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CBCS Exam prep
Test/Quiz questions
| Question | Answer |
|---|---|
| After a third party payer validates a claim, what takes place next? | claim adjudication |
| HIPAA transaction standards apply to? | healthcare clearinghouses |
| What is the initial step in processing a Workers' Compensation claim? | first reporting of the injury |
| The provision of health insurance policies that specifies which coverage is considered primary or secondary is called what? | coordination of benefits |
| Medicare enforces mandatory submission of electronic claims for most providers. What is allowed to be submitted for paper claims to Medicare? | the provider's office has fewer than 10 full time employees |
| What is the outcome if block 13 is left blank when submitting a claim? | the third party payer reimburses the patient and the patient is responsible for reimbursing the provider |
| Patient charges that haven't been paid will appear where? | accounts receivable |
| A billing and coding specialist needs to know how much Medicare has paid on a claim before billing the secondary insurance. Where should the specialist look for this information? | remittance advice |
| A billing and coding specialist should add modifier 50 to codes when reporting what? | bilateral procedures |
| The star symbol in the CPT book is used to indicate what? | telemedicine |
| In 1995 and 1997, what was introduced regarding documentation guidelines to Medicare carriers to ensure that services that have been paid for have been provided and were medically necessary? | CMS |
| What is allowed when billing procedural codes? | billing that uses two digit CPT modifiers to indicate a procedure as performed that differs from its usual five digit codes |
| The destruction of lesions using cryosurgery would use which treatment? | cold treatment |
| When a patient has a condition that is both acute and chronic how is it reported? | code both with acute first |
| When coding on UB 04 form, the billing and coding specialist must sequence the diagnostic codes according to the ICD guidelines. What is the first listed diagnostic code? | the principal diagnosis |
| What describes the content of a medical practice aging report? | overview of the practice's outstanding claims |
| After reading a provider's notes about a new patient, a coding specialist decides to code for a longer length of time rather than the actual office visit. What describes the specialist's action? | fraud |
| A claim is denied because the service wasn't covered by the insurance company. Upon confirmation of no errors on the claim, what is the next process after the claim is denied? | the claim isn't submitted and the patient is sent the bill |
| A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with what? | the billing worksheet from the patient account |
| What should the billing and coding specialist include in an authorization to release information? | the entity to whom the information is being released to |
| What security feature is required during the transmission of PHI and medical claims to third party payers? | encryption |
| What medical term refers to the sac that encloses the heart? | pericardium |
| What act applies to the administration simplification guidelines? | HIPAA |
| Z codes are used to identify what? | immunizations |
| What is true regarding a deductible? | the deductible is the patient's responsibility |
| A patient presents with chest pain and shortness of breath. After an ECG , a cardiologist is called and given the patient's symptoms. What portion of HIPAA allows the provider to speak to the cardiologist prior to obtaining a patient's consent? | Title II |
| What is a verbal or written agreement that gives approval to release a patient's PHI? | consent |
| A provider performs an exam on a patient's sore throat during an office visit. What is the level of the exam? | problem-focused examination |
| A dependent child whose parents both have health insurance coverage comes into the clinic. The birthday rule is used to determine whose policy is the primary insurance. What is the birthday rule? | the parent whose birthday comes first is the primary insurance |
| What section of the medical record is used to determine the correct E/M code used for billing and coding? | the history and physical |
| What modifier should be used to indicate a professional service that has been discontinued prior to completion? | 53 |
| When an electronic claim is rejected due to incomplete information, what action should the medical billing specialist take? | complete the information and re-transmit it according to the third party standards |
| What is the purpose of running an aging report each month? | it indicates which claims are outstanding |
| A physician covered a comprehensive metabolic panel for a 70 year old patient who has Medicare as her primary insurance. What form is required so the patient knows she may be responsible for payment? | advanced beneficiary notice |
| What describes an obstruction of the urethra? | urethratresia |
| What is an example of an electronic claim submission? | claims that are submitted via a secure network |
| Test results indicated no abnormalities were found in the brain and the brains electrical activity patterns are normal. What test was used to conduct this exam? | EEG |
| When billing a secondary insurance company, what block should the billing and coding specialist fill out on the CMS 1500 claim form? | 9a |
| What action should the billing and coding specialist take to effectively manage accounts receivable? | collect co-payments from the patient at the time of services |
| Blue Cross/Blue Shield provider receives an explanation of benefits for a patient account. The charged amount was $100. BC/BS allowed $80 and applied $40 to the patient's annual deductible. BC/BS paid the balance at 80%. What was the patient's balance? | $48 |
| What is the maximum number of ICD codes that can be entered on the CMS 1500 claim form as of February 2012? | 12 |
| What is considered the final determination of the issues involving the settlement of an insurance claim? | adjudication |
| What is true regarding the release of a patient's records? | the patient's access to the psychotherapy notes may be restricted |
| What action should the billing and coding specialist take to prevent fraud and abuse in the medical office? | internal monitoring and auditing |
| Why does correct claims processing rely on an accurately completed encounter form? | the encounter form streamlines the patient's billing by summarizing the services rendered for a given date of service |
| What time period should the billing and coding specialist track unpaid claims before taking follow up action? | 30 days |
| When posting payments accurately, what item should the billing and coding specialist include? | the patient's responsibility |
| A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is responsible for what percentage of the bill? | 0% |
| A biller will electronically submit a claim to the carrier via what method? | a direct data entry |
| The standard medical abbreviation "ECG" refers to a test used to access what body system? | cardiovascular |
| A 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 the year. What is this called? | deductible |
| When a physician documents a patient's response to symptoms and various body systems, the results are documented as what? | review of systems |
| What is the correct entry of a charge of $150 in Block F on the CMS 1500 claim form? | 150 00 |
| On the CMS 1500 claim form, blocks 1-13 include what information? | the patient's demographics |
| What would constitute a consultation? | services rendered by a physician whose opinion or advice is requested by another physician or agency |
| If a patient has osteomyelitis, he has problems with what area? | bones and bone marrow |
| What form must the patient or representative sign to allow the release of a patient's PHI? | authorization form |
| Block 17b on the CMS 1500 claim form should list what? | the referring physician's NPI number |
| What was developed to reduce Medicare program expenditures by detecting inappropriate codes and eliminating improper coding practices? | NCCI |
| What describes the status of a claim that doesn't include required preauthorization for a service? | denied |
| What body system regulates immunity? | lymphatic |
| What is used by providers to remove errors from claims before they are submitted to third party payers? | a clearinghouse |
| What information should a billing and coding specialist put in block 33a on the CMS 1500 claim form? | the national provider identification number |
| A provider receives reimbursement from a third party payer accompanied by which document? | explanation of benefits |
| What is the third stage of the life cycle of a claim? | claims adjudication |
| In what block on the CMS 1500 claim form do you report a Workers' Compensation case/ | 10a |
| Two providers from the same practice visit a patient in the emergency department using the same CPT code. The claim may be denied. Why? | duplicated services |
| A patient has an emergency appendectomy while on vacation. the claim is rejected because the patient obtained services out of the network. What information should be included in the claim appeal? | the patient was out of town during the emergency |
| What is a type of claim that will be denied by a third party payer? | an incomplete claim |
| What steps should be a part of a physician's practice compliance program? | internal monitoring and auditing |
| A patient has a Medicare deductible of $150. The patient's coinsurance is 20% and the allowed amount is $600. What would be the patient's out of pocket expense? | $120 |
| What primary information is used to determine the priority of collection letters to patients? | the age of the account |
| What type of claim would appear on an aging report? | one that is delinquent for 60 days |
| What is the portion of the account balance that the patient must pay after services are rendered and the annual deductible is met? | coinsurance |
| What do physician's use to electronically submit claims? | a clearinghouse |
| What is a requirement of some third party payers before a procedure is performed? | a preauthorization form |
| What indicates that a claim should be submitted on paper rather than electronically? | the claim requires an attachment |
| Which coding manual is used to identify products, supplies, and services? | HCPCS level II |
| A billing and coding specialist should enter the prior authorization number on the CMS 1500 claim form in which block? | 23 |
| Which document is required to disclose an adult patient's information? | a signed release from the patient |
| Which Medicare part covers prescriptions? | part D |
| What billing patterns are the best practice action? | documenting the patient's chief complaint, history, exam, assessment, and plan for care |
| Behavior plays an important part of being a team player in a medical practice. What is an appropriate form of action for the billing and coding specialist to take? | communicating with the front desk staff during a team meeting about missing information in patient files |
| 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 what? | the provider will receive the payment directly from the payer |
| What is the correct term for an amount that has been determined to be uncollectable? | bad debt |
| 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 hasn't been met. How much should the physician write off of the patient's account? | $40 |
| Accepting assignments on CMS 1500 claim forms indicates what? | the physician agrees to accept the payment under the terms of the payer's program terms |
| What is true regarding the determination of the patient financial responsibility by reviewing the remittance advice? | any coinsurance, copayments, or deductibles can be collected from the patient |
| what is an example of a violation of an adult patient's confidentiality? | patient information was disclosed to the patient's parent without consent |
| What is a function of the respiratory system? | oxygenating blood cells |
| What is the name of a private insurance carrier? | Blue Cross/Blue Shield |
| Which insurance is considered the payer of a last resort? | Medicaid |
| What is a purpose of an internal auditing program in a physician's office? | to verify that medical records and billing records match |
| in an outpatient setting, what form is used as a financial report of all services provided to patients? | the patient account record |
| What is the appropriate diagnosis for a patient who has had an abnormal accumulation of fluid in their lower leg that has resulted in swelling? | edema |
| What type of insurance plan best describes a government sponsored benefit program? | TRICARE Prime |
| What organization identifies improper payments made on CMS claims? | Recovery Audit Contractor (RAC) |
| What information is required to include on an Advance Beneficiary Notice (ABN) form? | the reasons Medicare may not pay |
| What block on the CMS 1500 claim form is used to bill ICD codes? | Block 21 |
| What is an advantage of an electronic claim submission? | claims are expedited |
Created by:
crystal_r
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