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NHA BILLING AND CODING TEST BANK (CBCS
MOCK EXAM) 2024 QUESTIONS AND CORRECT
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Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? - CORRECT 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? - CORRECT 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 - CORRECT 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? - CORRECT ANSWER>>>Coordination of benefits (Coordination of benefits ensures that the insured benefits from all insured companies do not exceed 100% of allowable medical expenses)
A coroner's autopsy is comprised of which of the - CORRECT ANSWER>>>Gross Examination (Gross examination is an integral part of an autopsy.) Which of the following statements is true regarding the release of patient records? A. Verbal requests for records from life insurance companies are appropriate. B. Identification is not required when requesting access to patient records. C. Providers cannot share a patient's medical information with other health care professionals if the patient is mentally unstable. D. Patient access to psychotherapy notes may be restricted - CORRECT ANSWER>>>Patient access to psychotherapy notes may be restricted (Patients cannot access psychotherapy notes or information compiled for lawsuits.) Which of the following actions by a billing and coding specialist would be considered fraud? A. Submitting a claim for services that are not medically necessary B. Violating participating provider agreements with third-party payers C. Billing for services not provided D. Billing non-covered services as covered services - CORRECT 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?
C. Health care clearinghouses D. Educational facilities - CORRECT 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? A. Signature on file B. Military identification C. Assignment of benefits D. Provider signature - CORRECT ANSWER>>>Military identification (Military identification cards pertain to retirees, active duty sponsors, and their eligible family members as a means of identification for TRICARE. The standard medical abbreviation "ECG" refers to a test used to assess which of the following body systems? - CORRECT ANSWER>>>Cardiovascular system (An electrocardiogram is a test that checks for problems with the electrical activity of the heart.) Which of the following is an example of a violation of an adult patient's confidentiality? A. While reviewing a claim, the billing and coding specialist reads the diagnosis before realizing that the patient is a neighbor. B. A billing and coding specialist queries the physician about a diagnosis in a patient's medical record. C. The physician uses his home phone to discuss patient care with the nursing staff.
D.Patient information was disclosed to the patient's parent without consent. - CORRECT 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 - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT 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?
C. $
D. $48 - CORRECT ANSWER>>>$
Which of the following statements is correct regarding a deductible? A. Coinsurance is a type of deductible. B. The physician should write off the deductible. C. The insurance company pays for the deductible. D. The deductible is the patient's responsibility. - CORRECT ANSWER>>>The deductible is the patient's responsibility. (The patient pays the deductible as part of the insurance contract.) 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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
A. Gatekeeper B. Privacy officer C. Compliance official D. Health insurance administrator - CORRECT 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. - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER>>>Nephrolithiasis (Nephrolithiasis is the destruction of kidney stones.) Ambulatory surgery centers, home health care, and hospice organizations use the A. CMS-1500 claim form. B. UB-04 claim form. C. Advance Beneficiary Notice.
CHAMPVA
Medicare TRICARE - CORRECT 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 - CORRECT 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 - CORRECT 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. - CORRECT ANSWER>>>The billing and coding specialist sends the patient's records to the patient's partner. (Because the patient does not have anyone designated with power of attorney, the only people able to access his medical records are the patient and medical personnel. Sending the patient's medical records to his partner is a HIPAA violation.) Which of the following is used to code diseases, injuries, impairments, and other health-related problems? A. International Classification of Diseases (ICD) Current Procedural Terminology (CPT) Healthcare Common Procedures Coding Systems (HCPCS) Current Dental Terminology (CDT) - CORRECT ANSWER>>>A. International Classification of Diseases (ICD) (ICD is used to code disease, injuries, impairments, and other health-related problems.) An insurance claims register (aged insurance report) facilitates which of the following? A. Batching of claims for submission to the insurance carrier Determination of the patient's insurance coverage Completion of the CMS-1500 claim form
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. - CORRECT 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 - CORRECT ANSWER>>>D. Telemedicine (The star symbol is used to indicate a code approved for telemedicine.) A patient's portion of the bill should be discussed with the patient before a procedure is performed for which of the following reasons? To determine the procedure To verify insurance coverage To give the patient the option to negotiate their portion of the bill
To ensure the patient understands his portion of the bill - CORRECT ANSWER>>>D. To ensure the patient understands his portion of the bill (The bill should be discussed prior to the procedure to ensure the patient understands how much the procedure will cost and how much the patient is responsible to pay.) 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? Fraud Abuse Adjudication Spend-down - CORRECT ANSWER>>>A. Fraud (This scenario is considered fraud because the patient is responsible for paying the deductible.) When posting payment accurately, which of the following items should the billing and coding specialist include? CPT codes ICD codes Insurance number Patient's responsibility - CORRECT ANSWER>>>D. Patient's responsibility (The patient's responsibility could include a copayment, deductible, or coinsurance.) On the CMS-1500 claim form, Blocks 1 through 13 include which of the following?
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? Invalid Adjusted Denied Incomplete - CORRECT ANSWER>>>C. Denied (The provider should receive a denied claim status from the third-party payer.) Which of the following types of claims is 120 days old? Clean Delinquent Open Closed - CORRECT ANSWER>>>B. Delinquent (A delinquent claim is a claim that is 120 days old or older and is not paid.) A nurse is reviewing a patient's lab results prior to discharge and discovers an elevated glucose level. Which of the following health care providers should be alerted before the nurse can proceed with discharge planning? The attending physician The admitting physician The nursing supervisor The physician's assistant - CORRECT ANSWER>>>A. The attending physician
(The attending physician is responsible for the patient's care, as well as discharge decisions; therefore, the attending physician should be notified of unexpected lab results, including elevated glucose levels.) Which of the following is considered the final determination of the issues involving settlement of an insurance claim? Processing Translation Adjudication Transmission - CORRECT ANSWER>>>C. Adjudication (Adjudication is the process of putting an insurance claim through a series of edits for final determination.) Urine moves from the kidneys to the bladder through which of the following parts of the body? Ureters Renal pelvis Urethra Adrenal gland - CORRECT ANSWER>>>A. Ureters (The ureters transport urine to the bladder from the kidneys.) 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? Reference column Description column
