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NHA CBCS Exam 2019
| Question | Answer |
|---|---|
| What indicates a claim should be submitted on paper instead of electronically? | The claim requires an attachment |
| Part of a physician's practice compliance program? | Internal monitoring and auditing |
| An advantage of electronic claim submission | Claims are expedited |
| 3rd stage of the life cycle of a claim | Claims adjudication |
| In an outpatient setting, what form is used as a financial report of all services provided to the patient? | Patient account record |
| What document is required to disclose an adult patient's information? | A signed release from the patient |
| Type of claim that will be denied by the third party payer? | Incomplete claim |
| What is the best practice action for billing patterns? | Documenting the patients chief complaint, history, exam, assessment, and plan for care |
| A CBCS should refer to the ____________________ to know how much Medicare paid on a claim before billing the secondary insurance | Remittance Advice |
| Sac that encloses the heart | Pericardium |
| Consultation | Services rendered by a physician whose opinion or advice is requested by another physician or agency |
| Purpose of running an aging report each month | It indicates which claims are outstanding |
| Block on the CMS 1500 required to indicate a workers' compensation claim | 10a |
| Verbal or written agreement that gives approval to release protected health information(PHI) | Consent |
| Part of Medicare that covers prescriptions | Part D |
| The symbol "O" in the CPT reference is used to indicate? | Reinstated or recycled code |
| Two providers from the same practice visit a patient in the ER using the same CPT code. The claim may be denied due to what reason? | Duplication of service |
| CMS 1500 block used to bill ICD codes | 21 |
| Example of electronic claim submission | Claims submitted via a secure network |
| When a patient has a condition that is both acute and chronic, how should it be reported? | Code both acute and chronic, sequencing the acute first |
| What is the function of the respiratory system | Oxygenating blood cells |
| What portion of HIPAA allows a provider to speak to another provider about a patient prior to obtaining consent? | Title II |
| A provider receives reimbursement from a third party payer accompanied by what documents? | Explanation of benefits |
| What portion of the account balance must the patient pay after services are rendered and the annual deductible is met? | Coinsurance |
| What coding manuals is used primarily to identify products, supplies, and services? | HCPCS Level II Manual |
| What is the primary information used to determine the priority of collection letters to patients? | The age of the account |
| A requirement for some third party payers before a procedure is performed? | Preauthorization form |
| Term for the amount that has been determined to be uncollectable | Bad debt |
| Developed to reduce Medicare program expenditures by detecting inappropriate codes and eliminating improper coding practices | NCCI - National Correct Coding Initiative |
| When submitting claims, what is the outcome if Block 13 is left blank | The 3rd party payer reimburses the patient and the patient is responsible for reimbursing the provider |
| When posting payments accurately, what items should the CBCS include? | Patient's responsibility |
| What should the CBCS include in an authorization to release information? | The entity to whom the information is to be released |
| Organization that identifies improper payments made on the CMS claims | Recovery Audit Contractor |
| Z codes are used to identify what? | Immunizations |
| A CBCS should add modifier -50 to codes when reporting what? | bilateral procedure |
| A beneficiary of Medicare/Medicaid crossover claim submitted by a participating provider is responsible for what percentage? | 0% |
| Block 17b on the CMS 1500 should list what? | Referring physician's NPI number |
| What statement is true when determining patient financial responsibility by reviewing the RA? | Any coinsurance, copayments, or deductibles can be collected from the patient |
| What modifier should be used to indicate a professional service has been discontinued prior to completion | -53 |
| Obstruction of the urethra | Urethratresia |
| Correct entry of a charge of $150 in Block 24F of the CMS1500 claim form? | 150 00 |
| What is allowed when billing procedural codes | Billing using two digit CPT modifiers to indicate a procedure as performed differs from its usual 5 digit code |
| Initial step in processing a workers' compensation claim | First report of injury |
| Why does correct claim processing rely on accurately completed encounter forms | streamline patient billing by summarizing the services rendered for a given date of service |
| What act applies to the Administrative Simplification guidelines? | HIPAA |
| What action should the CBCS take to prevent fraud and abuse in the medical office? | Internal monitoring and auditing |
| Information required to include on an Advance Beneficiary Notice form | The reason Medicare may not pay |
| Osteomyelitis is having problems with what? | Bones and bone marrow |
| A biller will electronically submit a claim to the carrier via ? | Direct data entry |
| What block on the CMS 1500 is the prior authorization number entered? | Block 23 |
Created by:
acpotter