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CBCS Exam prep

Test/Quiz questions

QuestionAnswer
After a third party payer validates a claim, what takes place next? claim adjudication
HIPAA transaction standards apply to? healthcare clearinghouses
What is the initial step in processing a Workers' Compensation claim? first reporting of the injury
The provision of health insurance policies that specifies which coverage is considered primary or secondary is called what? coordination of benefits
Medicare enforces mandatory submission of electronic claims for most providers. What is allowed to be submitted for paper claims to Medicare? the provider's office has fewer than 10 full time employees
What is the outcome if block 13 is left blank when submitting a claim? the third party payer reimburses the patient and the patient is responsible for reimbursing the provider
Patient charges that haven't been paid will appear where? accounts receivable
A billing and coding specialist needs to know how much Medicare has paid on a claim before billing the secondary insurance. Where should the specialist look for this information? remittance advice
A billing and coding specialist should add modifier 50 to codes when reporting what? bilateral procedures
The star symbol in the CPT book is used to indicate what? telemedicine
In 1995 and 1997, what was introduced regarding documentation guidelines to Medicare carriers to ensure that services that have been paid for have been provided and were medically necessary? CMS
What is allowed when billing procedural codes? billing that uses two digit CPT modifiers to indicate a procedure as performed that differs from its usual five digit codes
The destruction of lesions using cryosurgery would use which treatment? cold treatment
When a patient has a condition that is both acute and chronic how is it reported? code both with acute first
When coding on UB 04 form, the billing and coding specialist must sequence the diagnostic codes according to the ICD guidelines. What is the first listed diagnostic code? the principal diagnosis
What describes the content of a medical practice aging report? overview of the practice's outstanding claims
After reading a provider's notes about a new patient, a coding specialist decides to code for a longer length of time rather than the actual office visit. What describes the specialist's action? fraud
A claim is denied because the service wasn't covered by the insurance company. Upon confirmation of no errors on the claim, what is the next process after the claim is denied? the claim isn't submitted and the patient is sent the bill
A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with what? the billing worksheet from the patient account
What should the billing and coding specialist include in an authorization to release information? the entity to whom the information is being released to
What security feature is required during the transmission of PHI and medical claims to third party payers? encryption
What medical term refers to the sac that encloses the heart? pericardium
What act applies to the administration simplification guidelines? HIPAA
Z codes are used to identify what? immunizations
What is true regarding a deductible? the deductible is the patient's responsibility
A patient presents with chest pain and shortness of breath. After an ECG , a cardiologist is called and given the patient's symptoms. What portion of HIPAA allows the provider to speak to the cardiologist prior to obtaining a patient's consent? Title II
What is a verbal or written agreement that gives approval to release a patient's PHI? consent
A provider performs an exam on a patient's sore throat during an office visit. What is the level of the exam? problem-focused examination
A dependent child whose parents both have health insurance coverage comes into the clinic. The birthday rule is used to determine whose policy is the primary insurance. What is the birthday rule? the parent whose birthday comes first is the primary insurance
What section of the medical record is used to determine the correct E/M code used for billing and coding? the history and physical
What modifier should be used to indicate a professional service that has been discontinued prior to completion? 53
When an electronic claim is rejected due to incomplete information, what action should the medical billing specialist take? complete the information and re-transmit it according to the third party standards
What is the purpose of running an aging report each month? it indicates which claims are outstanding
A physician covered a comprehensive metabolic panel for a 70 year old patient who has Medicare as her primary insurance. What form is required so the patient knows she may be responsible for payment? advanced beneficiary notice
What describes an obstruction of the urethra? urethratresia
What is an example of an electronic claim submission? claims that are submitted via a secure network
Test results indicated no abnormalities were found in the brain and the brains electrical activity patterns are normal. What test was used to conduct this exam? EEG
When billing a secondary insurance company, what block should the billing and coding specialist fill out on the CMS 1500 claim form? 9a
What action should the billing and coding specialist take to effectively manage accounts receivable? collect co-payments from the patient at the time of services
Blue Cross/Blue Shield provider receives 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%. What was the patient's balance? $48
What is the maximum number of ICD codes that can be entered on the CMS 1500 claim form as of February 2012? 12
What is considered the final determination of the issues involving the settlement of an insurance claim? adjudication
What is true regarding the release of a patient's records? the patient's access to the psychotherapy notes may be restricted
What action should the billing and coding specialist take to prevent fraud and abuse in the medical office? internal monitoring and auditing
Why does correct claims processing rely on an accurately completed encounter form? the encounter form streamlines the patient's billing by summarizing the services rendered for a given date of service
What time period should the billing and coding specialist track unpaid claims before taking follow up action? 30 days
When posting payments accurately, what item should the billing and coding specialist include? the patient's responsibility
A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is responsible for what percentage of the bill? 0%
A biller will electronically submit a claim to the carrier via what method? a direct data entry
The standard medical abbreviation "ECG" refers to a test used to access what body system? cardiovascular
A 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. What is this called? deductible
When a physician documents a patient's response to symptoms and various body systems, the results are documented as what? review of systems
What is the correct entry of a charge of $150 in Block F on the CMS 1500 claim form? 150 00
On the CMS 1500 claim form, blocks 1-13 include what information? the patient's demographics
What would constitute a consultation? services rendered by a physician whose opinion or advice is requested by another physician or agency
If a patient has osteomyelitis, he has problems with what area? bones and bone marrow
What form must the patient or representative sign to allow the release of a patient's PHI? authorization form
Block 17b on the CMS 1500 claim form should list what? the referring physician's NPI number
What was developed to reduce Medicare program expenditures by detecting inappropriate codes and eliminating improper coding practices? NCCI
What describes the status of a claim that doesn't include required preauthorization for a service? denied
What body system regulates immunity? lymphatic
What is used by providers to remove errors from claims before they are submitted to third party payers? a clearinghouse
What information should a billing and coding specialist put in block 33a on the CMS 1500 claim form? the national provider identification number
A provider receives reimbursement from a third party payer accompanied by which document? explanation of benefits
What is the third stage of the life cycle of a claim? claims adjudication
In what block on the CMS 1500 claim form do you report a Workers' Compensation case/ 10a
Two providers from the same practice visit a patient in the emergency department using the same CPT code. The claim may be denied. Why? duplicated services
A patient has an emergency appendectomy while on vacation. the claim is rejected because the patient obtained services out of the network. What information should be included in the claim appeal? the patient was out of town during the emergency
What is a type of claim that will be denied by a third party payer? an incomplete claim
What steps should be a part of a physician's practice compliance program? internal monitoring and auditing
A patient has a Medicare deductible of $150. The patient's coinsurance is 20% and the allowed amount is $600. What would be the patient's out of pocket expense? $120
What primary information is used to determine the priority of collection letters to patients? the age of the account
What type of claim would appear on an aging report? one that is delinquent for 60 days
What is the portion of the account balance that the patient must pay after services are rendered and the annual deductible is met? coinsurance
What do physician's use to electronically submit claims? a clearinghouse
What is a requirement of some third party payers before a procedure is performed? a preauthorization form
What indicates that a claim should be submitted on paper rather than electronically? the claim requires an attachment
Which coding manual is used to identify products, supplies, and services? HCPCS level II
A billing and coding specialist should enter the prior authorization number on the CMS 1500 claim form in which block? 23
Which document is required to disclose an adult patient's information? a signed release from the patient
Which Medicare part covers prescriptions? part D
What billing patterns are the best practice action? documenting the patient's chief complaint, history, exam, assessment, and plan for care
Behavior plays an important part of being a team player in a medical practice. What is an appropriate form of action for the billing and coding specialist to take? communicating with the front desk staff during a team meeting about missing information in patient files
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 will receive the payment directly from the payer
What is the correct term for an amount that has been determined to be uncollectable? bad debt
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 hasn't been met. How much should the physician write off of the patient's account? $40
Accepting assignments on CMS 1500 claim forms indicates what? the physician agrees to accept the payment under the terms of the payer's program terms
What is true regarding the determination of the patient financial responsibility by reviewing the remittance advice? any coinsurance, copayments, or deductibles can be collected from the patient
what is an example of a violation of an adult patient's confidentiality? patient information was disclosed to the patient's parent without consent
What is a function of the respiratory system? oxygenating blood cells
What is the name of a private insurance carrier? Blue Cross/Blue Shield
Which insurance is considered the payer of a last resort? Medicaid
What is a purpose of an internal auditing program in a physician's office? to verify that medical records and billing records match
in an outpatient setting, what form is used as a financial report of all services provided to patients? the patient account record
What is the appropriate diagnosis for a patient who has had an abnormal accumulation of fluid in their lower leg that has resulted in swelling? edema
What type of insurance plan best describes a government sponsored benefit program? TRICARE Prime
What organization identifies improper payments made on CMS claims? Recovery Audit Contractor (RAC)
What information is required to include on an Advance Beneficiary Notice (ABN) form? the reasons Medicare may not pay
What block on the CMS 1500 claim form is used to bill ICD codes? Block 21
What is an advantage of an electronic claim submission? claims are expedited
Created by: crystal_r
 

 



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