which of the following planes divides the body into left and right? Inform the patient of the reason of the denial -question to the answer-A patient is upset about a bill she received. Her insurance company denied the claim. Which of the following actions is an appropriate way to handle the situation? The claim is overdue for payment -question to the answer-Which of the following describes a delinquent claim? Use Arial size 10 font -question to the answer-When completing a CMS-1500 paper claim form, which of the following is an acceptable action for the billing and coding specialist to take? Pericardium -question to the answer-Which of the following medical terms refers to the sac that encloses the heart? Adjudication -question to the answer-Which of the following is considered the final determination of the issues involving settlement of an insurance claim? Encounter form -question to the answer-A form that contains charges, DOS, CPT codes, ICD codes, fees, and copayment information is called which of the following? Using data encryption software on office workstations -question to the answer- Which of the following privacy measures ensures protected health information (PHI)?
It indicates which claims are outstanding -question to the answer-Which of the following is the purpose of running an aging report each month? Billing for services not provided -question to the answer-Which of the following actions by a billing and coding specialist would be considered fraud? Paper claim -question to the answer-Which of the following claims is submitted and then optically scanned by the insurance carrier and converted to an electronic form? Block 12 -question to the answer-Which of the following blocks requires the patient's authorization to release medical information to process a claim? Block 24D -question to the answer-Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim form for procedures, services, or supplies? Guidelines prior to each section -question to the answer-The unlisted codes can be found in which of the following locations in the CPT manual? $40 -question to the answer-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 been met. How much should the physician write off the patient's account? Provider -question to the answer-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? Procedure descriptors -question to the answer-The "><" symbol is used to indicate new and revised text other than which of the following? The claim requires an attachment -question to the answer-Which of the following indicates a claim should be submitted on paper instead of electronically?
Health care clearinghouse -question to the answer-HIPAA transaction standards apply to which of the following entities? First report of injury -question to the answer-Which of the following is the initial step in processing a workers' compensation claim? Coordination of benefits -question to the answer-The provision of health insurance policies that specifies which coverage is considered primary or secondary is called which of the following? A provider's office with fewer than 10 full-time employees -question to the answer-Medicare enforces mandatory submission of electronic claims for most providers. Which of the following providers is allowed to submit paper claims to medicare? The 3rd party payer reimburses the patient, and the patient is responsible for reimbursing the provider. -question to the answer-When submitting claims, which of the following is the outcome if block 13 is left blank? accounts receivable -question to the answer-Patient charges that have not been paid will appear in which of the following? Remittance advice -question to the answer-A billing and coding specialist needs to know how much Medicare paid on a claim before billing secondary insurance. To which of the following should the specialist refer? A bilateral procedure -question to the answer-A billing and coding specialist should add modifier -50 to codes when reporting which of the following? CMS -question to the answer-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?
Billing using 2 digit CPT modifiers to indicate a procedure as performed differs from its usual 5 digit code -question to the answer-Which of the following is allowed when billing procedural codes? Cold treatment -question to the answer-The destruction of lesions using cryosurgery would use which of the following treatments? Code both acute and chronic sequencing the acute first -question to the answer- When a patient has a condition that is both acute and chronic how should it be reported? An overview of the practice's outstanding claims -question to the answer- Which of the following describes the content of a medical practice aging report? Fraud -question to the answer-After reading a provider's 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? The claim will not be re submitted and the patient will be sent a bill -question to the answer-A claim is denied because the service was not covered by the insurance company. Upon confirmation of no errors on the claim, which of the following describes the process that will follow the denial? A billing worksheet from the patient account -question to the answer-A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which of the following documents? Encryption -question to the answer-Which of the following security features is required during transmission of protected health information and medical claims to third party payers? HIPAA -question to the answer-Which of the following acts applies to the Administrative Simplification guidelines?
30 days -question to the answer-For which of the following time periods should the billing and coding specialist track unpaid claims before taking follow up action 0% -question to the answer-A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is responsible for which of the following percentages? Direct data entry -question to the answer-A biller will electronically submit a claim to the carrier via which of the following? Review of systems -question to the answer-When a physician documents a patient's response to symptoms and various body systems, the results are documented as which of the following? 150 00 -question to the answer-Which of the following is a correct entry of a charge of $140 in Block 24F of the CMS-1500 claim form? Services rendered by a physician whose opinion or advice is requested by another physician or agency - question to the answer-Which of the following situations constitutes a consultation? Bones and bone marrow -question to the answer-If a patient has osteomyelitis he has a problem with which of the following areas? An authorization -question to the answer-Which of the following forms must the patient or representative sign to allow the release of protected health information? Referring physician's national provider identifier (NPI) number -question to the answer-Block 17b on the CMS-1500 claim form should list which of the following information? NCCI -question to the answer-Which of the following was developed to reduce Medicare program expenditures by detecting inappropriate codes and eliminating improper coding practices?
Denied -question to the answer-Which of the following describes the status of a claim that does not include required preauthorization for a service? Lymphatic system -question to the answer-Which of the following parts of the body system regulates immunity? Clearinghouse -question to the answer-Which of the following is used by providers to remove errors from claims before they are submitted to 3rd party payers? Explanation of benefits -question to the answer-A provider receives reimbursement from a 3rd party payer accompanied by which of the following documents? Claims adjudication -question to the answer-Which of the following is the 3rd stage of the life cycle of a claim? Block 10a -question to the answer-Which of the following blocks on the CMS- 1500 claim form is required to indicate a workers' compensation claim? Duplication of services -question to the answer-2 providers from the same practice visit a patient in the emergency department using the same CPT code. The claim may be denied due to which of the following reasons? The patient was out of town during the emergency -question to the answer-A patient has an emergency appendectomy while on vacation. The claim is rejected due to the patient obtaining services out of network. Which of the following information should be included in the claim appeal? Incomplete claim -question to the answer-Which of the following is a type of claim that will be denied by the 3rd party payer?
Communicating with the front desk staff during a team meeting about missing information in patient files -question to the answer-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? $40 -question to the answer-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? The physician agrees to accept payment under the terms of the payer's program -question to the answer-Accepting assignment on the CMS- claim form indicates which of the following? Any coinsurance, copayments, or deductibles can be collected from the patient - question to the answer- Which of the following statements is true when determining patient financial responsibility by reviewing the remittance advice? Patient account record -question to the answer-In an outpatient setting, which of the following forms is used as a financial report of all services provided to patients? Edema -question to the answer-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? TRICARE Prime -question to the answer-Which of the following types of health insurance plans best describes a government sponsored benefit program? Recovery Audit Contractor (RAC) -question to the answer-Which of the following organizations identifies improper payments made on CMS claims? The reason Medicare may not pay -question to the answer-Which of the following information is required to include on an Advance Beneficiary Notice (ABN) form?
Block 21 -question to the answer-Which of the following blocks on CMS-1500 claim form is used to bill ICD codes? Claim adjustment codes -question to the answer-Which of the following terms is used to communicate why a claim line item was denied or payed differently than it was billed? The name, address, and ZIP code of the facility where services were rendered goes in this block. - question to the answer-Block 32con the CMS form contains what? -question to the answer-A provider's office requests a subpoena requesting medical documentation from a patient's medical record. After confirming the correct authorization, which of the following actions should the billing & coding specialist take? 12 months from the date of service -question to the answer-Which of the following is the deadline for a Medicare for claims submission? CMS-1500 -question to the answer-Which of the following forms does a 3rd party payer require for physician services? Charging excessive fees -question to the answer-Which of the following is an example of Medicare abuse? Adjustment -question to the answer-Which of the following terms refers to the difference between the billed and allowed amounts? Durable medical equipment -question to the answer-Which of the following HMO managed care services requires a referral? Advanced beneficiary notice (ABN) -question to the answer-Which of the following explains why Medicare will deny a particular service or procedure?
