NHA Medical Billing and Coding 2021 Exam Study Guide Review Questions, Exams of Nursing

Download NHA Medical Billing and Coding 2021 Exam Study Guide Review Questions and more Exams Nursing in PDF only on Docsity!

NHA - Certified Billing and Coding

Specialist CBCS 2021 Exam Study Guide

Review Questions (100 Terms) with

Definitive Answers & Rationales

Updated 2023-2024.

Which of the following describes the reason for a claim rejection because of

Medicare NCCI edits? - Answer: Improper Code Combinations

(Medicare NCCI edits will trigger a claim rejection for improper code combinations) 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? - Answer: Invalid

(Invalid claim contains illogical or incorrect information and is returned to the provider unprocessed) Medigap coverage is offered to Medicare beneficiaries by which of the following -

Answer: Private Third-Party Payers

(Private third-party payers offer supplement coverage to Medicare beneficiaries who pay their Medicare premium.) Which of the following provisions ensures that an insured's benefits from all insurance companies do not exceed 100% of allowable medical expenses? -

Answer: Coordination of benefits

C. Billing for services not provided

D. Billing non-covered services as covered services - Answer: Billing for services

not provided (Billing for services not provided is considered fraud and can result in fines for the billing and coding specialist and the physician.) Which of the following components of an explanation of benefits expedites the process of a phone appeal? A. NPI number B. Claim control number C. Insured's ID number

D. Check number - Answer: B. Claim control number

(The claim control number expedites the process of a phone appeal.) On the CMS-1500 claim form, blocks 14 through 33 contain information about

which of the following? - Answer: The patient's condition and the provider's

information (The patient's condition and the provider's information are found on the CMS- 1500 at blocks 14 through 33.)

A billing and coding specialist should understand that the financial record source

that is generated by a provider's office is called a - Answer: Patient ledger

account. (A patient ledger account is a history of the patient's financial record.) Which of the following medical terms refers to the sac that encloses the heart? -

Answer: Pericardium

(Peri- means "around" and -cardium means "pertaining to heart.") HIPPA transaction standards apply to which of the following entities? A. Employers who provide workers' compensation plans B. Automobile insurance agencies C. Health care clearinghouses

D. Educational facilities - Answer: Health care clearinghouses

(Entities covered by HIPAA regulations include health care clearinghouses, providers of health care services, and health care third-party payers who submit transactions electronically.) All dependents 10 yrs of age are required to have which of the following for TRICARE?

D. Patient information was disclosed to the patient's parent without consent. -

Answer: Patient information was disclosed to the patient's parent without

consent. (Disclosing information to anyone without the patient's consent is a violation of patient confidentiality.) Claims that are submitted without an NPI number will delay payment to the

provider because - Answer: the number is needed to identify the provider.

(An NPI number is provided by the Centers for Medicare and Medicaid Services to all providers.) Which section of the medical record is used to determine the correct Evaluation

and Management code used for billing and coding? - Answer: History and

physical (The Evaluation and Management code for the patient's current condition can be found in the history and physical section.) What actions should be taken if an insurance company denies a service as not

medically necessary? - Answer: Appeal the decision with a provider's report.

(Appealing the decision with a provider's report is the appropriate action.)

Which is the portion of the account balance the patient must pay after services

are rendered and the annual deductible is met? - Answer: Coinsurance

(Coinsurance is the portion the patient is responsible to pay after the annual deductible has been met.) Which of the following is the function of the respiratory system? A. Deoxygenating blood cells B. Oxygenating blood cells C. Generating red blood cells

D. Generating white blood cells - Answer: Oxygenating blood cells

(The lungs, which are part of the respiratory system, are responsible for providing oxygen for the blood.)

What describes a delinquent claim? - Answer: The claim is overdue for payment.

(A claim is considered delinquent when it is overdue for payment.) Which of the following actions should the billing and coding specialist take if he observes a colleague in an unethical situation? A. File a complaint with the company compliance officer.

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? A. HIPAA B. Advanced Beneficiary Notice C. Assignment of benefits

D. CMS-1500 claim form - Answer: B. Advanced Beneficiary Notice

(Advanced Beneficiary Notice, or ABN, is a form that is required for Medicare recipients.) Which of the following is the purpose of precertification? A. Verification of coverage B. Assignment of benefits C. Determining the annual deductible amount

D. Determining the coinsurance amount - Answer: Verification of coverage

(Verification of coverage is the purpose of precertification.) Which of the following claims is submitted and then optically scanned by the insurance carrier and converted to an electronic form?

A. Paper claim B. Pending claim C. Clean claim

D. Rejected claim - Answer: Paper claim

(A paper claim is submitted on paper and requires optical scanning to convert to electronic form.) Which of the following information is required on a patient account record? A. Name and address of guarantor B. Procedures performed C. Family history of the guarantor

D. Diagnosis - Answer: Name and address of guarantor

(The guarantor's name and address are a required part of the patient account record.) Which of the following includes procedures and best practices for correct coding? A. Coding Compliance Plan B. Retrospective audit C. Prospective review

D. Diagnosis Related Groups - Answer: Coding Compliance Plan

A. Gatekeeper B. Privacy officer C. Compliance official

D. Health insurance administrator - Answer: Privacy officer

(A privacy officer ensures security, privacy, and safety within the health care industry.) Which of the following indicates a claim should be submitted on paper instead of electronically? A. The software claims review process indicates the claim is not complete. B. The claim needs authorization. C. The claim requires an attachment.

D. The practice management software is non-functional. - Answer: The claim

requires an attachment. (The billing and coding specialist should submit a paper form if the claim requires an attachment.) Which of the following should the billing and coding specialist include in an authorization to release information? A. The number of pages to be released

B. he health record number C. The entity to whom the information is to be released

D. The name of the physician - Answer: The entity to whom the information is to

be released (The receiving entity must be included in the authorization.) In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? A. Physical status modifiers B. Primary procedure code C. Mutually exclusive codes

D. Add-on codes - Answer: Add-on codes

(Add-on codes are listed after the primary procedure code, and cannot ever be listed as a primary, or be coded as the only procedure code.) When submitting a clean claim with a diagnosis of kidney stones, which of the following procedure names is correct? A. Nephrolysis B. Nephrectomy C. Nephrolithiasis

D. Nephrorrhexis - Answer: Nephrolithiasis

A. Diagnostic nonessential modifiers B. Procedure descriptors C. HCPCS descriptions

D. Diagnostic specificity - Answer: Procedure descriptors

(The "><" symbol is used to indicate new and revised text other than the procedure descriptors.) 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? Medicaid CHAMPVA Medicare

TRICARE - Answer: Medicaid

(Medicaid is the health plan that is referred to as the "payer of last resort." All of the patient's health plans must meet their obligations before Medicaid will pay.) Which part of Medicare covers prescriptions? Part A Part B Part C

Part D - Answer: Part D

(Medicare Part D covers prescriptions.) Which of the following actions by the billing and coding specialist prevents fraud? Writing off a deductible Performing periodic audits Unbundling codes

Upcoding claims - Answer: Performing periodic audits

(Performing audits on a routine basis will prevent fraud.) 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? A. The military provider requests the patient's records without a signed authorization to disclose form. B. The patient requests an amendment to his record. C. The billing and coding specialist sends the patient's records to the patient's partner. D. The patient's insurance company requests additional records to process the

claim. - Answer: The billing and coding specialist sends the patient's records to

the patient's partner.

(An aged insurance report is run by date. It can be sorted by date of service or date of submission.) 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? Compliance agreement Security rule agreement Consent agreement

HIPAA - Answer: C. Consent agreement

(Consent is the verbal or written agreement that gives approval to some action, situation, or statement.) 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? The parent who has the birthdate closest to the child The parent whose birthdate comes first in the calendar year The parent who is older In the case of identical birthdates, the parent whose name is first alphabetically -

Answer: B. The parent whose birthdate comes first in the calendar year

(The parent whose birthdate comes first in the calendar year is responsible for primary coverage of a dependent child.) Patient: Jane Austin; Social Security No.: 555-22-1111; Medicare ID No.: 555-33- 2222A; DOB: 05/22/1945. Claim information entered: Austin, Jane; Social Security No.: 555-22-1111; Medicare ID No.: 555-33-2222A; DOB: 052245. Which of the following is a reason the claim was rejected? The Medicare ID is entered incorrectly. The DOB is entered incorrectly. The patient's name is entered incorrectly.

The Social Security number is entered incorrectly. - Answer: B. The DOB is

entered incorrectly. (DOB format is two digits for the month and day and four digits for the year.) The star symbol in the CPT code book is used to indicate which of the following? New code Exempt from the use of modifier 51 Revised code

Telemedicine - Answer: D. Telemedicine

(The star symbol is used to indicate a code approved for telemedicine.)