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Nha practice test 2
NHA Practice test 2
| Question | Answer |
|---|---|
| When submitting claims, what is the outcome if block 13 is left blank? | The third party payer reimburses the patient, and the patient is responsible for reimbursing the provider. |
| What do physicians use to electronically submit claims? | Clearinghouse |
| When billing a secondary insurance company, which block should the billing and coding specialist fill out on the CMS-1500 claim form? | 9a |
| What is a requirement of some third-party payers before a procedure is performed? | Pre-authorization form |
| 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 process he is primary. Which of the following describes the birthday rule? | The parent whose birthday comes first in the calendar year |
| A prospective billing account audit prevents fraud by reviewing and comparing a complete claim form with what document | A billing worksheet from the patient account |
| Which of the following medical terms refers to the sac that encloses the heart? | Pericardium |
| What document is required to disclose an adult patient information? | A signed release from the patient |
| After reading a providers notes about a patient, a coding specialist decides to code for a longer length of time then the actual office visit. Which of the following describes the specialists action? | Fraud |
| On the CMS-1500 claim form, blocks 1 through 13 include which of the following? | The patient’s demographics |
| Two providers from the same practice visit a patient in the emergency department using the same CPT code. The claim may be denied due to | Duplication of services |
| The physician bill is $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. This amount is called | Deductible |
| Which security feature is required during transmission of protected health information and medical claims to third-party payers? | Encryption |
| What billing pattern is a best-practice action? | Documenting the patient’s chief complaint, history, exam, assessment, and plan for care |
| A billing and coding specialist is reviewing a CMS-1500 claim form. The “assignment of benefits box” has been checked “yes”. The checked box indicates what | The provider receives payment directly from the payer |
| A provider receives a reimbursement from a third-party payer accompanied by what document | Explanation of benefits |
| What is a correct entry of a charge of $150 and black 24 hours of the CMS-1500 claim form | 150 00 |
| A beneficiary of Medicare or Medicaid crossover claim submitted by a participating provider is responsible for what percentage? | 0% |
| What coding manual is used primarily to identify products, supplies, and services? | HCPCS level two manual |
| A billing and coding specialist needs to know how much Medicare paid on a claim before billing the secondary insurance. What should the specialist refer to? | The remittance advice |
| Which of the following describes an obstruction to the urethra? | Urethratresia |
| What is the function of the respiratory system? | Oxygenating blood cells |
| 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 |
| What insurance carrier is consider the pair of last resort | Medicaid |
| What is allowed when billing procedural codes? | Filling using two digit CPT modifiers to indicate a procedure as performed differs from its usual five digit code |
| What should the billing and coding specialist include in an authorization to release information? | The entity to whom the information is to be released |
| What type of health insurance plan best describes a government sponsored benefit program? | Tricare prime |
| What statement is true regarding the release of patient records? | Patient access to psychotherapy notes may be restricted |
| What is the correct term for an amount that has been determined to be uncollectible? | Bad debt |
| What should the billing and coding specialist and put into block 33a on the CMS-1500 claim form? | National provider identification number |
| A provider for hormones and examination of the patient sore throat during an office visit. What describes the level of the examination? | Problem focused examination |
| What part of Medicare covers prescriptions? | Part D |
| What type of claim will be denied by the third-party payer? | Incomplete claim |
| If a patient has osteomyelitis, he has a problem with which area.? | Bones and bone marrow |
| Block 17 be on the CMS 1500 claim form should list what information? | Referring physicians national provider identification (NPI) number |
| What is considered the final determination of the issues involving settlement of an insurance claim? | Adjudication |
| What action should the billing and coding specialist take to prevent fraud and abuse in the medical office? | Internal monitoring and auditing |
| What actions to the billing and coding specialist take it to effectively manage accounts receivable? | Collect copayment from the patient at the time of service |
| What acts supplies the administrative simplification guidelines? | Health insurance portability and accountability act HIPAA |
| The provision of health insurance policy that specifies which coverage is considered primary or secondary is called | Coordination of benefits |
| What is the purpose of running an aging report each month? | It indicates which claims are outstanding |
| What is the primary information used to determine the priority of collection letters to patients | The Age of the account |
| The symbol “O” in the current procedural terminology reference is used to indicate what | Reinstated or recycled code |
| Medicare enforces mandatory submission of electronic claims for most providers. What provider is allowed to submit paper claims to Medicare? | A providers office with fewer than 10 full-time employees |
| In 1995 and 1997, what introduced documentation guidelines to Medicare carriers to ensure that services paid for I have been provided and were medically necessary? | CMS The centers for Medicare and Medicaid services enforce coding requirements. |
| Z codes are used to identify | Immunizations |
| What claim would appear on an aging report? | A claim that is delinquent for 60 days |
| When a physician documents a patient’s response to symptoms and various body systems, the results are documented as | Review of systems |
| What is an example of a violation of an adult patient’s confidentiality? | Patient information was disclosed to the patient’s parents without consent |
| In an outpatient setting what form is used as a financial report of all services provided to the patients? | Patient account record |
| What is used by providers to remove errors from claims before they are submitted to third-party payers? | Clearinghouse |
| What modifier should be used to indicate a professional service has been discontinued prior to completion? | -53 |
| A billing and coding specialist should add modifier -50 to codes when reporting | A bilateral procedure |
| When an electron a claim is rejected due to incomplete information, what actions should the medical billing specialist take? | Complete the information and re-transmit according to the third-party standards |
| Excepting assignment on the CMS 1500 claim form indicates | The physician agrees to except payment under the terms of the payers program |
| The claim is denied because the service was not covered by the insurance company. Upon confirmation of no errors on the claim, what describes the process that will follow the denial? | The claim will not be resubmitted and the patient will be sent a bill |
| What statement is true when determining patient financial responsibility by reviewing the remittance advice? | Any coinsurance, copayments, or deductibles can be collected from the patient. |
| What is the appropriate diagnosis for a patient who has an abnormal accumulation of fluid in her lower leg that has resulted in swelling? | Edema |
| The standard medical abbreviation ECG refers to a test used to assess what body system? | Cardiovascular system |
| Patient charges that have not been paid will appear on | Accounts receivable |
| The destruction of lesions using cryosurgery would be used | Cold treatment |
| What statement is correct regarding a deductible? | The deductible is the patients responsibility |
| What was developed to reduce Medicare program expenditures by detecting in appropriate codes and eliminating improper coding practices? | NICCI National correct coding initiative was implemented in 1996 to detect inappropriate codes and eliminate and proper coding practices |
| Test results indicated that no abnormalities were found in the brain and the brains electrical activity patterns are normal. What test was used to conduct this exam? | EEG |
| What is the third stage of a lifecycle claim | Claims adjudication |
| What describes the content of a medical practice aging report? | In overview of the practices outstanding claims |
| What situation constitutes a consultation? | Services rendered by a physician whose opinion or advice is requested by another physician or agency |
| Patient has an emergency appendectomy while on vacation. The claim is rejected due to the patient as hearing services out of network. What information should they include in the claim appeal ? | The patient was out of town during emergency |
| What verbal or written agreement gives approval to release protected health information (PHI)? | Consent |
| HIPAA transaction standards apply to what entity | Health care clearinghouses |
| What organization identifies improper payments made on the CMS claims? | Recovery audit contractor (RAC) |
| What section of the medical record is used to determine the correct evaluation and management code use for billing and coding? | History and physical |
| What time. Should the billing and coding specialist track unpaid claims before taking follow-up action? | 30 days |
| What is the initial step in processing a workers compensation claim? | First report the injury |
| What information is required to include on an advanced beneficiary notice (ABN)form? | The reason Medicare may not pay |
| Behavior plays an important part of being a team player in a medical practice. What is an appropriate action for the billing and coding specialist to take? | Communicating with the front desk staff during a team meeting about missing information in the patient files |
| What is the portion of the account balance that patient must pay after service are rendered and the annual deductible is met, | Coinsurance |
| 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 |
| A patient has chest pain &shortness of breath. After the ECG result, the provider called a cardiologist and 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 |
| When coding on the UB-04 form, the billing and coding specialist must sequence the diagnosis codes according to a cd guidelines what is the first listed diagnosis code? | Principal diagnosis |
| What forms must the patient or representative sign to allow the release of protected health information ? | An authorization |
| After a third-party payer validates a claim, what takes place next | Claims adjudication |
| What is the maximum number of ICD codes that can be entered on a CMS-1500 claim form as of February 2012? | 12 |
| A billing and coding specialist should enter their prior authorization number on the CMS 1500 claim form in which block | Block 23 |
| What is an example of an electronica claim submission? | Clams submitted via a secure network |
| What blocks on the CMS-1500 claim form are used to bill ICD codes? | Block 21 |
| What steps would be part of a physicians practice compliance program? | Internal monitoring and auditing |
| If edition ordered a comprehensive metabolic panel for 70-year-old patient who has Medicare as a primary insurance. Which of the following forms is required so that the patient knows she may be responsible for payment? | Advanced beneficiary notice, ABN |
| A bill or will electronically submit a claim to the carrier via | Direct data entry |
| What is the advantage of electronic claim submission? | Claims are expedited |
| What is the purpose of an internal and auditing program and a physicians office? | Verifying that the medical records and the billing record match |
| What indicates a claim should be submitted on paper instead of electronically? | The claim requires an attachment |
| What describes the status of a claim that does not include require preauthorization for a service? | Denied |
| When posting payment accurately what item should the billing and coding specialist include? | Patients responsibility |
| What blocks on the CMS-1500 claim form is required to indicate a Worker’s Compensation Claim? | Block 10a |
| What part of the body system regulates immunity? | Lymphatic system |
Created by:
Dmanning0811