NCCT Test Exam Questions with Verified Solutions 100% 2024, Exams of Advanced Education

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NCCT Test Exam Questions With

Verified Solutions 100% 2024

A patient has two health insurance policies-a group insurance plan through her full-time employer and another group insurance plan through her husband's employer. Which of the following policies should be billed as primary? - CORRECT ANSWERS-her policy Which of the following must a patient sign prior to an insurance claim being processed?

• CORRECT ANSWERS-an Authorization to Release Information A patient was seen in the office today for a follow up visit for neck and shoulder pain. After 20 minutes of face to face time with more than 50% of the time spent counseling the patient, it was decided the patient would benefit from a trigger point injection. After consent was taken, the physician injected 4 muscles. Which of the following CPT codes should be assigned? - CORRECT ANSWERS-99213-25, 20553 A patient presents to the ED with severe abdominal pain and constipation. X-rays were ordered to rule out a blockage in the intestine. Which of the following is the correct ICD- 10-CM coding? - CORRECT ANSWERS-R10.9,K56. The physician examines a patient for cervical radiculopathy. An electromyography is also reported as 95861. Which of the following code assignments represents the correct order the billing and coding specialist should use to submit services? - CORRECT ANSWERS-99214-25, Which of the following processes makes a final determination for payment in an appeal board? - CORRECT ANSWERS-arbitration A physician performed a bilateral L4/L5 Laminectomy on a patient in an ambulatory surgical center. Which of the following place of service codes should be used on the CMS 1500? - CORRECT ANSWERS- When there is a professional courtesy awarded to a patient's account the insurance and coding specialist should post the amount under the - CORRECT ANSWERS-adjustment column When posting an insurance payment via an EOB, the amount that is considered contractual is the - CORRECT ANSWERS-insurance allowed amount A 26 year old female presented to the Emergency Department with the complaint of severe headaches of 10-hour duration. An expanded problem focused history and examination were performed. The MDM was of moderate complexity. Which of the

following is the correct Evaluation and Management code for services provided? - CORRECT ANSWERS- If a provider refuses to accept assignment, when must the patient pay for services? - CORRECT ANSWERS-time of service The patient present to the ED with RLQ pain and fever. The physician lists appendicitis as a possible diagnosis. Which of the following ICD-10-CM codes should be assigned? - CORRECT ANSWERS-R10.31,R50. When using an EHR system to enter CPT codes on a CMS 1500 claim form for electronic submission, which of the following should be entered on the claim form first? - CORRECT ANSWERS-the most resource-intensive procedure or service A patient was seen in the office. Charges were recorded and submitted to the patient's insurance, and an EOB was received by the office with a payment of 78.89. These transactions should be recorded in the - CORRECT ANSWERS-patient ledger The provider is paid the same rate per patient wether or not they provide services and no matter which services were provided. This payment is known as - CORRECT ANSWERS-capitation The patient suffers from atherosclerotic heart disease caused by plaque deposits in a grafted internal mammary artery. The patient underwent arterial bypass graft four months ago. Which of the following ICD-10-CM codes should be assigned? - CORRECT ANSWERS-I25. Which of the following MCO's always requires an authorization before seeing a specialist? - CORRECT ANSWERS-HMO A 45-year-old patient with ESRD receives a unilateral cadaver kidney transplant. The surgeon performs the bench work in addition to the transplant. Which of the following CPT codes should be assigned? - CORRECT ANSWERS-50300, 50323 Developing and insurance claim begins - CORRECT ANSWERS-when the patient calls to schedule an appointment A patient present to office with RUQ abdominal pain. The physician sends the patient for HIDA scan to asses for possible cholelithiasis. Which of the following is the correct ICD-10-CM assignment? - CORRECT ANSWERS-R10. The patient's diagnosis is vesicoureteral reflux with nephropathy (without hydroureter) and chronic obstructive pyelonephritis due to E-coli infection. Which of the following ICD-10-CM codes should be assigned? - CORRECT ANSWERS-N13.729, N11.1, B96.

An insurance and coding specialist is reviewing Appendix M in the CPT book. Which of the following is she most likely performing? - CORRECT ANSWERS-checking for renumbered codes The insurance and coding specialist calls a carrier to verify a patient's insurance and the representative states that the patient's insurance was cancelled three months ago. Which of the following should the insurance and coding specialist do first? - CORRECT ANSWERS-Ask the patient for another form of insurance coverage. Which of the following financial reports produces a quarterly review of any dollar amount a patient still owes after all insurance carriers claims payments have been received? - CORRECT ANSWERS-aging A patient presents to the ED with multiple stab wounds to the arms and chest. On examination there are 3 deep lacerations to the arms measuring 1.2 cm, 1.4 cm, and 2.1 cm requiring complex closure, and 2 superficial wounds measuring 1.3 cm and 2. cm requiring intermediate closure. Which of the following is the correct CPT code assignment? - CORRECT ANSWERS-13121, 12032- Wound-Repair-Arm-Complex-Select Size Range-Arm Intermediate-Mod 59 (Distinct Procedural Service) Which of the following is the correct CPT code assignment for mediastinal and region lymphadenectomy with a RT video-assisted thoracic (VATS) lobectomy? - CORRECT ANSWERS-32663-RT, 32674 The patient is sent a statement for an office visit. The total amount of the bill is $100. and this amount must be paid before the insurance company will pay on the claim. Which of the following is this called? - CORRECT ANSWERS-deductible A Medicare patient presents to an outpatient hospital facility for a scheduled hysterectomy. To which Medicare plan should the facility submit the claim? - CORRECT ANSWERS-Part B Encounter forms should be audited to ensure the - CORRECT ANSWERS-diagnosis is in proper ICD-10-CM format Applying the birthday rule, a minor child comes in. Both parents have remarried and the child is listed on the mother's, father's, and both step-parents' policies. The mother's birthday is April 16, stepfather's birthday March 19, father's birthday is February 19th, and the stepmother's birthday is January 20th. Which of the following is correct? - CORRECT ANSWERS-Father's plan is primary,Mother's plan is secondary If the carrier's rate of benefits is 80%, the remaining 20% is known as - CORRECT ANSWERS-coinsurance

Which of the following fees posted to the patients account is an example of "usual, customary, and reasonable?" - CORRECT ANSWERS-allowed amount Collection agencies are regulated by the - CORRECT ANSWERS-Fair Debt Collections Practice Act Which of the following forms should be transmitted to obtain reimbursement following a physician's office visit for a patient with active Medicaid coverage? - CORRECT ANSWERS-CMS- HIPAA allows a health care provider to communicate with a patient's family, friends, or other persons who are involved in the patient's care regarding their mental health status providing - CORRECT ANSWERS-the patient does not object. The Fair Debt Collection Practices Act restricts debt collectors from engaging in conduct that includes - CORRECT ANSWERS-calling before 8:00 AM or after 9:00 PM, unless permission is given. When is a referral from a provider required? - CORRECT ANSWERS-when contained in the individual policy. When reviewing the charges for a patient procedure using computer assisted coding software (CAC), the insurance and coding specialist should first - CORRECT ANSWERS-review the chart for needed information. The patient presents today for upper gastrointestinal (GI) endoscopy and a biopsy of the stomach. Which of the following is the correct CPT code assignment? - CORRECT ANSWERS- A patient has not had an alcoholic drink for two years but has been diagnosed with alcoholic cirrhosis with ascities. Which of the following ICD-10-CM codes should be assigned? - CORRECT ANSWERS-K70.31, F10. Cirrhosis-Alcohol-Ascities Abstinence from Alcohol .21 Specifies that patient is in remission and not withdrawals. A patient was diagnosed with cancer in both breasts and was prepped for surgery today. A simple bilateral mastectomy was performed. Which of the following is the correct CPT code assignment? - CORRECT ANSWERS-19303- Mastectomy-Simple Mod 50 (Bilateral Procedure) Which of the following codes are correct when coding hypertension, chronic kidney disease, stage 3? - CORRECT ANSWERS-I12.9, N18. Kidney-Disease-Stage 3 Hypertension (Not specified must look at notes to find proper code)

was injured. Which of the following CPT codes should be assigned? - CORRECT ANSWERS-44120, 20103 Which of the following is an appropriate way to open the discussion when explaining practice fees to a patient? - CORRECT ANSWERS-"Do you have any questions about the cost of today's visit?" Which of the following defines the maximum time that a debt can be collected from the time it was incurred or became due? - CORRECT ANSWERS-statute of limitations When should a provider have a patient sign an ABN? - CORRECT ANSWERS-when the items may be denied and prior to performing the service. When posting transactions for electronic claim submission, it is necessary to enter which of the following items onto the claim? - CORRECT ANSWERS-physician's office fee Which of the following regulations prohibits the submission of a fraudulent claim or making a false statement or representation in connection with a claim? - CORRECT ANSWERS-Federal False Claims Act Which of the following federal regulations requires disclosure of finance charges, late fees, amount, and due dates for all payment plans? - CORRECT ANSWERS-Truth in Lending Act Which of the following modifiers is required for a return to the operating room for an unplanned related procedure or service by the same physician during the postoperative period? - CORRECT ANSWERS-- If the insurance and coding specialist suspects Medicare fraud she should contact the - CORRECT ANSWERS-OIG Office of Inspector General A patient is seen in the office for a candidal paronychia nail abscess was incised and drained. Which of the following is the correct CPT code assignment for physician services only? - CORRECT ANSWERS- A claim submitted with all the necessary and accurate information so that it can be processed and paid is called a - CORRECT ANSWERS-clean claim In order to have claims paid as quickly as possible, the insurance specialist must be familiar with which of the following? - CORRECT ANSWERS-payer's claim processing procedures A healthy 32-year-old patient required urgent vaginal hysterectomy following delivery of her third child. Which of the following anesthesia codes should be assigned? - CORRECT ANSWERS-01962-P

A 70-year-old patient was admitted for coronary ASHD. Cardiac catheterization performed showed numerous native vessels to be 70% to 100% blocked. The patient was taken to the operating room. A CABG was performed using five venous grafts and four coronary arterial grafts. Which of the following is the correct CPT coding? - CORRECT ANSWERS-33536, 33522 If the removal of the fallopian tubes and ovaries is the only procedure performed, which of the following is the appropriate code? - CORRECT ANSWERS- Collecting statistics on the frequency of copay collection at time of service is a step in the process of - CORRECT ANSWERS-managing A/R. Which of the following forms should be transmitted to obtain reimbursement following a physician's office visit for a patient with active Medicaid coverage? - CORRECT ANSWERS-CMS- A patient presents with low back pain. The physician ordered an MRI and discovered the patient has L5/S1 spondylolisthesis. Which of the following is the correct ICD-10-CM code assignment? - CORRECT ANSWERS-M43.