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NCCT practice test
| Question | Answer |
|---|---|
| When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim? | Physician's office fee |
| A 72 year old patient is undergoing a corneal transplant. An anesthesiologist is personally performing monitored anesthesia care. Which of the following modifiers should be reported for the anesthesia? | -AA-QS |
| Based on the CMS manual system, when updating or maintaining the billing code database, which of the following does the "R" denote? | Revised |
| When should a provider have a patient sign an ABN? | When the items may be denied and prior to performing the service. |
| Which of the following information is necessary to post payments from the RA?EOB? Select 3 correct answers | Billed CPT codes, patient's name, date of service |
| Which of the following Medicare parts covers inpatient hospital stays? | Part A |
| When following up on a denied claim, an insurance and coding specialist should have which of the following information available when speaking with the insurance company? Three correct answers` | date of service, physician's NPI, patient's insurance ID number |
| The patient is sent a statement for and office visit. The total amount of the bill is $100.00 and this amount must be paid before the insurance company will pay on the claim. Which of the following is this called? | deductible |
| A medicare patient has an 80/20 plan. The charged amount was $300.00. The amount allowed was $100.00. Which of the following is the patient's coinsurance? | $20.00 |
| Which of the following MCOs always requires an authorization before seeing a specialist? | HMO |
| Which of the following forms provides information from the Managed Care Organization that paid on the claim? | EOB |
| Which of the following federal regulations requires disclosure of finance charges, late fees, amount, and due dates for all payment plans? | Truth in Lending Act |
| The patients total charges are $300. The allowed amount is $150. Benefits pay at 60%. Which of the following will the patient have to pay? | $60 |
| A physician performed a bilateral L4/L5 Laminectomy on a patient in a ambulatory surgical center. Which of the following place of service codes should be used on the CMS 1500? | 24 |
| When using an EHR system to enter CPT codes on a CMS 1500 claim form for electronic submission, which of the following should be entered on the claim form first? | The most resource-intensive procedure or service |
| The provider is paid the same rate per patient whether or not they provide services and no matter which services were provided. This payment is known as | Capitation |
| In order to have claims paid as quickly as possible, the insurance specialist must be familiar with which of the following? | Payer's claim processing procedures |
| A patient was seen in office. Charges were recorded and submitted to the patient's insurance, and an EOB was received by the office with a payment of $70.89. These transactions should be recorded in the | Patient Ledger |
| Which of the following are violations of the Stark Law? Two answers | Accepting gifts in place of payment from patients, referring patients to facilities where the provider has a financial interest. |
| Collections agencies are regulated by the | Fair Debt collections practices Act |
| Which of the following patient information is needed to determine a Medicaid sliding fee scale? Three answers | Poverty level, number of dependents, salary |
| Which of the following financial reports produces a quarterly review of any dollar amount a patient still owes after all insurance carriers claim payments have been received? | aging |
| A Medicare patient presents to an outpatient hospital facility for a scheduled hysterectomy. To which Medicare plan should the facility submit the claim? | Part B |
| A patient has two health insurance policies- a group insurance plan through her full time employer and another group insurance plan through her husband's employer. which of the following policies should be billed as primary? | Her policy |
| When filling an electronic insurance claim, the insurance and coding specialist processes which of the following forms | CMS-1500 |
| When document is changed in an EHR, the original documentation is | hidden |
| When is a referral from a provider required? | when contained in the individual policy |
| If the insurance carrier's rate of benefits is 80%, the remaining 20% is known as | Coinsurance |
| A patient has called to schedule for an office visit to see the doctor tomorrow for an earache. It is discovered during the scheduling process that the insurance policy on file has been cancelled. Which of the following should the insurance and coding spe | Advise the patient to bring current insurance information to the appointment. |
| Which of the following items are mandatory in patient financial policies? 3 correct answers | expectation of payment due date at time of service, collection process, statement that responsibility for payment lies with patient. |
Created by:
Hunt.desirae