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CBCS Exam prep
Test/Quiz questions
| Question | Answer |
|---|---|
| Which of the following Medicare policies determines if a particular item or service is covered by Medicare? | National coverage Determination (NCD) |
| 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? | denied |
| A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? | aging report |
| Which of the following should a billing and coding specialist use to submit a claim with supporting documents? | claims attachment |
| Which of the following terms is used to communicate why a claim line item was denied or paid differently than it was billed? | claim adjustment codes |
| On a CMS 1500 claim form, which of the following information should the billing and coding specialist enter into block 32? | service facility location information |
| A provider's office receives a subpoena requesting medical documentation regarding a patient's medical record. After confirming the correct authorization, which of the following should the billing and coding specialist take? | send the medical information pertaining to the dates of service requested |
| Which of the following is the deadline for Medicare claim submission? | 12 months from the date of service |
| Which of the following forms does a third party payer require for physician services? | CMS 1500 |
| 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? | the billing and coding specialist sends the patient's records to the patient's partner |
| Which of the following is an example of Medicare abuse? | charging excessive fees |
| Which of the following terms refers to the difference between the billed and allowed amounts? | adjustment |
| Which of the following HMO managed care services requires a referral? | durable medical equipment |
| Which of the following explains why Medicare will deny a particular service or procedure? | Advance Beneficiary Notice (ABN) |
| Which of the following types of claims is 120 days old? | delinquent |
| When reviewing an established patient's insurance card, the billing and coding specialist notices a minor change from the existing card on file. Which of the following actions should the billing and coding specialist take? | photocopy both sides of the new card |
| A husband and wife each have insurance through their employers. The wife has an appointment with her provider. Which insurance should be used as primary for the appointment? | the wife's insurance |
| Which of the following would most likely result in a denial on a Medicare claim? | an experimental chemotherapy treatment for a patient who has stage III renal cancer |
| Which of the following pieces of guarantor information is required when establishing a patient's financial record? | phone number |
| A provider surgically punctures through the space between the patient's ribs using an aspirating needle to withdraw fluid from the chest cavity. Which of the following is the name of this procedure? | pleurocentesis |
| A patient has AARP as secondary insurance. In which of the following blocks o n the CMS 1500 claim form should this information be entered? | block 9 |
| a Medicare non-participating (non-PAR) provider's approved payment amount is $200 for a lobectomy and the deductible has been met. Which of the following amounts is the limiting charge for this procedure? | $230 |
| In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? | add on codes |
| Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes which of the following procedures? | angioplasty |
| which of the following actions by a billing and coding specialist would be considered fraud? | billing for services not provided |
| Which of the following statements is accurate regarding the diagnostic codes in block 21? | these codes must correspond to the diagnosis pointer in block 24E |
| Which of the following parts of the Medicare insurance program is managed by private, third party insurance providers that have been approved by Medicare? | Part C |
| A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by first using which of the following processes? | precertification |
| Which of the following is considered fraud? | the billing and coding specialist unbundles a code to receive higher reimbursement |
| The authorization number for a service that was approved before the service was rendered is indicated in which of the following blocks on the CMS 1500 claim form? | block 23 |
| A patient is preauthorized to receive vitamin B12 injections from January 1 to May 31. On June 2, the provider orders an additional 6 months of injections. In order for the patient to continue with coverage of care, which of the following should occur? | the provide should contact the patient's insurance carrier to obtain a new authorization |
| Which of the following symbols indicates a revised code? | triangle |
| If both parents have full coverage for a dependent child, which of the following is considered to be the primary insurance holder? | the parent whose birthday comes first in the calendar year will be used as primary insurance |
| Which of the following entities defines the essential elements of a comprehensive compliance program? | Office of Inspector General (OIG) |
| The "><" symbol is used to indicate new and revised text other than which of the following? | procedure descriptors |
| Which of the following describes the organization of an aging report? | by date |
| Which of the following is the purpose of coordination of benefits? | prevent multiple users from paying benefits covered by other policies |
| A billing and coding specialist submitted a claim to Medicare electronically. No errors were found by the billing software or clearinghouse. Which of the following describes this claim? | clean claim |
| Which of the following qualifies as an exception to the HIPAA Privacy Rule? | psychotherapy notes |
| Which of the following would result in a claim being denied? | an italicized code used as the first listed diagnosis |
| Which of the following standardized formats are used in the electronic filing of claims? | HIPAA standard transactions |
| Which of the following describes a two digit CPT code used to indicate that the provider supervised and interpreted a radiology procedure? | professional component |
| Which of the following formats are used to submit electronic claims to a third party payer? | 837 |
| Urine moves through the kidneys to the bladder through which of the following parts of the body? | ureters |
| As of April 1, 2014, what is the maximum number of diagnoses that can be reported on the CMS 1500 claim form before a further claim is required? | 12 |
| Which of the following does a patient sign to allow payment of claims directly to the provider? | assignments of benefits |
| Which of the following is the primary function of the heart? | pumping blood in the circulatory system |
| Which of the following is true regarding Medicaid eligibility? | patient eligibility is determined monthly |
| The explanation of benefits states that the amount billed was $80. The allowed amount is $60, and the patient is required to pay a $20 copay. Which of the following describes the insurance check amount to be posted? | $40 |
| Which of the following provisions ensures that an insured's benefits from all insurance companies don't exceed 100% of allowable expenses? | coordination of benefits |
| If a clean claim is received on March 1 of this year, which of the following is the allowable last day of payment in order to meet Medicare compliance requirements? | March 30 |
| On a remittance advice form, which of the following is responsible for writing off the difference between the amount billed and the amount allowed by the agreement? | provider |
| Which of the following is the maximum number of modifiers that the billing and coding specialist can report on the CMS 1500 claim form in block 24D? | four |
| When the remittance advice is sent from the third party payer to the provider, which of the following actions should the billing and coding specialist perform first? | ensure that proper payment has been made |
| Which of the following is a reason that a claim would be denied? | incorrectly linked codes |
| The billing and coding specialist should follow the guidelines in the CPT manual for which of the following reasons? | the guidelines define items that are necessary to accurately code |
| Which of the following documentation is a valid authorization to release medical information to the judicial system? | subpoena duces tecem |
| A claim is denied due to termination of coverage, which of the following actions should the billing and coding specialist take next? | follow up with the patient to determine the current name, address, and insurance carrier for resubmission |
| A patient who has a primary malignant neoplasm of the lung should be referred to which of the following specialist? | pulmonary oncologist |
| Which of the following is a HIPAA compliance guideline affecting electronic health records? | the electronic transmission and code set standards require every provider to use the healthcare transactions, code sets, and identifiers |
| Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? | operative report |
| Which of the following blocks on the CMS 1500 claim form is used to accept assignment of benefit? | block 27 |
| Which of the following is an example of a remark code from an explanation of benefits document? | contractual allowance |
| Which of the following describes the term "crossover" as it relates to Medicare? | when an insurance company transfers data to allow coordination of benefits of a claim |
| The unlisted codes can be found in which of the following locations in the CPT manual? | guidelines prior to each section |
| Which of the following privacy measures ensures protected health information (PHI)? | using data encryption software on office workstations |
| A physician's office fee is $100 and the Medicare Part B allowed amount is $85. Assuming that the beneficiary has not met his annual deductible, the office should bill the patient which of the following amounts? | $85 |
| Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? | UB 04 |
| A patient has laboratory work done in the emergency department after an inhalation of toxic fumes from a faulty exhaust fan at her place of employment. Which of the following is responsible for the charges? | Workers' compensation |
| A billing and coding specialist is preparing a claim form for a provider from a group practice. The billing and coding specialist should enter the rendering providers national provider identifier (NPI) into which of the following blocks on the CMS 1500? | 24J |
| Which of the following is included in the release of patient information? | the date of the last disclosure |
| Which of the following describes a key component of an evaluation and management service? | history |
| Which of the following reports is used to arrange the accounts receivable from the date of service? | aging report |
| Which of the following best describes medical ethics? | medical standard of conduct |
| A provider performs an examination of a patient's knee joint via small incisions and an optical device. Which of the following terms describes this procedure? | arthroscopy |
| Which of the following accurately describes code symbols found in the CPT manual? | a product pending FDA approval is indicated as a lightning bolt symbol |
| On the CMS 1500 claim form, blocks 14-33 contain information about which of the following? | the patient's condition and the provider's information |
| Which of the following describes an insurance carrier that pays the provider who rendered services to the patient? | third party payer |
| In 1996, CMS implemented which of the following to detect inappropriate and improper codes? | National Correct Code Initiative (NCCI) |
| Which of the following prohibits a provider from referring Medicare patients to a clinical laboratory service in which a provider has a financial interest? | Stark law |
| Which of the following sections of the SOAP note indicates a patient's level of pain to a provider? | subjective |
| Which of the following planes divides the body into left and right? | sagittal |
| Which of the following electronic forms is used to post payments? | electronic remittance advice (ERA) |
| The explanation of benefits states the amount billed was $170. However, the allowed amount is $150. The patient has an unmet deductible of $50 and a copay of $20. Which of the following amounts is the patient's responsibility? | $70 |
| which of the following is a government health insurance program? | TRICARE |
| For non-crossover claims, the billing and coding specialist should prepare an additional claim for the secondary payer and send it with a copy of which of the following? | remittance advice (RA) |
| Which of the following actions by the billing and coding specialist prevents fraud? | performing periodic audits |
| When coding a front torso burn, which of the following percentages should be coded? | 18% |
| Which of the following blocks should the billing and coding specialist complete on the CMS 1500 claim form for procedures, services, or supplies? | 24D |
| Which of the following blocks on the CMS 1500 claim form indicates an ICD diagnosis code? | block 21 |
| Which of the national provider identifiers (NPIs) is required in block 33a on the CMS 1500 claim form? | billing provider |
| Which of the following causes a claim to be suspended? | services require additional information |
| Which of the following terms is used to describe the location of the stomach, the spleen, part of the pancreas, part of the liver, and part of the small and large intestines? | left upper quadrant |
| Which of the following actions should the billing and coding specialist take when submitting a claim to Medicaid for a patient who has primary and secondary insurance coverage? | attach the remittance advice from the primary insurance to the Medicaid claim |
| A billing and coding specialist has four past due charges: $400 that is 10 weeks past due; $800 that is 6 weeks past due; $1,000 that is 4 weeks past due; and $2,000 that is 8 weeks past due. Which of the following should be sent to collections first? | $2.000 |
| In which of the following blocks on the CMS 1500 claim form should the billing and coding specialist enter the referring provider's national provider identifier (NPI)? | 17b |
| When a third party payer requests copies of patient information related to a claim, the billing and coding specialist must make sure which of the following is included in the patient's file? | signed release of information form |
| A patient who has an HMO insurance plan needs to see a specialist for a specific problem. From which of the following should the patient obtain a referral? | primary care provider |
| Which of the following organizations fights waste, fraud, and abuse in Medicare and Medicaid? | Office of Inspector General (OIG) |
| Which of the following is used to code diseases, injuries, impairments, and other health related problems? | ICD- International classification of Diseases |
Created by:
crystal_r
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