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CBCS Exam prep

Test/Quiz questions

QuestionAnswer
The standard medical abbreviation "ECG" refers to a test used to assess which of the following body systems? Cardiovascular system
The billing and coding specialist should first divide the evaluation and management code by which of the following? Place of service
Urine moves from the kidneys to the bladder through which of the following parts of the body? Ureters
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 that she may be responsible for payment? Advanced Beneficiary Notice
To be compliant with HIPAA, which of the following positions should be assigned in each office? Privacy officer
A parent's portion of the bill should be discussed with the patient before a procedure is performed for which of the following reasons? To ensure the patient understands his portion of the bill
All dependents 10 years of age or older are required to have which of the following for TRICARE? Military identification
On a remittance advice form, which of the following is responsible for writing off the difference between the amount billed and the amouont allowed by the agreement? Provider
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? Invalid
Which of the following is used to code diseases, injuries, impairments, and other health-related problems? international Classification of Diseases (ICD)
Which of the following actions should the billing and coding specialist take if he observes a colleague in an unethical situation? Report the incident to a supervisor
Which of the following medical terms refers to the sac that encloses the heart? Pericardium
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? Adjustment column of the credits
Which of the following is the function of the respiratory system? Oxygenating blood cells
Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim form for procedures, services, or supplies? Block 24D
Which of the following do physicians use to electronically submit claims? Clearinghouse
When coding in the UB-04 form, the billing and coding specialist might sequence the diagnosis codes according to ICD guidelines. Which of the following is the first listed diagnosis code? Principle diagnosis
Which of the following is an example of a violation of an adult patient's confidentiality? Patient information was disclosed to the patient's parent without consent
Which of the following provisions ensures that an insured's benefits from all insurance companies do not exceed 100% of allowable medical expenses? Coinsurance
A dependent child whose parents both have insurance coverage comes to the clinic. The billing and coding specialist uses the birthday rule to determine which insurance policy is primary. Which of the following describes the birthday rule? The parent whose birthday comes first in the calendar year
Which of the following actions should be taken when a claim is billed for a level four office visit and paid at a level three? Submit an appeal to the carrier with the supporting documentation
When posting payment accurately, which of the following items should the billing and coding specialist include? Patient's responsibility
Which of the following does a patient sign to allow payment of claims directly to the provider? Assignment of benefits
A patient who has a primary malignant neoplasm of the lung should be referred to which of the following specialists? Pulmonary oncologist
Claims that are submitted without an NPI number will delay payment to the provider because the number is needed to identify the provider
Which of the following describes an obstruction of the urethra? Urethratresia
Ambulatory surgery centers, home health care, and hospice organizations the UB-04 claim form
Which of the following shows outstanding balances? Aging report
A form that contains charges, DOS, CPT codes, ICD codes, fees, and copay information is called which of the following? Encounter form
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 has not been met. How much should the physician write off the patient's account? $40
A patient is upset about a bill she received. Her insurance company denied the claim. Which of the following action is an appropriate way to handle the situation? Inform the patient of the reason for the denial
On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the following? The patient's condition and the provider's information
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
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 term describes this scenario? Fraud
In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? Add-on codes
Which of the following actions should be taken if an insurance company denies a service as not medically necessary? Appeal the decision with a provider's report
A coroner's autopsy is comprised of which of the following examinations? Gross examination
Which of the following privacy measures ensures protected health information (PHI)? Using data encryption software on office workstations
A provider performs an examination of a patient's sore throat during an office visit. Which of the following describes the level of the examination? Problem-focused examination
Which of the following actions by a billing and coding specialist would be considered fraud? Billing for services not provided
A patient with a past due balance requests that his records be sent to another provider. Which of the following actions should be taken? Accommodate the request and send the records
A patient comes in with chest pain and shortness of breath. After an unexpected ECG result, the provider summarizes the patient's symptoms. What portion of HIPAA allows the provider to speak to the cardiologist prior to obtaining the patient's consent? Title II
Which of the following is the advantage of electronic claim submission? Claims are expedited
On the CMS-1500 claim form, Blocks 1 through 13 include which of the following? The patient's demographics
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 planes divides the body into left and right? Sagittal
Which of the following is the purpose of running an aging report each month? It indicates which claims are outstanding
The unlisted codes can be found in which of the following locations in the CPT manual? Guidelines prior to each section
The star symbol in the CPT code book is used to indicate which of the following? Telemedicine
Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? Operative report
All e-mail correspondence to ta third-party payer containing patients' protected health information (PHI) should be encrypted
Medigap coverage is offered to Medicare beneficiaries by which of the following? Private third-party payers
Which of the following is the primary function of the heart? Pumping blood in the circulatory system
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 statements is correct regarding a deductible? The deductible is the patient's responsibility
Why does correct claim processing rely on accurately completed encounter forms? They streamline patient billing by summarizing the services rendered for a given date of service
According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500 claim form in Block 24J? NPI
Which part of Medicare covers prescriptions? Part D
Patient: Jane Austin; SS No.: 555-22-1111; Medicare ID No.: 555-33-2222A; DOB: 05/22/1945. Claim information entered: Austin, Jane; SS No.: 555-22-1111; Medicare ID No.: 555-33-2222A; DOB: 052245. What is a reason this claim was rejected? The DOB is entered incorrectly
Which of the following color formats allows optical scanning of the CMS-1500 claim form? Red
Which of the following components of an explanation of benefits expedites the process of a phone appeal? Claim control number
Which of the following types of claims is 120 days old? Delinquent
A claim can be denied or rejected for which of the following reasons? Block 24D contains the diagnosis code
Which of the following information is required on a patient account record? Name and address of guarantor
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 actions should be taken first when reviewing a delinquent claim? Verify the age of the account
Which of the following should the billing and coding specialist complete to be reimbursed for the provider's services? CMS-1500 claim form
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
Which of the following blocks requires the patient's authorization to release medical information to process a claim? Block 12
A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500 claim form should this information be entered? Block 9
A patient who is an active member of the military recently returned home 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 sections of the medical record is used to determine the correct Evaluation and Management code used for billing and coding? History and Physical
Which of the following is considered for the final determination of the issues involving settlement of an insurance claim? Adjudication
HIPAA transaction standards apply to which of the following entities? Health care clearinghouses
The "><" symbol is used to indicate new and revised text other than which of the following? Procedure descriptors
Which of the following information should the billing and coding specialist input into Block 33A on the CMS-1500 claim form? National provider identification number
Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? UB-04
Which of the following describes a delinquent claim? The claim is overdue for payment
Which of the following is a private insurance carrier? Blue Cross/Blue Shield
A billing and coding specialist should understand that the financial record source that is generated by a provider's office is called a patient ledger account
The 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. The amount is called which of the following? Deductible
Which of the following actions by the billing and coding specialist prevents fraud? Performing periodic audits
Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? Improper code combinations
A patient comes to the hospital for an inpatient procedure. Which of the following hospital staff members is responsible for the initial patient interview, obtaining demographic and insurance information, and documenting the chief complaint? Admitting clerk
Which of the following includes procedures and best practices for correct coding? Coding compliance plan
When submitting a clean claim with a diagnosis of kidney stones, which of the following procedure names is correct? Nephrolithiasis
Blue Cross/Blue Shield got 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%. How much should the patient expect to pay? $48
Which of the following should the billing and coding specialist include in an authorization to release information? The entity to whom the information is to be released
Which of the following is the portion of the account balance to the patient must pay after services are rendered and the annual deductible is met? Coinsurance
Which of the following claims is submitted and then optically scanned by the insurance carrier and converted to an electronic form? Paper claim
Which of the following is the purpose of precertification? Verification of coverage
Which of the following is one of the purposes of an internal auditing program in a physician's office? Verifying that the medical records and the billing record match
An insurance claim register (aged insurance report) facilitates which of the following ? Follow up of insurance claims by date
In which of the following departments should a patient be seen for psoriasis? Dermatology
Which of the following indicates a claim should be submitted on paper instead of electronically? The claim requires an attachment
Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays 30%? Coinsurance
A patient's health plan is referred to as the "payer of last resort." The patient is covered by which of the following health plans? Medicaid
Which of the following statements is true regarding the release of patient records? Patient access to psychotherapy notes may be restricted
When completing a CMS-1500 paper claim form, which of the following is an acceptable action for the billing and coding specialist to take? Use Arial size 10 font
Which of the following is the verbal or written agreement that gives approval to some action, situation, or statement, and allows the release of patient information? Consent agreement
Created by: crystal_r
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