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Billing & Coding
Prep Exam items
| Question | Answer |
|---|---|
| what form used to post payments? | remittance advice |
| the authorization number for a service approved before service was rendered is indicated in which block on cms-1500 claim form? | block 23 |
| which block of cms-1500 form if the federal tax ID entered? | block 25 |
| which block of cms-1500 form indicates an ICD diagnosis code? | block 21 |
| which block of cms-1500 form is additional claim information entered? | block 18 |
| what standardized format is used in the electronic filing of claims? | HIPPA standard transactions |
| which block of cms-1500 form is used to accept assignment of benefit? | block 27 |
| on cms-1500 claim form, blocks 14 - 33 contain what information? | patients condition and provider's information |
| the EOB states the amount billed was $80. the amount allowed is $60, and the patient is required to pay a $20 copayment. what insurance check amount should be posted? | $40 |
| what should a billing and coding specialist use to submit a claim with supporting documents? | claim attachment |
| what medicare policy determines if a particular item or service is covered by medicare? | National Coverage Determination (NCD) |
| what is an example of a remark code from EOB document? | contractual allowance |
| what form should a billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? | UB-04 |
| a claim is denied due to termination of coverage (TOC). what action should the billing and coding specialist take next? | follow up with the patient to determine the current name, address, and carrier for resubmission |
| what NPI # is required in block 33a of cms-1500 claim form? | billing provider |
| what reason a claim would be denied? | incorrectly linked codes |
| when the remittance advice is sent from third-party payer to provider; what action should the billing and coding specialist perform first? | ensure the proper payment has been made |
| what term is used to describe the location of the stomach, spleen, part of pancreas, part of liver, and part of the small & large intestines? | LUQ |
| when coding a front torso burn, what percentage should be coded? | 18% |
| which statement is true regarding Medicaid eligibility? | patient eligibility is determined monthly |
| which of the following describes a key component of E/M service? | history |
| which of the following is considered a fraud? | a billing and coding specialist unbundles a code to receive higher reimbursement |
| which of the following is an example of medicare abuse? | charging excessive fees |
| what organization fights waste, fraud, and abuse in medicare and Medicaid? | OIG - Office of the Inspector General |
| medicare part A | hospital services |
| medicare part B | provides insurance for outpatient and physician services |
| medicare part C | managed by private, third-party insurance providers approved by medicare |
| medicare part D | prescription services |
| what part of medicare insurance program is managed by private, third-party insurance providers approved by medicare? | medicare part C |
| a patient's employer has not submitted a premium payment. what claim status should the provider receive from third-party payer? | denied |
| what block on cms-1500 claim form should a billing and coding specialist complete for procedures, services, or supplies? | block 24d |
| what describes an insurance carrier that pays the provider who rendered services to a patient? | third-party payer |
| what format is used to submit electronic claims to a third-party payer? | 837 |
| what entity defines essential elements of a comprehensive compliance program? | OIG |
| what causes a claim to be suspended? | services required additional information |
| a medicare non-participating (non-PAR) provider's approved payment amount is $200 for a lobectomy and deductible has been met. what amount is the limiting charge for this procedure? | $230 |
| for non-crossover claims, the billing and coding specialist should prepare a copy of what form? | primary insurance card |
| a billing and coding specialist can ensure insurance coverage for an outpatient procedure by using what process? | precertification |
| when a third-party payer requests copies of patient information related to claim, billing and coding specialist must include what document from patient's file? | signed release of information form |
| in the anesthesia section of CPT manual, what is considered a qualifying circumstance? | add-on codes |
| what describes the term "crossover" relating to medicare? | when insurance company transfers data to allow (COB) coordination of benefits of a claim |
| a provider performs an examination of patient's knee joint via small incisions and optical device. what term describes this procedure? | arthroscopy |
| a billing and coding specialist has 4 past-due charges: $400 - 10 weeks past due; $800 - 6 weeks past due; $1,000 - weeks past due; and $2,000 - 8 weeks past due. what charge should be sent to collections first? | $2000 |
| the EOB states the amount billed was $170. The allowed amount is $150. The patient has an unmet deductible of $50 and a copayment of $20. what dollar amount is the patient responsible for? | $70 |
| what term refers to difference between billed & allowed amounts? | adjustment |
| these <> symbols are used to indicate new and revised text of what description? | procedure descriptors |
| what HIPAA compliance guideline affects electronic health records? | electronic transmission & code set standards require every provider to use healthcare transactions, code sets, & identifiers |
| what describes a code that would be denied? | an italicized code as the primary diagnosis |
| what section of SOAP note indicates a patient's level of pain to a provider? | subjective |
| what HMO managed care services requires a referral? | DME |
| what explains why medicare will deny a service / procedure? | ABN - advance beneficiary notice |
| which block of cms-1500 form should a billing & coding speacialist enter the referring provider's NPI# ? | block 17b |
| coronal, frontal | vertical plane divides body into front & back |
| transverse | horizontal plan divides the body into top & bottom sections |
| sagittal | vertical plane divides body into right and left sides |
| anterior, ventral | front of body |
| posterior, dorsal | back of body |
| superior | above |
| proximal | near or towards the origin, closer |
| distal | far / away form origin |
| inferior | below |
| lateral | side |
| bilateral | both sides |
| medial | middle of body |
| what action should billing & coding specialist take when submitting a claim to medicaid for a patient that has primary & secondary insurance coverage? | attach remittance advice from primary insurance along w/ medicaid claim |
| what term is used to communicate why a claim line item was denied or paid differently than billed? | claim adjustment codes |
| two surgeon successfully performed closure of a vaginal fistiula thru patient's abdomen. for both providers' claims, the billing & coding specialist should use what cpt codes & modifiers? | 57305-62 |
| in 1996, cms implemented which entity to detect inappropriate & improper codes? | National Correct Code Initiative (NCCI) |
| what plane divides the body into left & right? | sagittal |
| a billing & coding specialist is preparing a claim form for a provider from a group practice. the billing & coding specialist should enter the rendering providers NPI# in which block on cms-1500 form? | 24j |
| on a remittance advice form, who is responsible for writing off difference between amount billed and the amount allowed by agreement? | the provider |
| what is the purpose o coordination of benefits (COB)? | prevent multiple insurers from paying benefits covered by other policies |
| which block of cms-1500 claims form is the report modifiers section? | 24d |
| as of april 1, 2014 what is the maximum number of diagnoses that can be reported on CMS-1500 claim form before a further claim is required? | 12 |
| what best describes medical ethics? | medical standard of conduct |
| a patient has AARP as secondary insurance. what block on cms-1500 claim form should enter information? | block 9 |
Created by:
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