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NHA BILLING AND CODING PRACTICE TEST (CBCS)
QUESTIONS AND CORRECT DETAILED
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When reviewing an established patient's insurance card, the billing coding specialist notices a minor change from the existing card on file. Which of the the following actions should the billing and coding specialist take? - CORRECT ANSWER>>>Photocopy both sides of the new card Which of the following accurately describes code symbols found in the CPT manual? - CORRECT 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 service is covered by Medicare? - CORRECT ANSWER>>>National Coverage Determination (NCD) Which of the electronic forms is used to post payments? - CORRECT ANSWER>>>Electronic Remittance advice (ERA) Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes which of the following procedures? - CORRECT ANSWER>>>Angioplasty The authorization number for a service that was approved before the service was rendered is indicated in which of the following blocks on the CMS-1500 form? - CORRECT ANSWER>>>Block 23 Which of the following block of the CMS-1500 claim form indicates an ICD diagnosis? - CORRECT ANSWER>>>Block 21 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? - CORRECT ANSWER>>>Primary care provider A provider surgically punctures through the space between the patient's ribs using an aspirating needle to withdraw fluid from the chest cavity. Which of the following is the name of this procedure? - CORRECT ANSWER>>>Pleurocentesis Which of the following standardized formats are used in the electronic filing of claims? - CORRECT ANSWER>>>HIPPA standard transactions
Which of the following blocks on the CMS-1500 claim form is used to accept assignment of benefit? - CORRECT ANSWER>>>Block 27 On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the following? - CORRECT ANSWER>>>The patient's condition and the provider's information The explanation of benefits states the amount billed was $80. The allowed amount is $60, and the patient is required to pay a $20 copayment. Which of the following describes the insurance check amount to be posted? - CORRECT ANSWER>>>$ Which of the following should a billing and coding specialist use to submit a claim with support documents? - CORRECT ANSWER>>>Claims attachment Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - CORRECT ANSWER>>>Operative report Which of the following is an example of a remark code from an explanation of benefits document? - CORRECT 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? - CORRECT ANSWER>>>UB- 04 A claim is denied due to termination of coverage. Which of the following actions should the billing and coding specialist take next? - CORRECT ANSWER>>>Follow up with the patient to determine current primary care provider for resubmission Which of the following national provider indentifiers (NPIs) is required in block 33a of a CMS-1500 claim form? - CORRECT ANSWER>>>Billing provider Which of the following is a reason a claim would be denied? - CORRECT ANSWER>>>Incorrectly linked codes
Which of the following organizations fights waste, fraud, and abuse in Medicare and Medicaid? - CORRECT ANSWER>>>Office of Inspector General (OIG) A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? - CORRECT ANSWER>>>Aging report Which of the following parts of the Medicare insurance program is managed by private, third-party insurance providers that have been approved by Medicare? - CORRECT ANSWER>>>Medicare Part C 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? - CORRECT ANSWER>>>Denied Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim form for procedures, services or supplies? - CORRECT ANSWER>>>Block 24D Which of the following forms does a third-party payer require for physician services? - CORRECT ANSWER>>>CMS- 1500 Which of the following reports is used to arrange the accounts receivable from the date of service? - CORRECT ANSWER>>>Aging report Which of the following provisions ensures that an insured's benefits from all insurance companies do not exceed 100% of allowable medical expenses? - CORRECT ANSWER>>>Coordination of benefits A physician's office fee is $100 and the Medicare Part B allowed amount is $85. Assuming the beneficiary has not met his annual deductible, the office should bill the patient for which of the following amounts?
- CORRECT ANSWER>>>$ Which of the following statements is accurate regarding the diagnostic does in Block 21? - CORRECT ANSWER>>>These codes must correspond to the diagnosis pointer in Block 24E
Which of the following describes an insurance carrier that pays the provider who rendered services to a patient? - CORRECT ANSWER>>>Third-party payer Which of the following formats are used to submit electronic claims to a third-party payer? - CORRECT ANSWER>>> Which of the following entities defines the essential elements of a comprehensive compliance plan? - CORRECT ANSWER>>>Office of Inspector General (OIG) Which of the following causes a claim to be suspended? - CORRECT ANSWER>>>Services require additional information A Medicare non-participating (non-PAR) provider's approval payment amount is for $200 for a lobectomy and the deductible has not been met. Which of the following amounts is the limiting charge for this procedure? - CORRECT ANSWER>>>$ For non-crossover claims, the billing and coding specialist should prepare an additional claim for the secondary payer and send it with a copy of which of the following? - CORRECT ANSWER>>>Remittance advice 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? - CORRECT ANSWER>>> On a CMS-1500 claim form , which of the following information should should the billing and coding specialist enter in Block 32? - CORRECT ANSWER>>>Service facility location information Which of the following best describes medical ethics? - CORRECT ANSWER>>>Medical standard of conduct A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500 claim form should this information be entered? - CORRECT ANSWER>>>Block 9
A billing and coding specialist has four past-due charges: $400 that is 10 weeks past due; $800 that is 6 weeks past due; $1,000 that is 4 weeks past due; and $2,000 that is 8 weeks past due. Which of the following charges should be sent to collections first? - CORRECT ANSWER>>>$2, Which of the following is a federal government health insurance program? - CORRECT ANSWER>>>Tricare A patient who is an active member of the military recently returned from overseas and is in need of specialty care. The patient does not have anyone designated with power of attorney. Which of the following is considered a HIPPA violation? - CORRECT ANSWER>>>The billing and coding specialist sends the patient's records to the patient's partner Which of the the following documentation is a valid authorization to release medical information to the judicial system? - CORRECT ANSWER>>>Subpoena duces tecum The explanation of benefits states the amount billed was $170. However, the allowed amount is $150. The patient has an unmet deductible of $50 and a copayment of $20. Which of the following amounts is the patient's responsibility? - CORRECT ANSWER>>>$ Which of the following is the primary function of the heart? - CORRECT ANSWER>>>Pumping blood in the circulatory system Which of the following is used to code diseases, injuries, impairments, and other health related problems? - CORRECT ANSWER>>>International Classification of Diseases (ICD) A husband and wife have group insurance through their employers. The wife has an appointment with her provider. Which insurance should be used as primary for the appointment? - CORRECT ANSWER>>>The wife's insurance Which of the following is the deadline for Medicare Claim submission? - CORRECT ANSWER>>> months from the date of service
Which of the following prohibits a provider from referring Medicare patients to a clinical laboratory service in which the provider has a financial interest? - CORRECT ANSWER>>>Stark Law Which of the following terms refers to the difference between the billed and allowed amount? - CORRECT ANSWER>>>Deductible A patient is preauthorized to receive Vitamin B12 injections from January 1 to May 31. On June 2, the provider orders an additional 6 months of injections. In order for the patient to continue with coverage of care, which of the following should occur? - CORRECT ANSWER>>>The provider should contact the patient's insurance carrier to obtain new authorization The "><" is used to indicate new and revised text other than which of the following? - CORRECT ANSWER>>>Procedure descriptors Which of the following pieces of guarantor information is required when establishing a patient's financial record? - CORRECT ANSWER>>>phone number Which of the following is a HIPPA compliance guideline affecting electronic health records? - CORRECT ANSWER>>>The Health Information Technology for Economic and Clinical Health (HITECH) Which of the following describes a code that would be denied? - CORRECT ANSWER>>>An italicized code as the primary diagnosis Urine moves from the kidneys to the bladder through which of the following parts of the body? - CORRECT ANSWER>>>Ureters Which of the following section of the SOAP note indicates a patient's level of pain to a provider? - CORRECT ANSWER>>>Subjective Which of the following actions by the billing and coding specialist would be considered fraud? - CORRECT ANSWER>>>Billing for services not provided
In 1996, CMS implemented which of the following to detect inappropriate and improper codes? - CORRECT ANSWER>>>National Correct Code Initiative (NCCI) Which of the following planes divides the body into left and right? - CORRECT ANSWER>>>Sagittal A billing and coding specialist is preparing a claim form for a provider from a group practice. The billing and coding specialist should enter the rendering provider's national provider identifier (NPI) into which of the following blocks on the CMS-1500 form? - CORRECT ANSWER>>>Block 24J Which of the following would most likely result in a denial on a Medicare claim? - CORRECT ANSWER>>>An experimental chemotherapy medication for a patient who has stage III renal cancer On a remittance advice form , which of the following is responsible for writing off the difference between the amount billed an the amount allowed by the agreement? - CORRECT ANSWER>>>Provider A billing and coding specialist submitted a claim to Medicare electronically. No errors were found by the billing software or clearinghouse. Which of the following describes this claim? - CORRECT ANSWER>>>Clean claim Which of the following is the purpose of coordination of benefits? - CORRECT ANSWER>>>Prevent multiple insurers from paying benefits covered by other policies Which of the following does a patient sign sign to allow payment of claims directly to the provider? - CORRECT ANSWER>>>Assignment of benefits Which of the following is the maximum number of modifiers that the billing and coding specialist can report on a CMS-1500 claim form in block 24D? - CORRECT ANSWER>>>Four What actions should a billing and coding specialist take if he sees a colleague acting unethically? - CORRECT ANSWER>>>Report the incident to the supervisor
When posting payment accurately, what items should the billing and coding specialist include? - CORRECT ANSWER>>>Patient responsibility What action should be taken if an insurance company denies a service as not medically necessary? - CORRECT ANSWER>>>File an appeal with the provider's documentation showing medical necessity
