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The attending physician - Solution-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 - Solution-On the CMS- 1500 Claims for, blocks 14 through 33 contain information about which of the following? Problem focused examination - Solution-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 - Solution-The symbol "O" in the Current Procedural Terminology reference is used to indicate which of the following? Coinsurance - Solution-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 - Solution-The billing and coding specialist should divide the evaluation and management code by which of the following? Cardiovascular system - Solution-The standard medical abbreviation "ECG" refers to a test used to access which of the following body systems? add on codes - Solution-In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? 12 - Solution-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 - Solution-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 - Solution- Which of the following is one of the purposes of an internal auditing program in a physician's office? The DOB is entered incorrectly - Solution-Patient: Jane Austin; Social Security # 555-22-1111; Medicare ID: 555-33-2222A; DOB: 05/22/1945.
NHA Billing and Coding Real Test
(CBCS) 2025
Claim information
Deductible - Solution-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 this year. International Classification of Disease (ICD) - Solution-Which of the following is used to code diseases, injuries, impairments, and other health related problems? Ureters - Solution-Urine moves from the kidneys to the bladder through which of the following parts of the body? Angioplasty - Solution-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 - Solution-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 - Solution-Which of the following actions by the billing and coding specialists prevents fraud? Name and address of guarantor - Solution-Which of the following information is required on a patient account record? Invalid - Solution-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 - Solution-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. - Solution-Which of the following is HIPAA compliance guideline affecting electronic health records? Verification of coverage. - Solution-Which of the following is the purpose of precertification The entity to whom the information is to be released - Solution-Which of the following should the billing and coding specialist include in an authorization to release information? Report the incident to a supervisor - Solution-Which of the following actions should the billing and coding specialist take if he observes a colleague in an unethical situation?
Patient's responsibility - Solution-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 - Solution-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 - Solution-Which of the following statements is true regarding the release of patient records? Denied - Solution-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 - Solution-Which of the following do physicians use to electronically submit claims? principal diagnosis - Solution-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 - Solution-A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500 claim form should this information be entered? NPI - Solution-According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500 claim form in Block 24j? Oxygenating blood cells - Solution-Which of the following is the function of the respiratory system? Coordination of benefits - Solution-Which of the following provisions ensures that an insured's benefits from all insurance companies do not exceed 100% of allowable medical expenses? Consent agreement - Solution-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? Fraud - Solution-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? Gross examination - Solution-A coroner's autopsy is comprised of which of the following examinations?
Part D - Solution-Which part of Medicare covers prescriptions? Dermatology - Solution-In which of the following departments should a patient be seen for psoriasis? Patient information was disclosed to the patient's parent without consent. - Solution-Which of the following is an example of a violation of an adult patient's confidentiality? Improper code combinations - Solution-Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? History and physical - Solution-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 - Solution-Which of the following is a private insurance carrier? National provider identification number - Solution-Which of the following information should the billing and coding specialist input into Block 33a on the CMS- 1500 claim form? UB-04 - Solution-Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? Pulmonary oncologist - Solution-A patient who has a primary malignant neoplasm of the lung should be referred to which of the following specialists? They streamline patient billing by summarizing the services rendered for a given date of service - Solution-Why does correct claim processing rely on accurately completed encounter forms? Sagittal - Solution-Which of the following planes divides the body into left and right? Inform the patient of the reason of the denial - Solution-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 - Solution-Which of the following describes a delinquent claim?
Use Arial size 10 font - Solution-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 - Solution-Which of the following medical terms refers to the sac that encloses the heart? Adjudication - Solution-Which of the following is considered the final determination of the issues involving settlement of an insurance claim? Encounter form - Solution-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 - Solution-Which of the following privacy measures ensures protected health information (PHI)? It indicates which claims are outstanding - Solution-Which of the following is the purpose of running an aging report each month? Billing for services not provided - Solution-Which of the following actions by a billing and coding specialist would be considered fraud? Paper claim - Solution-Which of the following claims is submitted and then optically scanned by the insurance carrier and converted to an electronic form? Block 12 - Solution-Which of the following blocks requires the patient's authorization to release medical information to process a claim? Block 24D - Solution-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 - Solution-The unlisted codes can be found in which of the following locations in the CPT manual? $40 - Solution-A physician is contracted with an insurance company to accept the allowed amount. The insurance company allows $80 of a $ billed amount, and $50 of the deductible has been met. How much should the physician write off the patient's account? Provider - Solution-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 - Solution-The "><" symbol is used to indicate new
The claim requires an attachment - Solution-Which of the following indicates a claim should be submitted on paper instead of electronically? Coinsurance - Solution-Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays 30%? The number is needed to identify the provider - Solution-Claims that are submitted without an NPI number will delay payment to the provider because UB-04 claim form - Solution-Ambulatory surgery centers, home health care, and hospice organizations use the Red - Solution-Which of the following color formats is acceptable on the CMS- 1500 claim form? The deductible is the patient's responsibility - Solution-Which of the following statements is correct regarding a deductible? Adjustment column of the credits - Solution-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? The billing and coding specialist sends the patient's records to the patient's partner. - Solution-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 HIPAA violation? Medicaid - Solution-A patient's health plan is referred to as the "payer of last resort." The patient is covered by which of the following health plans? Claim adjudication - Solution-After a 3rd party payer validates a claim, which of the following takes place next? Health care clearinghouse - Solution-HIPAA transaction standards apply to which of the following entities? First report of injury - Solution-Which of the following is the initial step in processing a workers' compensation claim? Coordination of benefits - Solution-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 - Solution- 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. - Solution-When submitting claims, which of the following is the outcome if block 13 is left blank? accounts receivable - Solution-Patient charges that have not been paid will appear in which of the following? Remittance advice - Solution-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 - Solution-A billing and coding specialist should add modifier -50 to codes when reporting which of the following? CMS - Solution-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 - Solution-Which of the following is allowed when billing procedural codes? Cold treatment - Solution-The destruction of lesions using cryosurgery would use which of the following treatments? Code both acute and chronic sequencing the acute first - Solution- 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 - Solution-Which of the following describes the content of a medical practice aging report? Fraud - Solution-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 - Solution-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 - Solution-A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which of the following documents?
Review of systems - Solution-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 - Solution-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 - Solution-Which of the following situations constitutes a consultation? Bones and bone marrow - Solution-If a patient has osteomyelitis he has a problem with which of the following areas? An authorization - Solution-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 - Solution- Block 17b on the CMS-1500 claim form should list which of the following information? NCCI - Solution-Which of the following was developed to reduce Medicare program expenditures by detecting inappropriate codes and eliminating improper coding practices? Denied - Solution-Which of the following describes the status of a claim that does not include required preauthorization for a service? Lymphatic system - Solution-Which of the following parts of the body system regulates immunity? Clearinghouse - Solution-Which of the following is used by providers to remove errors from claims before they are submitted to 3rd party payers? Explanation of benefits - Solution-A provider receives reimbursement from a 3rd party payer accompanied by which of the following documents? Claims adjudication - Solution-Which of the following is the 3rd stage of the life cycle of a claim? Block 10a - Solution-Which of the following blocks on the CMS-1500 claim form is required to indicate a workers' compensation claim? Duplication of services - Solution-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 - Solution-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 - Solution-Which of the following is a type of claim that will be denied by the 3rd party payer? Internal monitoring and auditing - Solution-Which of the following steps would be part of a physician's practice compliance program? $120 - Solution-A patient has met a Medicare deductible of $150. The patient's coinsurance is 20% and the allowed amount is $600. Which of the following is the patient's out of pocket expense? The age of the account - Solution-Which of the following is the primary information used to determine the priority of collection letters to patients? A claim that is delinquent for 60 days - Solution-Which of the following claims would appear on an aging report? Preauthorization form - Solution-Which of the following is a requirement of some 3rd party payers before a procedure is performed? HCPCS Level 2 manual - Solution-Which of the following coding manuals is used primarily to identify products, supplies, and services? Block 23 - Solution-A billing and coding specialist should enter the prior authorization number on the CMS-1500 claim form in which of the following blocks? A signed release from the patient - Solution-Which of the following documents is required to disclose an adult patient's information? Documenting the patient's chief complaint, history, exam, assessment, and plan for care
- Solution-Which of the following billing patterns is a best practice action? Communicating with the front desk staff during a team meeting about missing information in patient files - Solution-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 - Solution-A physician is contracted with an insurance company to accept the allowed amount. The insurance company allows $80 of a $ billed amount, and $50 of the deductible has not been met. How much should the physician write off the patient's account?
Charging excessive fees - Solution-Which of the following is an example of Medicare abuse?
Adjustment - Solution-Which of the following terms refers to the difference between the billed and allowed amounts? Durable medical equipment - Solution-Which of the following HMO managed care services requires a referral? Advanced beneficiary notice (ABN) - Solution-Which of the following explains why Medicare will deny a particular service or procedure? Delinquent - Solution-What type of claim is 120 days old? Photo copy both sides of the card - Solution-When reviewing an established patient's insurance card, the billing and specialist notices a minor change from the existing card on file. Which of the following actions should the billing & coding specialist take? The wife's insurance - Solution-A husband and wife each have group insurance through their employers. The wife has an appt. with her provider. Which insurance should be used as the primary for this appt? An experimental chemotherapy medication for a patient who has stage 3 renal cancer. - Solution-Which of the following would most likely result in a denial on a Medicare claim? Phone number - Solution-Which of the following pieces of guarantor information is required when establishing a patient's financial record? Pleurocentesis - Solution-A provider surgically punctures through 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? Block 9 - Solution-A patient has AARP as secondary insurance. Which block on the CMS 1500 claim form should this information be entered? $230 - Solution-A medicare non-participating provider's approved payment for $200 for a lobectomy and the deductible was met. Which amounts is the limiting charge for this? add-on codes - Solution-In the anesthesia section of the CPT manual, which are considered qualifying circumstances? These codes must correspond to the diagnosis blocker in Block 24E - Solution- Which of the following statements is accurate regarding the diagnostic codes in Block 21?
Incorrectly linked codes - Solution-Which of the following would be a reason a claim would be denied? The guidelines define items that are necessary to accurately code - Solution- The billing and coding specialists should follow the guidelines in the CPT manual for which of the following reasons? operative report - Solution-Which of the following options is considered proper supportive documentation for reporting CPT & ICD codes for surgical procedures? Block 27 - Solution-Which of the following blocks on the CMS-1500 claim form is used to accept assignment of benefits? Contractual allowance - Solution-Which of the following is an example of a remark code from an explanation of benefits document? When an insurance company transfers data to allow coordination of benefits of a claim - Solution-Which of the following describes the term "crossover" as it relates to Medicare? block 24j - Solution-Rendering Provider ID Number goes on what block on the CMS-1500 claim form? The date of the last disclosure - Solution-Which of the following is included in the release of patient information? History - Solution-Which of the following describes a key component of an evaluation & management service? Aging report - Solution-Which of the following reports is used to arrange the accounts receivable from the date of service? Medical standard of conduct - Solution-Which of the following best describes medical ethics? Arthroscopy - Solution-An examination of a patient's knee joint via small incisions & an optical device. Which of the following terms describes this procedure? A product pending FDA approval is indicated as a lightning bolt symbol - Solution-Which of the following accurately describes code symbols found in the CPT manual? 3rd party payer - Solution-Which of the following describes an insurance carrier that pays the provider who rendered services to a patient?
Stark law - Solution-Which of the following prohibits a provider from referring Medicare patients to a clinical laboratory service in which the provider has a financial interest? Electronic remittance advice - Solution-Which of the following electronic forms is used to post payments? Remittance advice - Solution-For non-crossover claims, the billing & coding specialists should prepare an additional claim for the secondary payer & send it with a copy of which of the following? 18% - Solution-When coding a front torso burn, which of the following percentages should be coded? block 21 - Solution-Which of the following blocks of the CMS-1500 claim form indicates an ICD diagnosis code? Billing provider - Solution-Which of the following national provider identifiers (NPIs) is required from block 33A of a CMS-1500 claim form? services require additional information - Solution-Which of the following causes a claim to be suspended? Left upper quadrant - Solution-Which of the following terms is used to describe the location of the stomach, the spleen, part of the pancreas, part of the liver, & part of the small & large intestines? Attach the remittance advice from the primary insurance along with the Medicaid claim.
- Solution-Which of the following actions should the billing and coding specialist take when submitting a claim to Medicaid for a patient who has primary & secondary coverage? 17b - Solution-National provider # Signed release of information form - Solution-When a 3rd party payer requests copies of patient information related to a claim, the billing and coding specialists must make sure which of the following is included in the patient's file? Primary care provider - Solution-A patient who has an HMO insurance place needs to see a specialists for a specific problem. From which of the following should the patient obtain the referral? Office inspector general - Solution-Which of the following organizations fights waste, fraud, and abuse in medicare and Medicaid?
