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Medical Billing and Coding Exam Questions and Answers, Exams of Nursing

A list of questions and answers related to medical billing and coding. The questions cover topics such as claim rejection, aging reports, coinsurance, diagnosis codes, fraud prevention, and patient information release. The answers are already verified. useful for students studying medical billing and coding, as well as for professionals in the field who want to test their knowledge.

Typology: Exams

2023/2024

Available from 10/17/2023

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Download Medical Billing and Coding Exam Questions and Answers and more Exams Nursing in PDF only on Docsity! NHA CBCS Exam 2023-2024 | 2 Exam Versions | Question and Answers | Already Verified Answers! Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? ----CORRECT ANSWER----------Improper code combinations Which of the following is the purpose of running an aging report each month? ---- CORRECT ANSWER----------It indicates which claims are outstanding 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? ----CORRECT ANSWER-------- --Coinsurance 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? ----CORRECT ANSWER----------Principal diagnosis Which of the following actions by the billing and coding specialists prevents fraud? ---- CORRECT ANSWER----------Performing periodic audits Which of the following does a patient sign to allow payment of claims directly to the provider? ----CORRECT ANSWER----------Assignment of benefits Which of the following actions should the billing and coding specialist take if he observes a colleague in an unethical situation? ----CORRECT ANSWER----------Report the incident to a supervisor Which of the following is the purpose of precertification? ----CORRECT ANSWER--------- -Verification of coverage A provider performs an examination of a patient's throat during an office visit. Which of the following describes the level of the examination? ----CORRECT ANSWER---------- Problem focused examination 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? ---- CORRECT ANSWER----------Constant agreement A claim can be denied or rejected for which of the following reasons? ----CORRECT ANSWER----------Block 24D contains the diagnosis code On the CMS-1500 claim form, Blocks 1 through 13 include which of the following? ---- CORRECT ANSWER----------The patient demographics Which of the following do physicians use to electronically submit claims? ----CORRECT ANSWER----------Clearinghouses Which of the following should the billing and coding specialist include in an authorization to release information? ----CORRECT ANSWER----------The entity to whom the information is to be released Which of the following information is required on a patient account record? ---- CORRECT ANSWER----------Name and address of guarantor 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 Which of the following is considered the final determination of the issues involving settlement of an insurance claim? ----CORRECT ANSWER----------Adjudication A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called which of the following? ----CORRECT ANSWER----------Encounter form 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? ---- CORRECT ANSWER----------Admitting clerk Why does correct claim processing rely on accurately completed encounter forms? ---- CORRECT ANSWER----------They streamline patient billing by summarizing the services rendered for a given date of service 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? ----CORRECT ANSWER----------Medicaid Which of the following color formats is acceptable on the CMS-1500 claim form? ---- CORRECT ANSWER----------Red Which of the following is an example of a violation of an adult patient's confidentiality? -- --CORRECT ANSWER----------Patient information was disclosed to the patient's parents without consent. In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? ----CORRECT ANSWER----------Add-on codes Ambulatory surgery centers, home health care, and hospice organizations use the ---- CORRECT ANSWER----------UB-04 claim form Which of the following is a private insurance carrier? ----CORRECT ANSWER---------- Blue Cross/ Blue Shield Which of the following shows outstanding balances? ----CORRECT ANSWER---------- Aging report Which of the following is one of the purposes of an internal auditing program in a physician's office? ----CORRECT ANSWER----------Verifying that the medical records and the billing record match The star symbol in the CPT code book is used to indicate which of the following? ---- CORRECT ANSWER----------Telemedicine Medigap coverage is offered to Medicare beneficiaries by which of the following? ---- CORRECT ANSWER----------Private third party payers A patient's portion of the bill should be discussed with the patient before a procedure is performed for which of the following reasons? ----CORRECT ANSWER----------To ensure the patient understands his portion of the bill 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. This amount is called ----CORRECT ANSWER----------Deductible 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? ----CORRECT ANSWER----------The billing and coding specialist sends the patient's records to the patient's partner. 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? ---- CORRECT ANSWER----------Inform the patient of the reason of the denial A patient presents to the provider with chest pain and SOB. After an unexpected ECG result, the provider calls a cardiologist and summarizes the patient's symptoms. What portion of HIPAA allows the provider to speak to the cardiologist prior to obtaining the patient's consent? ----CORRECT ANSWER----------TITLE II 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? ----CORRECT ANSWER---------- Advanced Beneficiary Notice An insurance claims register (aged insurance report) facilitates which of the following? -- --CORRECT ANSWER----------Follow up of insurance claims by date When posting payment accurately, which of the following items should the billing and coding specialist include? ----CORRECT ANSWER----------Patient's responsibility Which of the following should the billing and coding specialist complete to be reimbursed for the provider's services? ----CORRECT ANSWER----------CMS-1500 claim form 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? ----CORRECT ANSWER--- -------12 Which of the following describes an obstruction of the urethra? ----CORRECT ANSWER----------Urethratresia 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 describes a delinquent claim? ----CORRECT ANSWER---------- The claim is overdue for payment All dependents 10 year of age or older are required to have which of the following for TRICARE? ----CORRECT ANSWER----------Military identification Which of the following types of claims is 120 days old? ----CORRECT ANSWER---------- Delinquent HIPAA transaction standards apply to which of the following entities? ----CORRECT ANSWER----------Health care clearinghouse 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? ----CORRECT ANSWER----------Submit an appeal to the carrier with supporting documentation When submitting a clean claim with a diagnosis of kidney stones, which of the following procedure names is correct? ----CORRECT ANSWER----------Nephrolithiasis All e-mail correspondence to a third party payer containing patients' protected health information (PHI) should be ----CORRECT ANSWER----------Encrypted Which of the following statements is correct regarding a deductible? ----CORRECT ANSWER----------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 form? ----CORRECT ANSWER----------Paper claim A patient who has a primary malignant neoplasm of the lung should be referred to which of the following specialists? ----CORRECT ANSWER----------Pulmonary oncologist Which of the following statements is true regarding the release of patient records? ---- CORRECT ANSWER----------Patient access to psychotherapy notes may be restricted Which of the following is the primary function of the heart? ----CORRECT ANSWER------ ----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? ----CORRECT ANSWER----------Fraud 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 patient with a past due balance requests that his records be sent to another provider. Which of the following actions should be taken? ----CORRECT ANSWER---------- Accommodate the request and send the records 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? ----CORRECT ANSWER----------Invalid Which of the following medical terms refers to the sac that encloses the heart? ---- CORRECT ANSWER----------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 been met. How much should the physician write off the patient's account? ---- CORRECT ANSWER----------$40 A billing and coding specialist is review a CMS-1500 claim form. The assignment of the benefits box has been checked yes. The check box indicates which of the following? ---- CORRECT ANSWER----------The provider receives payment directly form the payer Which of the following describes the content of a medical practice aging report? ---- CORRECT ANSWER----------an overview of the practices outstanding claims When a physician documents a patient's response to symptoms and various body systems, the results are documented as which of the following? ----CORRECT ANSWER----------Review of systems Medicare enforces mandatory submission of electronic claims for most providers. Which of the following providers is allowed to submit paper claims to medicare? ----CORRECT ANSWER----------A provider's office with fewer than 10 full time employees Which of the following is the correct term for an amount that has been determined to be uncollectible? ----CORRECT ANSWER----------Bad debt Which of the following actions should the billing and coding specialist take to effectively manage accounts receivable? ----CORRECT ANSWER----------Collect copayment from the patient at the time of service If a patient has osteomyelitis. he has problems with which of the following areas? ---- CORRECT ANSWER----------Bones and bone marrow Which of the following is used by providers to remove errors from claims before the are submitted to third-party payers? ----CORRECT ANSWER----------Clearinghouse A provider receives a reimbursement from a third-party payer accompanied by which of the following documents? ----CORRECT ANSWER----------Explanation of Benefits 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? ----CORRECT ANSWER----------Edema Which of the following blocks on the CMS-1500 claim form is used to bill ICD codes? --- -CORRECT ANSWER----------Block 21 Patient charges that have not been paid will appear in which of the following? ---- CORRECT ANSWER----------Accounts receivable When billing a secondary insurance company, which block should the billing & coding specialist fill out on the CMS-1500 claim form? ----CORRECT ANSWER----------9a Which of the following forms must the patient or representative sign to allow for the release of protected health information? ----CORRECT ANSWER----------Authorization What is the maximum number of ICD codes that can be entered on a CMS-1500 claim form as of Feb. 2012? ----CORRECT ANSWER----------12 When a patient has a condition that is both acute and chronic, how should it be reported? ----CORRECT ANSWER----------Code both acute and chronic, sequencing the acute first After a third-party payer validates a claim, which of the following takes place next? ---- CORRECT ANSWER----------Claim adjudication Which of the following acts applies to the administrative simplification guidelines? ---- CORRECT ANSWER----------HIPAA 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? ----CORRECT ANSWER----------Fraud A biller will electronically submit a claim to the carrier via which of the following? ---- CORRECT ANSWER----------Direct data entry 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? ----CORRECT ANSWER----------$120 Which of the following billing patterns is a best-practice action? ----CORRECT ANSWER----------Documenting the patient's chief complaint, history, exam, assessment and plan of care 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? ---- CORRECT ANSWER----------Communicating with the front desk staff during a team meeting about missing information in patient files A billing and coding specialist should enter the prior authorization number on the CMS- 1500 claim form in the following block? ----CORRECT ANSWER----------Block 23 Which of the following is the primary information used to determine the priority of collection letters to patients? ----CORRECT ANSWER----------The age of the account Which of the following is the initial step in processing a workers compensation claim? --- -CORRECT ANSWER----------First report of injury Block 17b on the CMS-1500 claim form should list what information? ----CORRECT ANSWER----------Referring physicians NPI Which of the following is allowed when billing procedure codes? ----CORRECT ANSWER----------Billing using 2-digit CPT modifiers to indicate a procedure as performed differs from its usual 5-digit code 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 on the claim appeal? ----CORRECT ANSWER----------The patient was out of town during the emergency A billing and coding specialist should add modifier -50 to codes when reporting which of the following? ----CORRECT ANSWER----------Bilateral procedure Which of the following situations constitutes a consultation? ----CORRECT ANSWER---- ------Services rendered by a physician whose opinion or advice is requested by another physician or agency In 1995 and 1997, the following introduced documentation guidelines to Medicare carriers to ensure that services paid for have been provided and were medically necessary? ----CORRECT ANSWER----------CMS Which of the following is a correct entry of a charge of $150 in block 24F of the CMS- 1500 claim form? ----CORRECT ANSWER----------150 00 Which of the following statements is true when determining patient financial responsibility by reviewing the remittance advice? ----CORRECT ANSWER----------Any coinsurance, deductibles can be collected by the patient Which of the following blocks on the CMS-1500 claim form is required to indicate a workers compensation claims? ----CORRECT ANSWER----------10a When an electronic claim is rejected due to incomplete information, which of the following actions should the medical billing specialist take? ----CORRECT ANSWER----- -----Complete the information and re-transmit according to the 3rd party standards The provision of health insurance policies that specifies which coverage is considered primary or secondary is called ----CORRECT ANSWER----------Coordination of benefits For which of the following time periods should the billing and coding specialist track unpaid claims before taking follow up action? ----CORRECT ANSWER----------30 days Which of the following claims would appear on an aging report? ----CORRECT ANSWER----------A claim that is delinquent for 60 days When submitting claims, which of the following is the outcome if block 13 is left blank? -- --CORRECT ANSWER----------The 3rd party payer reimburses the patient and the patient is responsible for reimbursing the provider Which of the following was developed to reduce Medicare program expenditures by detecting inappropriate codes and eliminating improper coding practices? ----CORRECT ANSWER----------NCCI Which of the following organizations identifies improper payments made on CMS claims? ----CORRECT ANSWER----------Recovery Audit Contractors Which of the following describes the status of a claim that does not include required preauthorization for a service? ----CORRECT ANSWER----------Denied 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? ----CORRECT ANSWER----------The claim will not be resubmitted and the patient will be sent a bill Test results indicated that no abnormalities we found in the brain and the brains electrical activity patterns are normal. What test was used? ----CORRECT ANSWER----- -----EEG When coding a front torso burn,which of the following percentages should be coded? --- -CORRECT ANSWER----------18% Which of these would describe the common method for sorting of an Aging report? ---- CORRECT ANSWER----------By date Anesthesia is found ----CORRECT ANSWER----------00100-01999, 99100-99140 Radiology is ----CORRECT ANSWER----------7710-79999 S in soap is ----CORRECT ANSWER----------Subjective O in soap is ----CORRECT ANSWER----------Objective A in soap is ----CORRECT ANSWER----------Assessment Which of the following is a example of a remark code from a Explanation of Benefits document? ----CORRECT ANSWER----------Contractual allowance 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 name, address and insurance carrier for resubmission Which of the following national provider identifiers (NPI) is required in Block33a on the CMS-1500 claim form? ----CORRECT ANSWER----------Billing provider When the remittance advice is sent from the third-party payer to the provider, which of the following actions should the billing and coding specialist perform first? ---- CORRECT ANSWER----------Ensure proper payment has been made Which of the following symbols indicates a revised code? ----CORRECT ANSWER------- ---Triangle Which of the following terms is used to describe the location of the stomach, the spleen, part of pancreas, part of the liver, and part of the small and large intestines? ---- CORRECT ANSWER----------Left upper quadrant Which of the following is true regarding Medicare eligibility? ----CORRECT ANSWER---- ------Patient eligibility is determined monthly Which of the following is considered fraud? ----CORRECT ANSWER----------The billing and coding specialist unbundles a code to receive higher reimbursement Which of the following is an example of medicare abuse? ----CORRECT ANSWER------- ---Charging excessive fees Which of the following organizations fights waste, fraud and abuse in medicare and medicaid? ----CORRECT ANSWER----------Office of inspector general (OIG) Which of the following forms does the third party payer require for physician services? -- --CORRECT ANSWER----------CMS -1500 Which of the following statements is accurate regarding the diagnostic codes in Block 21? ----CORRECT ANSWER----------These codes must correspond to the diagnosis pointer in Block 24E Which of the following describes the term "crossover" as it relates to medicare? ---- CORRECT ANSWER----------When a insurance company transfers data to allow coordination of benefits of a claim 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 pieces of guarantor information is required when establishing a patient's financial record? ----CORRECT ANSWER----------Phone number NHA CBCS EXAM 2 2023-2024 | Questions and 100% Correct Answers Which of the following Medicare policies determines if a particular item or service is covered by Medicare? -----CORRECT ANSWER----------National Coverage Determination (NCD) 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 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 should a billing and coding specialist use to submit a claim with supporting documents? -----CORRECT ANSWER----------Claims attachment Which of the following terms is used to communicate why a claim line item was denied or paid differently than it was billing? -----CORRECT ANSWER----------Claim adjustment codes On a CMS-1500 claim form, which of the following information should the billing and coding specialist enter into Block 32? -----CORRECT ANSWER----------Service facility location information A provider's office receives a subpoena requesting medical documentation from a patient's medical record. After confirming the correct authorization, which of the following actions should the billing and coding specialist take? -----CORRECT ANSWER----------Send the medical information pertaining to the dates of service requested Which of the following is the deadline for Medicare claim submission? -----CORRECT ANSWER----------12 months from the date of service Which of the following forms does a third-party payer require for physician services? ---- -CORRECT ANSWER----------CMS-1500 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 designed with power of attorney. Which of the following is considered a HIPAA violation? -----CORRECT ANSWER----------The billing and coding specialist sends the patient's records to the patient's partner. Which of the following terms refers to the difference between the billing and allowed amounts? -----CORRECT ANSWER----------Adjustment Which of the following HMO managed care services requires a referral? -----CORRECT ANSWER----------Durable medical equipment Which of the following explains why Medicare will deny a particular service or procedure? -----CORRECT ANSWER----------Advance Beneficiary Notice (ABN) Which of the following types of claims is 120 days old? -----CORRECT ANSWER--------- -Delinquent Which of the following entities defines the essential elements of a comprehensive compliance program? -----CORRECT ANSWER----------Office of Inspector General (OIG) The >< symbol is used to indicate new and revised text other than which of the following? -----CORRECT ANSWER----------Procedure descriptors Which of the following describes the organization of an aging report? -----CORRECT ANSWER----------By date Which of the following is the purpose of coordination of benefits? -----CORRECT ANSWER----------Prevent multiple insurers from paying benefits covered by other policies 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 qualifies as an exception to the HIPAA Privacy Rule? ----- CORRECT ANSWER----------Psychotherapy notes Which of the following would result in a claim being denied? -----CORRECT ANSWER--- -------An italicized code used as the first listed diagnosis Which of the following standardized formats are used in the electronic filing of claims? -- ---CORRECT ANSWER----------HIPAA standard transactions Which of the following describes a two-digit CPT code used to indicate that the provider supervised an interpreted a radiology procedure? -----CORRECT ANSWER---------- Professional component Which of the following formats are used to submit electronic claims to a third-party payer? -----CORRECT ANSWER----------837 Urine moved from the kidneys to the bladder through which of the following parts of the body? -----CORRECT ANSWER----------Ureters 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-- --------12 Which of the following does a patient sign to allow payment of claims directly to the provider? -----CORRECT ANSWER----------Assignment of benefits Which of the following is the primary function of the heart? -----CORRECT ANSWER----- -----Pumping blood in the circulatory system Which of the following is true regarding Medicaid eligibility? -----CORRECT ANSWER--- -------Patient eligibility is determined monthly 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---------- $40 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 If a clean claim is received on March 1 of this year, which of the following is the allowable last day of payment in order to meet Medicare compliance requirements? ----- CORRECT ANSWER----------March 30 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? ----- CORRECT ANSWER----------Provider 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----------4 When the remittance advice is sent from the third-party payer to the provider, which of the following actions should the billing and coding specialist perform first? ----- CORRECT ANSWER----------Ensure proper payment has been made Which of the following is a reason a claim would be denied? -----CORRECT ANSWER-- --------Incorrectly linked codes The billing and coding specialist should follow the guidelines in the CPT manual for which of the following reasons? -----CORRECT ANSWER----------The guidelines define items that are necessary to accurately code Which of the following documentation is a valid authorization to release medical information to the judicial system? -----CORRECT ANSWER----------Subpoena duces tecum 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 name, address, and insurance carrier for resubmission A patient who has a primary malignant neoplasm of the lung should be referred to which of the following specialists? -----CORRECT ANSWER----------Pulmonary oncologist Which of the following is a HIPAA compliance guideline affecting electronic health records? -----CORRECT ANSWER----------The electronic transmission and code set standards require every provider to use the healthcare transactions, code sets, and identifiers 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 blocks on the CMS-1500 claim form is used to accept assignment of benefits? -----CORRECT ANSWER----------Block 27 Which of the following electronic forms is used to post payments? -----CORRECT ANSWER----------Electronic remittance advice (ERA) The explanation of benefits states the amount billed was $170. However, the allowed amount is $150. The patient has an unmet deductible of $50.00 and a copayment of $20. Which of the following amounts is the patient's responsibility? -----CORRECT ANSWER----------$70 Which of the following is a federal government health insurance program? ----- CORRECT ANSWER----------TRICARE 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 Which of the following actions by the billing and coding specialist prevents fraud? ----- CORRECT ANSWER----------Performing periodic audits When doing a front torso burn, which of the following percentages should be coded? ---- -CORRECT ANSWER----------18% 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 blocks of the CMS-1500 claim form indicates an ICD diagnosis code? -----CORRECT ANSWER----------Block 21 Which of the following national provider identifiers (NPIs) is required in Block 33a of a CMS-1500 claim form? -----CORRECT ANSWER----------Billing provider Which of the following causes a claim to be suspended? -----CORRECT ANSWER------- ---Services require additional information Which of the following terms is used to describe the location of the stomach, the spleen, part of the pancreas, part of the liver, and part of the small and large intestines? ----- CORRECT ANSWER----------Left upper quadrant Which of the following terms is used to describe the location of the right lobe of the liver, the gallbladder, part of the pancreas, and part of the small and large intestine? ----- CORRECT ANSWER----------Right upper quadrant Which of the following terms is used to describe the location of the small and large intestine, the appendix, and the right ureter? -----CORRECT ANSWER----------Right lower quadrant Which of the following terms is used to describe the location of the small and large intestines and the left ureter? -----CORRECT ANSWER----------Left lower qaudrant Which of the following actions should the billing and coding specialist take when submitting a claim to Medicaid for a patient who has primary and secondary insurance coverage? -----CORRECT ANSWER----------Attach the remittance advice from the primary insurance along with the Medicaid claim 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----------$2,000 In which of the following blocks on the CMS-1500 claim form should the billing and coding specialist enter the referring provider's national provider identifier (NPI)? ----- CORRECT ANSWER----------Block 17b When a third-party payer requests copies of patient information related to a claim, the billing and coding specialist must make sure which of the following is included in the patient's file? -----CORRECT ANSWER----------Signed release of information form 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 Which of the following organizations fights waste, fraud, and abuse in Medicare and Medicaid? -----CORRECT ANSWER----------Office of Inspector General (OIG) Which of the following is used to code diseases, injuries, impairments, and other health- related problems? -----CORRECT ANSWER----------International Classification of Diseases (ICD) Actions should be taken if an insurance company denies a service as not medically necessary? -----CORRECT ANSWER----------Appeal the decision with a provider's report The actions should be taken when a claim is billed for a level four office visit and paid at a level three? -----CORRECT ANSWER----------Submit an appeal to the carrier with the supporting documentation All dependents 10 years of age or older are required to have a military identification card for TRICARE? -----CORRECT ANSWER----------Military identification All e-mail correspondence to a third-party payer containing patient's protected health information (PHI) should be? -----CORRECT ANSWER----------Encrypted Ambulatory surgery center, home health care, and hospice organizations use the? ----- CORRECT ANSWER----------UB-04 claim form A billing and coding specialist should understand that the financial record source that is generated by a provider's office is called a? -----CORRECT ANSWER----------Patient Ledger Account What component of an explanation of benefits expedites the process of a phone appeal? -----CORRECT ANSWER----------Claim control number A coroner's autopsy is comprised of which examination? -----CORRECT ANSWER------- ---Gross examination What do physician's used to electronically submit claims? -----CORRECT ANSWER------ ----Clearinghouse This privacy measure ensures protected health information (PHI). -----CORRECT ANSWER----------Using data encryption software on office workstations This provision ensures that an insured's benefits from all insurance companies does not exceed 100% of allowable medical expenses? -----CORRECT ANSWER---------- Coordination of benefits This statement is true regarding the release of patient records? -----CORRECT ANSWER----------Patient access to psychotherapy notes may be restricted Verbal or written agreement that gives approval to some action, situation, or statement, and allows the release of patient information? -----CORRECT ANSWER----------Consent agreement What actions should be taken first when reviewing a delinquent claim? -----CORRECT ANSWER----------Verify the age of the account What actions should the billing and coding specialist take if he observes a colleague in an unethical situation? -----CORRECT ANSWER----------Report the incident to a supervisor What claims is submitted and then optically scanned by the insurance carrier and converted to an electronic form? -----CORRECT ANSWER----------Paper claim What color formats is acceptable on the CMS-1500 claim form? -----CORRECT ANSWER----------RED What department should a patient be seen for psoriasis? -----CORRECT ANSWER------- ---Dermatology What form should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? -----CORRECT ANSWER----------UB-04 What information is required on a patient account record? -----CORRECT ANSWER----- -----Name and address of guarantor What information should the billing and coding specialist input in Block 33a on the CMS- 1500 claim form? -----CORRECT ANSWER----------National Provider Identification Number What is considered the final determination of the issues involving settlement of an insurance claim? -----CORRECT ANSWER----------Adjudication What is the advantage of electronic claim submission? -----CORRECT ANSWER---------- Claims are expedited What is the purpose of precertification? -----CORRECT ANSWER----------Verification of coverage What shows outstanding balances? -----CORRECT ANSWER----------Aging report What terms describes when a plan pays 70% of the allowed amount and the patient pays 30%? -----CORRECT ANSWER----------Coinsurance When coding on the UB-04 form, the billing and coding specialist must sequence the diagnosis codes according to ICD guidelines. Which of the following is the first listed diagnosis code? -----CORRECT ANSWER----------Patient's responsibility When submitting a clean claim with a diagnosis of kidney stones, the name of the procedure is? -----CORRECT ANSWER----------Nephrolithiasis Why does correct claim processing rely on accurately completed encounter forms? ----- CORRECT ANSWER----------They streamline patient billing by summarizing the services rendered for a given date of service Accepting assignment on the CMS-1500 claim form indicates that -----CORRECT ANSWER----------the physician agrees to accept payment under the terms of the payers program After a third-party payer validates a claim, which of the following takes place next? ----- CORRECT ANSWER----------Claim adjudication A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is responsible for which of the following percentages? -----CORRECT ANSWER----------0% A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by first using which of the following processes? -----CORRECT ANSWER----------Precertification A billing and coding specialist has four past do payments, which one goes to collections first? -----CORRECT ANSWER----------The largest past-due charge A billing and coding specialist is reviewing a CMS-1500 claim form. The "assignment of benefits box has been checked yes. The checked box indicates which of the following? - ----CORRECT ANSWER----------The provider receives payment directly from the payer Block 17b on the CMS-1500 claim form -----CORRECT ANSWER----------referring physicians NPI A billing and coding specialist needs to know how much Medicare paid on a claim before billing the secondary insurance. Which of the following should the specialist refer? -----CORRECT ANSWER----------Remittance Advice 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? -----CORRECT ANSWER----------The claim will not be resubmitted and the patient will be sent a bill The destruction of lesions using cryosurgery would use which of the following treatments? -----CORRECT ANSWER----------Cold treatment For non-crossover claims, the billing & coding specialist should prepare an additional claim for the secondary payer & send it with a copy of which of the following? ----- CORRECT ANSWER----------Remittance advice Which of the following causes a claim to be suspended? -----CORRECT ANSWER------- ---Services require additional info Which of the following coding manuals is used primarily to identify products, supplies, and services? -----CORRECT ANSWER----------HCPCS Level 2 Which of the following describes a two-digit CPT code used to indicate that the provider supervised and interpreted a radiology procedure? -----CORRECT ANSWER---------- Professional component 26 modifier Which of the following is allowed when billing procedural codes? -----CORRECT ANSWER----------Use two-digit CPT modifiers to indicate a procedure as preformed Which of the following is an example of electronic claim submission? -----CORRECT ANSWER----------Claims submitted via a secure network Which of the following is an example of Medicare abuse? -----CORRECT ANSWER------ ----Charging excessive fees Which of the following is a requirement of some third party payers before a procedure is preformed? -----CORRECT ANSWER----------Preauthorization forms Which of the following is the third stage of the life cycle of a claim? -----CORRECT ANSWER----------Claims adjudication Which of the following organizations identifies improper payments made on CMS claims? -----CORRECT ANSWER----------Recovery Audit Contractor (RAC) Which of the following statements is true when determining patient financial responsibility by reviewing the remittance advice? -----CORRECT ANSWER----------Any coinsurance, copayments, and deductibles are the patients responsibility Which symbol indicates a moderate sedation? -----CORRECT ANSWER---------- Bullseye Which symbol indicates an add on code? -----CORRECT ANSWER----------Plus sign Which symbol indicates a new code? -----CORRECT ANSWER----------Bullet Z codes are used to identify -----CORRECT ANSWER----------Immunizations A triangle (šŸž) represents? -----CORRECT ANSWER----------A change in the code description since the last edition What does two triangular symbols (ā§“) represent? -----CORRECT ANSWER---------- Changes in the text or definition between the triangles What does a bullet (āˆ™) represent? -----CORRECT ANSWER----------A new procedure or service code added since the previous edition of the manual The patient's birth date on the CMS-1500 claim form is entered in what format? ----- CORRECT ANSWER----------MM/DD/YYYY Temporary codes for drugs and medical equipment are what type of HCPCS codes? ---- -CORRECT ANSWER----------Q codes Which of the following modifiers should be used to indicate a professional service has been discontinued prior to completion? -----CORRECT ANSWER-----------53 Which of the following modifiers should be used to indicate a discontinued outpatient procedure prior to anesthesia administration? -----CORRECT ANSWER-----------73 Which of the following modifiers should be used to indicate that a service code was reduced from its original description? -----CORRECT ANSWER-----------52 Which of the following modifiers should be used to indicate a discontinued outpatient procedure after anesthesia administration? -----CORRECT ANSWER-----------74 A coding specialist should use which modifier to report a bilateral procedure? ----- CORRECT ANSWER-----------50 A coding specialist should use which modifier to report multiple procedures? ----- CORRECT ANSWER-----------51 A coding specialist should use which modifier to report reduced services? ----- CORRECT ANSWER-----------52 What are the three key components of an E/M code? -----CORRECT ANSWER---------- History, examination, and medical decision making What is a pre-existing condition? -----CORRECT ANSWER----------An illness or condition present before insurance coverage begins A new patient is: -----CORRECT ANSWER----------One who has not visited the physician in more than 3 years A patient is diagnosed with metastatic bone neoplasm. The neoplasms will be coded as? -----CORRECT ANSWER----------Secondary malignant Medical ethics are: -----CORRECT ANSWER----------Standards of conduct All of the following are correct regarding add-on codes except: -----CORRECT ANSWER----------They can be reported as stand-alone codes the way to correct an error on a patients medical record is? -----CORRECT ANSWER---- ------To cross out the incorrect data with a single line and write in the correct information followed by initials and date An organization that initiated the development of ICD codes is: -----CORRECT ANSWER----------WHO What is the percent of payment held back for a risk account in the HMO program called? -----CORRECT ANSWER----------Withhold Incentive