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Cbcs study guide
| Question | Answer |
|---|---|
| Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? A) reporting codes without proper modifiers B) coding without proper documentation C) improper code combinations D) use of outdated codes | C) improper code combinations |
| Which of the following actions should be taken if an insurance company denies a service as not medically necessary? A) send the patient a cooy of the remittance advice B) appeal the decision with a provider's report C) submit a claim to the patients secon | B) appeal the decision with a providers report |
| A coroners autopsy is comprised of which of the following examinations? A) suppression testing B) Gross examination C) diagnostic endoscopy D) mohs micrographic examination | B) gross examination |
| Which of the following conditions is associated with microcephaly? A) tetralogy of fallot B) down's syndrome C) microphthalmos D) achondroplasia | B) down's syndrome |
| Which of the following terms describes the process used to challenge a payer's decision to deny, reduce, or downcode a claim? A) audit B) appeal C) subrogation D) adjudication | B) appeal |
| When completing a CMS-1500 paper claim form, A) use surnames B) fold it in half for mailing C) use 10-pitch PICA font D) attach documents with staples in the left corner | C) use 10-pitch PICA font |
| In the CPT manual, an esophagectomy can be found in which of the following subsections? A) incision B) repair C) excision D) manipulation | C) excision |
| A nurse is reviewing a patients lab results prior to discharge and discovers anelevated glucose level. Which of the following health care providers should be alerted before the nurse can proceed with discharge planning? A) the attending physician B) the a | A) the attending physician |
| Which of the following sections of the CPT manual lists the appropriate code for WBC with differential, automated? A) surgery B) anesthesia C) pathology and laboratory D) evaluation and management | C) pathology and laboratory |
| To assign a diagnosis code to the highest level of specificity, a billing and coding specialist should A) check for a 3rd digit B) check for exclusion or inclusion notes C) check for 4th or 5th digit D) check for code first or code also notes | C) check for 4th or 5th digit |
| A patient suffers a 2nd-degree burn of the left axilla and a 3rd-degree burn of the left wrist. 12% was burned, with 3% of the burns designated as 3rd-degree. Which of the following demonstrates the proper coding sequence? | A) 3rd-degree burn of wrist, 2nd-degree burn of axilla; burn involving 10 to 19% of the body surface with less than 10% of that being 3rd-degree burns |
| Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays 30%? A) coinsurance B) deductible C) premium D) copayment | A) coinsurance |
| Representatives from which of the following accrediting agencies can visit office laboratories to review manuals and interview staff? A) CLIA B) JCAHO C) NAACLS D) CMS | A)CLIA |
| A patient undergoes hemodialysis. The code for this procedure is found in which of the following sections of the CPT manual? A) urinary B) medicine C) cardiovascular D) pathology and laboratory | B) medicine |
| V codes are used as the first-listed diagnosis to indicate A) poisoning B) an accident C) a late effect D) family history | D) family history |
| Which of the following scenarios describe HIPAA violation? A) recording elder abuse to law enforcement B) reporting communicable diseases to the health dept. C) reporting child abuse to child protective services D) reporting test results to a family membe | D) reporting test results to a family member via phone |
| Medigap coverage is offered to Medicare beneficiaries by which of the following? A) medicaid B) federal health plans C) managed care plans D) private third-party payers | D) private third-party payers |
| A patient has a new onset of diabetes mellitus. Which of the following medical specialists should the primary care provider (PCP) refer the patient to further treat the disease? A) urologist B) pathologist C) endocrinologist D) ophthalmologist | C) endocrinologist |
| A billing and coding specialist observes a coworker drinking alcohol during work hours. Which of the following actions should be taken? A) confront the coworker B) inform a coworker of the observation C) inform a coworker of the observation D) notify a lo | B) inform the supervisor of the observation |
| Which of the following is a covered entity affected by HIPAA security rules? A) patients B) beneficiaries C) health care clearinghouses D) family member of guarantors | C) health care clearinghouses |
| Which of the following defines a delinquent claim? A) the claim was submitted beyond the timely filing limit B) the claim had more than one procedure submitted C) the claim is an incomplete claim D) the claim is overdue for payment | D) the claim is overdue for payment |
| Which of the following transports oxygenated blood from the heart? A) aorta B) ventricles C) pulmonary veins D) superior vena cava | A) aorta |
| Patient Jane Austin; SS #: 555-22-1111; medicaid id #: 555-33-2222A; DOB 05/22/1945. Claim info entered: Austin, Jane; ss# 555-33-1111; medicare id 555-33-2222A DOB 052245. Which of the following is a reason the claim was rejected? A) medicare id entered | B) the DOB is entered incorrectly |
| According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500 claim form in block 24j? A) UPIN B) EIN C) SSN D) NPI | NPI |
| All dependents 10 yrs of age or older are required to have which of the following for TRICARE? A) signature on file B) military id C) assignment of benefits D) provider signature | B) military id |
| Which of the following describes the location for the appropriate code selection for the removal of a malignant lesion on the arm? A) ch. 2 B) subsection of integumentary system C) subsection of musculoskeletal system D) ch. 13 musculoskeletal system and | B) subsection of integumentary system |
| Which of the following takes precedence over ICD-9 ch-specific guidelines? A) WHO guidelines B) coding conventions and instruction C) carrier billing instructions D) managed care guidelines | B) coding conventions and instructions |
| A claim can be denied or rejected for which of the following reasons? A) all data is uppercase B) block 25 contains the EIN of the rendering provider C) the patients date of birth is in 8-digit format D) block 24d contains the diagnosis code | D) block 24d contains the diagnosis code |
| Whichof the following actions should be taken when a claim is billed for level 4 office visit and paid at a level 3? A) charge the patient for the difference between the two services B) submit the claim to the patients secondary carrier C) write-off the d | D) submit an appeal to the carrier with the supporting documentation |
| A claim is submitted with a transposed insurance member id # and returned to the provider. Which of the following best describes the status that should be assigned to the claim by the carrier? A) suspended B) pending C) denied D) invalid | D) invalid |
| When a patient presents for an incision and drainage of a pilonidal cyst, which of the following areas of the body is this referring to? A) coccyx B) phalanges C) cervix uteri D) metatarsals | A) coccyx |
| Under which of the following circumstances should a paper claim to be submitted to the insurance company? A) a claim containing modifier-24 B) a claim containing unlisted procedure codes C) a claim containing unspecified diagnosis code D) a claim containi | B) a claim containing unlisted procedure codes |
| When a patient signs an Acknowledgement of Notice of Privacy Practice, it indicates a patient can A) allow information to be used for TPO B) be billed for services provided that are not paid for by CMS C) allow information to be maintained in an EHR envio | D) accept the policies and procedures regarding how PHI is handled |
| Time reporting is a guideline for which of the following section of the CPT manual? A) SURGERY B) RADIOLOGY C) ANESTHESIA D) PATHOLOGY AND LABORATORY | C) ANESTHESIA |
| Which od the following is a reason for claim rejection? A) incomplete info B) failure to collect copayment C) insufficient coordination of benefits D) patients coinsurance has not been paid | A) incomplete info |
| A patient is admitted to the hospital & is in critical condition. The nursing unit gets a call from a caller who identifies herself as the patients mother and would like info on the patient. Which of tje following protects the patients confidentiality? A) | B) HIPAA |
| Codes indicated with a bulls eye symbol denote A) a new procedure or service added B) a code description has been revised C) moderate (conscious) sedation D) codes that are exempt for modifier-51 | |
| C) moderate (conscious) sedation | |
| Claims that are submitted without an NPI # will delay payment to the provider because A) the number is the patients id # B) The number is needed to identify the provider C) it is used as a claim number D) it is used as a preauthorization # | B) the number is needed to identify the provider |
| A patients health plan is referred to as the "payer of last resort". The patient is covered by which of the following health plans? A) medicaid B) CHAMPVA C) medicare D) TRICARE | A) medicaid |
| A form that contains charges, DOS, CPT codes, ICD-9-CM, fees and copayment info is an/a A) encounter form B) itemized bill C) charegmaster D) remittance advice | A) encounter form |
| To be compliant with HIPAA, which of the following positions should be assigned in each office? A) gatekeeper B) privacy officer C) compliance official D) health insurance administrator | B) privacy officer |
| HIPAA required standard transactions and code sets include which of the following? A) HCPCS level ll national codes B) HCPCS level lll codes C) ABC codes D) DSM-lV codes | A) HCPCS level ll national codes |
| Which of the following claims should a billing and coding specialist recognize as accurate, contains all necessary info, and is submitted within the policy time limit? A) incomplete B) rejected C) pending D) clean | D) clean |
| Which of the following systems in the surgical section of the CPT manual lists the correct code for ablation of renal cysts by laparascopy? A) urinary B) cardiovascular C) respiratory D) digestive | A) urinary |
| How many behavior classifications are included in the table of neoplasms? A) 2 B) 4 C) 6 D) 12 | C) 6 |
| Which of the following codes includes a history, an examination, and a medical decision making of high complexity? A) 00320 B) 74000 C) 88300 D) 99205 | D) 99205 |
| Which of the following scenarios describes an implied contract? A) a patient receives a minor surgical procedure in a providers office B) a patient is seen by a provider during a follow-up appt C) a patient schedules an appointment with a new providers of | C) a patient schedules an appointment with a new providers office |
| Which of the following should a billing and coding specialist obtain from a Medicare patient when services for a diagnostic test are not covered? A) a consultation report B) a predetermination C) a referral D) an ABN form | D) an ABN form |
| Which of the following is valid ICD-9-CM principle? A) assign codes to the lowest level of detail B) begin searching for a code in the tabular list C) use 3 digit codes to completely code late effects D) code signs and symptoms in the absence of an establ | D) code signs and symptoms in the absence of an established diagnosis |
| Of which of the following claim forms are professional outpatient services and procedures submitted? A) CMS-1500 B) CMS-1450 C) UB-04 D)UB-92 | A) CMS-1500 |
| A patient is upset about a bill she received. Her insurance company denied the claim. Which of the following actions is an appropriate way to handle the situation? A) tell the patient to resubmit the claim to the insurance company B) inform the patient of | B) inform the patient of the reason for the denial |
| Which of the following describes the symbol used to identify a new CPT code? A) plus sign B) solid circle C) triangle D) hollow circle | B) solid circle |
| Which of the following blocks requires the patients authorization to release medical information to process a claim? A) block 12 B) block 13 C) block 27 D) block 31 | A) block 12 |
| When submitting a clean claim with a diagnosis of kidney stones, which of the following procedures is correct? A) nephrolysis B) nephrectomy C) nephrolithiasis D) nephrorrhexis | C) nephrolithiasis |
| A provider charges $500 to a claim that had an allowable amount of $400. In which of the following colimns should the billing and coding specialist apply the non-allowable charge? A) reference column B) description column C) payment column of the credits | D) adjustment column of the credits |
| In which of the following scenarios is it most appropriate to submit an electronic claim? A) the claim is submitted to a secondary payer when the patient has both a primary and secondary health care plan B) the claim is submitted to a 3rd party liability | D) the claim submitted contains an outpatient procedure |
| Which of the following valves controls the opening between the right atrium and the right ventricle? A) aortic valve B) tricuspid valve C) pulmonary valve D) bicuspid valve | B) tricuspid valve |
| Which of the following is a congenital condition in which the urethra opens on the lateral aspect of the penis? A) epispadias B) paraspadias C) pagets disease D) peyronies disease | B) paraspadias |
| The provision of health insurance policies that specifies which coverage is considered primary or secondary is called which of the following? A) eligibility verication B) explanation of benefits C) assignment of benefits D) coordination of benefits | D) coordination of benefits |
| A billing and coding specialist should understand thst the financial source that is generated by a providers office is called a A) chargemaster B) fee schedule C) encounter form D) patient ledger account | D) patient ledger account |
| A patient developed a rash after taking medication his provider prescribed for him. Which of the following codes should be assigned to the reaction? A) level l code B) level ll code C) v code D) e code | D) e code |
| Which of the following proteins is associated with a PSA screening test? A) a protein found in the urine B) a protein made by the liver C) a protein produced by the prostate gland D) a protein hormone released by the parathyroid | C) a protein produced by the prostate gland |
| Which of the following is identified as a right according the patients bill of rights? A) the right to request confidential communication B) the right to request access to psychotherapy notes C) the right to delete information from health records D) the r | A) the right to request confidential communication |
| Which of the following medical terms describes the bodys inability to compensate for position change? A) vertigo B) syncope C) cephalic hypertension D) orthostatic hypotension | D) orthostatic hypotension |
| Which of the following is used in electronic claims transmission for provider services? A) ICD-9-CM B) APC C) DRG D) CPT | D) CPT |
| Where is the duodenum located? A) first section of the small intestine B) last section of the small intestine C) first section of the esophagus D) last section of the esophagus | A) first section of the small intestine |
| Which of the following organs are parts of the integumentary system? A) bones, muscles, and joints B) skin, hair, nails, glands C) large intestine, small intestine, and stomach D) thyroid gland, parathyroid glands, and pituitary gland | B) skin, hair, nails, glands |
| Which of the following organizations accepts electronis claims? A) JCAHO B) MAC C) NCQA D) CARF | B) MAC |
| To submit a clean claim for the application of a long leg cast, which of the following diagnosis is appropriate? A) scapula fracture B) metacarpal fracture C) humerus fracture D) patella fracture | D) patella fracture |
| If a patient has a history of breast cancer that has metastasized to the liver and is undergoing chemotherapy for the liver cancer, which of the following icd-9 codes should be sequenxed? A) 174.9 primary breast cancer B) 197.7 secondary liver cancer C) V | C) v58.11 chemotherapy |
| Which of the following color formats are acceptable on the CMS-1500 claim form? A) red B) blue C) green D) black | A) red |
| The CPT code was developed and is updated annually by the A) AMAA B) AMT C) AMA D) WHO | C) AMA |
| According to CLIA, when billing medicare for a waived laboratory test, which of the following modifiers should be used? A) QO B) QP C) QW D) QR | C) QW |
| A patient had 3 superficial wounds on her right thigh repaired. One was 2.5 cm in length, the second was 2.5 cm, and the third was 3 cm. Whichis the appropriate code? A) 12004 B) 12001, 12001, 12002 C) 12002, 12002 D) 12005 | A) 12004 |
| Which of the following components of an EOB expedites the process of a phone appeal? A) NPI # B) claim control # C) insureds id # D) check number | B) claim control # |
| Horizontal triangles are the symbols used in the HCPCS level l coding manual to identify A) a revised code B) a resequenced code C) new or revised test D) a modifier-51 exempt code | C) a new or revised test |
| Which of the following is an example of a diagnostic category code? A) 541 B) 250.0 C) 524.2 D) 62.0 | A) 541 |
| On a patients remittance advice a deductible of $100 has been applied. The provider has requested the patient account personnel to write off. Which of the following describes the scenario? A) fraud B) abuse C) adjudication D) spend-down | A) fraud |
| For a claim to be correctly processed via optical character recognition (ocr), the billing and coding specialist should A) type characters in lower case B) insert the date in 10-digit format C) use 12-pitch (PICA) characters D) record the providers infor | C) use 12-pitch (PICA) characters |
| A patient with a past due balance requested that his records be sent to another provider. Which of the following actions should be taken? A) withhold the records until the account is paid B) send the patient a statement and wait for payment C) accomodate | C) accomodate the request and send the records |
| How does a 3rd party determine timely filing for claims? A) the date of service is within 12 months B) the date of service is within 6 months C) the contract with the provider D) the contract with the clearinghouse | C) the contract with the provider |
| The + symbol found before a code refers to which of the following in the CPT manual? A) procedure that include moderate (conscious) sedation B) primary procedure requires an additional code C) new procedure and services D) a revision of a code description | B) primary procedure requires an additional code |
| An insurance specialist for a family practice needs to complete a claim form to get reimbursed for the providers services. Which of the following should the billing and coding specialist complete? A) cms 1500 claim form B)cms 1450 form C) superbill D) led | A) cms 1500 claim form |
| An insurance claims register (aged insurance report) facilities which of the following? A) batching of claims for submission to the insurance carrier B) determination of the patients insurance coverage C) completion of the cms-1500 claim form D) follow up | D) follow up of insurance claims by date |
| Which of the following is the purpose of precertification? A) verification of benefits B) assignment of benefits C) determining the annual deductible amount D) determining the coinsurance amount | A) verification of benefits |
| Which of the following accurately reflects the appropriate sequencing of icd-9 codes? A) pregnancy, sprained wrist, fall on floor B) aprained wrist swelling, pregnancy C) sprained wrist, pregnancy, fall on floor D) fall on floor, pregnancy, sprained wrist | C) sprained wrist, pregnancy, fall on floor |
| Which of the following actiins should be taken first when reviewing a delinquent claim? A) verify the age of the account B) query the insurance company C) obtain claim status D) resubmit the claim | A) verify the age of the account |
| After reviewing the assignment, the billing and coding specialist should recognize that A) only the diagnosis code for the pregnancy is required B) the diagnosis should have been coded as gestational diabetes C) the diagnosis requires an additional code D | C) the diagnosis requires an additional code |
| A provider is running a T3/T4 test. On which of the following anatomical sites is the provider running the test? A) lung and respiratory B) heart and cardiovascular system C) liver and digestive system D) thyroid and endocrine system | D) thyroid and endocrine system |
| All email correspondence to a 3rd party payer containing patients health information (PHI) should be A) encrypted B) removed C) forwarded to the patient D) accompanied with an authorization | A) encrypted |
| A patient complains of frequent urination, constant thirst, and weight loss. A review of the family history reveals the patients mother had diabetes mellitus. Which of the following lab test should the provider use to rule diabetes? A) hematocrit B) tsh/t | C) GTT |
| Which of the following plans requires providers to adhere to managed care provisions? A) indemnity plan B) self insured plan C) fee for service plan D) health maintenance organization plan | D) health maintenance organization plan |
| A billing and coding specialist should adhere to legal and ethical means at the workplace to ensure A) higher reimbursment B) that patient information is easily accessible C) the full reimbursement for allowable charge D) the integrity of profession | D) the integrity of profession |
| Which of the following is the correct term for the tube in the urinary system that transport urine from the kidney? A) ureter B) urethra C) distal convoluted tubule D) proximal convoluted tubule | A) ureter |
| Which if the following symptoms is associated with nocturia? A) blood in urine B) urinary incontinence C) excessive urination at night D) burning sensation during urination | C) excessive urination at night |
| Which of the following describes category lll codes? A) morphology codes B) performance codes C) emerging technology D) mental disorders | C) emerging technology |
| In managed care organizations, PPOs help control a patients insurance cost by A) offering low cost deductibles B) requiring low co payment amounts C) offering members the use of out of network providers D) requiring primary care provider referrals for cer | A) offering low cost deductibles |
| 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 D) first report of injury form | B) ub-04 claim form |
| A patients employer has not submited a premium payment. Which of the following claim statuses should the provider receive from the 3rd party payer? A) invalid B) pending C) denied D) incomplete | B) pending |
| In which of the following dept should a patient be seen for psoriasis? A) cardiology B) dermatology C) otolaryngology D) gastroenterology | B) dematology |
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