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NHA CBCS EXAM
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- A billing and coding specialist is reviewing delinquent claims and discovers that a third-party payer paid a claim that applied to the incorrect provider. The third-party payer will reimburse the payment once the improperly paid funds are we occupied which of the following terms is used to describe this claim? Ans>> Suspend
- billing and coding specialist is reviewing a remittance advance and encoun- ters a denial of payment for CPT code 44950 (appendectomy). The specialist discovers the ICD 10 CM code
2 / assigned to the case was J32.1(chronic frontal sinusitis) which of the following is a reason for this claim denial? Ans>> Incorrectly linked codes were reported to the claim
- The billing and coding specialist is reviewing it claim that was denied for services provided during the postoperative period.The patient was diagnosed with pneumonia during a postoperative encounter for a knee joint replacement two weeks ago. Which of the following modifiers should a specialist add to the client prior to resubmitting Ans>> -
- Which of the following actions should a biller and coder specialist take to assign a diagnosis code to the highest level of specificity Ans>> Apply characters four through seven to a claim
4 / and the mothers birthday is May 18, 1984 which of the following statements is correct for determining coverage Ans>> The parents who insurance policy has been acted the longest will be the primary insurer
- Which of the following links the ICD 10 CM and CPT codes for claims processing Ans>> Diagnosis pointer
- A providers office fee is $100 and the Medicare part B allowed amount is $85. Assuming they've been a beneficiary has not met their annual deductible, the patient should be billed for which of the following amounts Ans>> $
- A billing and coding specialist is preparing a claim for a
5 / procedure with a prolonged operative time that has modifier - 22 attached. Which of the follow- ing actions should the specialist take. Ans>> Send a copy of the operator report with the claim
- Z Codes are used to identify which of the following Ans>> Immunizations
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- Billing and coding specialist is reviewing a patient's encounter progress note. Which of the following modifiers indicates the patient receive general anesthesia from a surgeon? Ans>> -
- A patient who recently received care be an endocrinologist. The endocri- nologist is being referred to an infectious disease specialist. Which of the following types of referral does the patient need from their endocrinologist?- Ans>> Tertiary care referral
- A billing specialist is reviewing a remittance advice for Medicare and notices that the amount paid for a procedure is less than the contract amount which of the following is a potential reason they reduced amount of payment?-
8 / Ans>> The claim indicated incorrect place of service
- The billing and coding specialist is submitting a claim for a 5 year old child he was brought to the clinic by their maternal grandmother.The child's parents are divorced and remarried. And the child's mother has legal custody of the child, the specialist should recognize that the child's primary insurance cover- age is provided through which of the following insured individuals. Ans>> Biological mother
- A child was bought into a facility by their mother.The child is covered under both parents insurance policies. The child's father was born on 10 one 1980 and their mother was born on 10 to 1981 which of the following statements is true regarding the primary policy holder for the child. Ans>> The father is the primary policyholder because his birthday falls first in the calendar year
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- A billing and coding specialist is preparing a claim for a patient who had a procedure performed on their left index finger which of the following modifiers indicates the correct digit Ans>> -F
- Billing and coding specialist is processing the claim for the patient who broke their arm while repairing cars at their workplace. There is no nerve damage. The arm is placed in a cast for six weeks. The patient is clear to work in six weeks. Which of the following type of workers compensation apply to this patient Ans>> Temporary disability
- Based on CPT integumentary coding guidelines Mohs micrographic surgery involves the provider feeling which of the following rules Ans>> Both the surgeon in the pathologist
- A billing and coding specialist is arranging a payment plan with a patient who wants to leave post dated checks with the office. The patient proposes leaving one check post dated for
11 / three months one for four months and another one for five months in the future according to the federal collection law which of the following actions should a specialist take? Ans>> Notify the patient between three and 10 days prior to the depositing each check on the indicated date
- Which of the following qualifies a patient for eligibility under Medicare as the primary third-party prayer? Ans>> Individuals who are under the age of 65 and have a disability
- A billing and coding specialist is determining third-party payer respon- sibilities for a 70-year-old patient who has Medicare coverage. The patient spouse has insurance with Blue Cross Blue Shield through their employer. Which of the following actions should the specialist take Ans>> Establish coordination of benefits
- When reviewing an established patients insurance card a billing and cod- ing specialist notices a minor change from the existing card on file which of the following actions should the specialist take Ans>> Photocopy both sides of the new card
13 / types of modifiers should be assigned to indicate multiple procedures were performed to prevent bundling Ans>> Category modifier
- A billing and coding specialist is reviewing an encounter note that indi- cates a biopsy was performed. The specialist requires which of the following additional details to fully clothed this procedure. Ans>> Benign VS Malignant status
- Billing and coding specialist is determining the level of service for an office visit for a new patient which of the following code represents a detailed history and detailed exam with moderate medical decision making? Ans>> 99204
- Which of the following is true regarding Medicaid eligibility Ans>> Patient eligibility is determined at each visit
- Which of the following pieces of guarantor information is required when establishing a patient's financial record Ans>> Phone number
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- A billing and coding specialist is reviewing a delinquent claim which of the following actions should the specialist take first? Ans>> Verify the age of the account
- When A patient signs and acknowledgment of notice of Privacy practice it indicates which of the following Ans>> The patient excepts the policies and procedures regarding help protected health information PHI is Handled
- Which of the following should A billing and coding specialist complete to be reimbursed for a providers outpatient services? Ans>> CMS 1500 claim form
- A billing and coding specialist is preparing a claim for an epidemic to me and reports it with two units. They claim is then denied. Which of the following coding edits should be specialist have reviewed prior to submitting the claim Ans>> Medically unlikely edits
- A billing and coding specialist identifies a CPT code that is routinely being denied by third-party payer. Which of the following types of review should the specialist perform?
16 / with a 20% coinsurance fee which of the following is a patient's financial responsibility Ans>> $
- The claim is submitted to with a transposed insurance member ID number and returned to the provider which of the following describes a status that will be assigned to the claim by the third-party payer Ans>> Invalid
- Outstanding patient balances will appear on which of the following Ans>> Ac- counts receivable
- An explanation of benefits states the amount bill was $ the allowed amount Is $60, the patient is required to pay a $20 copayment. Which of the following describes the insurance check amount to be posted? Ans>> $
- A patient is upset about a bill they received because their third-party payer did not the claim. Which of the following
17 / actions should a billing incoding specialist take Ans>> Inform the patient of the reason for the denial
- A billing and coding specialist should identify that which of the following is is used to improve the efficiency and effectiveness of the healthcare system has mandated by hippa for providers Ans>> CMS 1500 claim form
- A billing and coding specialist is reviewing a claim for a patient who presented to the all providers office for an upper respiratory infection. During the encounter the patient also receive the influenza vaccine. Which of the following modifiers should be attached to the evaluation and management code Ans>> -
- A patient has a resection of the intestines with anastomosis through the abdominal walls. Which of the following is a type of anastomosis Ans>> Colostomy
- A billing including specialist is reviewing the procedure notes from a provider who selected a code indicating an incisional
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- Which of the following is an advantage of electronic claim submission? Ans>> - Claims are expediting
- For which of the following are reasons should I clean be resubmitted Ans>> The claim requires an attachment to support medical necessity
- A billing and coding specialist is reviewing a providers documentation for a patient who underwent repair of multiple wounds to the face and trunk. The provider coded repair of all wounds individually. The specialist should recog- nize that the provider should have applied which of the following concepts to the documentation of the repair for this patient's wounds Ans>> Wounds should be grouped by anatomic site and coded in order of complexity
- Which of the following editing system should a billing and coding spe- cialist reference to to determine if a supplies and materials code should be assigned to report a surgical used during an ambulatory procedure
20 / Ans>> National correct coding initiative NCCI
- Which of the following reasons should I billing and coding specialist follow the guidelines in the CPT manual Ans>> The guidelines define items that are necessary to accurately code
- A billing and coding specialist discovers that one private pay has not reimburse the provider for any claims submitted to the past year. Clean claims have been submitted to the payer and have been acknowledged. Which of the following entities should the specialist contact before the payers failure to submit timely reimbursement Ans>> State insurance commissioners office
- Which of the following symbols indicates an add-on code in the CPT Manuel Ans>> Plus sign
- Billing and coding specialist is collecting demographic information from a patient. Which of the following places of information should the specialist expect the Medicaid eligibility verification system to provide
