1 / 10
NHA- CBCS EXAM REVIEW
2022/2023(Verified Answers by Expert)
1.UROLOGIST✔✔ A would be the
provider who would perform an orchiopexy
2.EVALUATION AND MANAGEMENT CODES✔✔ The first section of
the CPT manual is the .
3.ALLOWED AMOUNT✔✔ means the
amount of reimbursement an insurance payer and patient agrees to
pay a provider.
4.PLACE OF SERVICE✔✔ A billing and coding specialist should
determine first, the
to determine an appropriate e/m code.
5.LOWER RIGHT QUADRANT✔✔ The appendix is located in the
of the abdomen.
6.POLICY NUMBER✔✔ For a patient whose insurance coverage is from
her partner, the is required to bill her claim.
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7.V CODE✔✔ An exposure to tuberculosis requires a
.
8.GUARANTOR INFORMATION✔✔ A billing and coding specialist should
use
when
transmitting a claim for a minor without health insurance.
9.OFFICE OF THE INSPECTOR GENERAL✔✔ The
investigates cases of fraud
and pre- pares a referral for prosecution.
10.CLEAN CLAIM✔✔ An insurance claim is considered a
when further reviewed by the
insurance company, is not necessary before submitting the claim.
11.PERFORM INTERNAL AUDITS TO MONITOR THE
BILLING PROCESS✔✔ A billing and coding specialist
should
to identify areas of
risk as- sociated with billing compliance.
12.THE BODY MAINTAINS NORMAL BALANCE AND FUNCTION✔✔ When
3 / 10
, then it is said to be
in a state of homeostasis.
13.ANSI ASC X12 837✔✔ The is
an example of an electronic claim format.
14.PATIENT’S DEDUCTIBLE✔✔ The
information is included
in an electronic remittance advice.
1 / 16
NHA CBCS EXAM REVIEW
2022/2023(Verified Answers by Expert)
1.Which of the following Medicare policies determines if a particular item
or service is covered by Medicare✔✔✔✔ National Coverage
Determination (NCD)
2.A patient’s employer has not submitted a premium payment. Which of
the following claim statuses should the provider receive from the thirdparty payer✔✔✔✔ Denied
3.A billing and coding specialist should routinely analyze which of the
following to determine the number of outstanding claims✔✔✔✔ Aging
report
4.Which of the following should a billing and coding specialist use to
submit a claim with supporting documents✔✔✔✔ Claims attachment
5.Which of the following terms is used to communicate why a claim line
item was denied or paid differently than it was billing✔✔✔✔ Claim
adjustment codes
6.On a CMS-1500 claim form, which of the following information should
the billing and coding specialist enter into Block 32✔✔✔✔ Service facility
location information
7.A provider’s office receives a subpoena requesting medical documenta-
2 / 16
tion from a patient’s medical record. After confirming the correct
authoriza- tion, which of the following actions should the billing and
coding specialist take✔✔✔✔ Send the medical information pertaining to
the dates of service requested
8.Which of the following is the deadline for Medicare claim
submission✔✔✔✔ 12 months from the date of service
9.Which of the following forms does a third-party payer require for
physician services✔✔✔✔ CMS-1500
10.A patient who is an active member of the military recently returned from
overseas and is in need of specialty care. The patient does not have
anyone designed with power of attorney. Which of the following is
considered a HIPAA violation✔✔✔✔ The billing and coding specialist
sends the patient’s records to the patient’s partner.
11.Which of the following terms refers to the difference between the
billing and allowed amounts✔✔✔✔ Adjustment
- Which of the following HMO managed care services requires a
referral?-
: Durable medical equipment
13.Which of the following explains why Medicare will deny a
particular service or procedure✔✔✔✔ Advance Beneficiary Notice
(ABN)
14.Which of the following types of claims is 120 days old✔✔✔✔
Delinquent
3 / 16
15.When reviewing an established patient’s insurance card, the billing
and coding specialist notices a minor change from the existing card on
file. Which of the following actions should the billing and coding
specialist take✔✔✔✔ Photocopy both sides of the new card
16.A husband and wife each have group insurance through their
employers. The wife has an appointment with her provider. Which
insurance should be used as primary for the appointment✔✔✔✔ The
wife’s insurance
17.Which of the following would most likely result in a denial on a
Medicare claim✔✔✔✔ An experimental chemotherapy medication for a
patient who has stage III renal cancer
18.Which of the following pieces of guarantor information is required
when establishing a patient’s financial record✔✔✔✔ Phone number
19.A provider surgically punctures through the space between the
patient’s ribs using an aspirating needle to withdraw fluid from the chest
cavity. Which of the following is the name of this procedure✔✔✔✔
Pleurocentesis
20.A patient has AARP as secondary insurance. In which of the
following blocks on the CMS-1500 claim form should the information be
entered✔✔✔✔ – Block 9
21.A Medicare non-participating (non-PAR) provider’s approved payment
amount is $200 for a lobectomy and the deductible has been met. Which
of the following amounts is the limiting charge for this procedure✔✔✔✔
$230
4 / 16
**A non-PAR who does not accept assignment, can collect a maximum
of 15% (the limiting charge) over the non-PAR Medicare fee schedule
amount.
22.In the anesthesia section of the CPT manual, which of the following
are considered qualifying circumstances✔✔✔✔ Add-on codes
23.Threading a catheter with a balloon into a coronary artery and
expanding it to repair arteries describes which of the following
procedures✔✔✔✔ Angioplasty
24.Which of the following actions by a billing and coding specialist
would be considered fraud✔✔✔✔ Billing for services not provided
25.Which of the following statements is accurate regarding the
diagnostic codes in Block 21✔✔✔✔ These codes must correspond to
the diagnosis pointer in Block 24E
26.Which of the following parts of the Medicare insurance program is managed by private, third-party insurance providers that have been approved
by Medicare✔✔✔✔ Medicare Part C
1 / 11
NHA CBCS PRACTICE TEST
2022/2023(Verified Answers by Expert)
1.2. A claim is submitted with a transposed insurance member ID number
& returned to the provider. This describes the status that should be
assigned to the claim by the carrier✔✔✔✔INVALID
2.3. Medigap coverage is offered to Medicare beneficiaries
by✔✔✔✔PRIVATE THIRD-PARTY PAYER
3.4. This provision ensures that an insured’s benefits from all insurance
companies does not exceed 100% of allowable medical: Coordination of
ben- efits
4.5. A coroner’s autopsy is comprised of which examination✔✔✔✔Gross
exami- nation.
5.6. This statement is true regarding the release of patient
records✔✔✔✔Patient access to psychotherapy notes may be
restricted.
- 7. Actions by a billing & coding specialist would be considered
fraud✔✔✔✔-
Billing for services not provided.
7.8. The components of an explanation of benefits expedites the process
of a phone appeal✔✔✔✔Claim control number.
8.9. On the CMS-1500 claim form, blocks 14 through 33 contain
2 / 11
information of?.: The patient’s condition & the provider’s information
- A billing & coding specialist should understand that the financial
record source that is generated by a provider’s office is called
a✔✔✔✔Patient Ledger Account.
10.11. The medical terms refer to the sac that endoses the
heart✔✔✔✔Pericardi- um.
11.12. HIPAA transaction standards apply to✔✔✔✔Health care
clearinghouse.
12.13. All dependents 10 years of age or older are required to have which
of the following for TRICARE✔✔✔✔Military identification.
13.14. The standard medical abbreviation “ECG” refers to a test used
to assess✔✔✔✔Cardiovascular system.
14.15. An example of a violation of an adult patient’s
confidentiality✔✔✔✔Patient information was disclosed to the patient’s
parent without consent.
15.16. Claims that are submitted without an NPI number will delay
payment to the provider because✔✔✔✔the number is needed to identify
the provider
3 / 11
16.17. Sections of the medical record is used to determine the correct
Evaluation & Management code used for billing & coding✔✔✔✔History &
physical
17.18. Actions should be taken if an insurance company denies a service
as not medically necessary✔✔✔✔Appeal the decision with a provider’s
report.
18.19. Missing #19: misssing
19.20. The function of the respiratory system✔✔✔✔Oxygenating blood
cells
20.21. This describes a delinquent claim✔✔✔✔The claim is overdue for
payment.
21.22. What actions should the billing & coding specialist take if he
observes a colleague in an unethical situation✔✔✔✔Report the incident
to a supervisor.
22.23. A participating Blue Cross/Blue Shield (BC/BS) provider receives an
explanation of benefits for a patient account. The charged amount was
$100. BC/BS allowed $80 & applied $40 to the patient’s annual deductible.
BC/BS paid the balance at 80%. How much should the patient expect to
pay✔✔✔✔$48.
23.24. This statement is correct regarding a deductible✔✔✔✔The
deductible is the patient’s responsibility.
24.25. A physician ordered a comprehensive metabolic panel for a
70-year-old patient who has Medicare as her primary insurance. This form
1 / 33
CBCS Exam Study Guide 2022/2023
(Verified Answers by Expert)
1.Medical Billing & Coding as a Career: *Claims assistant professional or
claims manager, *Coding Specialist, * Collection Manager, *Electronic
Claims Proces- sor, *Insurance Billing Specialist, * Insurance
Coordinator, *Insurance Counselor,
*Medical Biller, *Medical & Financial Records Manager, * Billing &
Coding Special- ist
2.What are Medical Ethics✔✔✔✔ Standards of conduct based on moral
principle. They are generally accepted as a guide for behavior towards
pt’s, dr’s, co-workers, the gov, and ins co’s.
3.What does acting within ethical behavior boundaries
mean✔✔✔✔carrying out one’s responsibilities w/ integrity, dignity,
respect, honesty, competence, fairness, & trust.
4.Compliance regulations✔✔✔✔ Most billing-related cases are based on
HIPPA and False Claims Act
5.Health Insurance Portability & Accountability Act (HIPPA): Enacted in
1996, created by the Health Care Fraud & Abuse Control Programenacted to check for fraud and abuse in the Medicare/Medicaid
Programs and private payers
2 / 33
6.What are the 2 provisions of HIPPA✔✔✔✔Title I: Insurance
Reform Title II: Administrative Simplification
7.What is Title I of HIPPA✔✔✔✔Insurance Reform-primary purpose is to
provide con- tinuous ins coverage for worker & their dependents when
they change or lose jobs. Also *Limits the use of preexisting conditions
exclusions *Prohibits discrimination from past or present poor health
*Guarantees certain employees/indv the right to purchase new health
ins coverage after losing job *Allows renewal of health ins cov
regardless of an indv’s health cond. that is covered under the
particular policy.
8.What is Title II of HIPPA✔✔✔✔Administrative Simplification-goal is
to focus on the health care practice setting to reduce administrative
cost & burdens. Has 2
parts- 1) development and implementation of standardized healthrelated financial & administrative activities electronically 2)
Implementation of privacy & security procedures to prevent the
misuse of health info by ensuring confidentiality
- What is the False Claims Act (FCA)✔✔✔✔Federal law that prohibits
submitting a fraudulent claim or making a false statement or
representation in connection w/ a claim. Also protects & rewards
whistle-blowers.
10.What is the National Correct Coding Initiative (NCCI)✔✔✔✔Developed
by CMS to promote the national correct coding methodologies & to
control improper coding that lead to inappropriate payment of Part B
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health ins claims.
4 / 33
11.How many edits does NCCI include✔✔✔✔2: 1)Column 1/Column 2
(prev called Comprehensive/Component) Edits
2) Mutually Exclusive Edits
12.Column 1/Column 2 edits (NCCI): Identifies code pairs that should not
be billed together b/c 1 code (Column 1) includes all the services
described by another code (Column 2)
13.Mutually Exclusive Edits (NCCI): ID’s code pairs that, for clinical
reasons, are unlikely to be performed on the same pt on the same day
14.What are the possible consequences of inaccurate coding and
incorrect billing✔✔✔✔*delayed processing & payment of claims
*reduced payments, denied claims *fine and/or imprisonment
*exclusion from payer’s programs, loss of dr’s license to practice med
15.Who has the task of investigate and prosecuting health care fraud
& abuse✔✔✔✔The Office of Inspector General (OIG)
16.Fraud: knowingly & intentionally deceiving or misrepresenting info
that may result in unauthorized benefits. It is a felony and can result
in fines and/or prison.
17.Who audits claims✔✔✔✔State & federal agencies as well as private
ins co’s
18.What are common forms of fraud✔✔✔✔billing for services not
furnished, un- bundling, & misrepresenting diagnosis to justify
payment
19.Abuse: incidences or practices, not usually considered fraudulent,
1 / 8
CBCS Practice Exam 2022/2023
(Verified Answers by Expert)
1.A patient presents to the provider with chest pain and shortness of
breath. After an unexpected ECG result, the provider calls a cardiologist
and sum- marizes 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
2.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 has not been met. How much should the
physician write off the patient’s account✔✔✔✔ $40
- Which of the following sections of the medical record is used to
determine the correct Evaluation and Management code used for billing
and coding?-
: History and physical
4.A billing and coding specialist is reviewing a CMS-1500 claim form. The
as- signment of benefits box has been checked yes. The checked box
indicates which of the following✔✔✔✔ The provider receives payment
directly from the payer. - Which of the following do physicians use to electronically submit
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claims?-
: Clearinghouse
6.Which of the following should the billing and coding specialist include in
an authorization to release information✔✔✔✔ The entity to whom the
information is to be released
7.Which of the following describes the content of a medical practice
aging report✔✔✔✔ An overview of the practice’s outstanding claims - HIPAA transaction standards apply to which of the followingentities✔✔✔✔ –
Health care clearinghouses
9.When a physician documents a patient’s response to symptoms and
various body systems, the results are documented as which of the
follow- ing✔✔✔✔ Review of systems
10.Which part of Medicare covers prescriptions✔✔✔✔ Part D
11.Which of the following indicates a claim should be submitted on
paper instead of electronically✔✔✔✔ The claim requires an
attachment.
12.Medicare enforces mandatory submission of electronic claims for most
providers. Which of the following providers is allowed to submit paper
claims to Medicare✔✔✔✔ A provider’s office with fewer than 10 fulltime employees
13.Which of the following is the correct term for an amount that has
been determined to be uncollectable✔✔✔✔ Bad debt
1 / 9
CBCS Final Exam 2022/2023
(Verified Answers by Expert)
1.When a billing and coding specialist is completing the CMS-1500
claim form, which of the following information is required to process a
medical claim✔✔✔✔CPT, ICD
- The allowed amount for a patient’s office visit is $175. The copayment is$15 and the amount the insurance paid is $85. Which of the following is the
amount of the adjustment✔✔✔✔$75
3.Which of the following suffixes refers to an abnormal condition✔✔✔✔-
osis
4.Which of the following entities contracts with Medicare to recoup
money form inappropriately paid claims✔✔✔✔Recovery Audit
Contractor
5.Which of the following abbreviations is used to describe the reason
a patient presents for an encounter at the office visit✔✔✔✔CC
6.A patient comes in the office with an injury form work. Which box on line
1 of the CMS-1500 claim from should the billing and coding specialist
check off to transmit the calm for payment✔✔✔✔FECA
7.Which of the following physical status modifiers should the billing and
2 / 9
coding specialist use to indicate a healthy patient who has no evidence
of disease at the time of anesthesia administration✔✔✔✔P1
8.Which of the following practices does HIPPA Title II define as
fraud✔✔✔✔Alter- ing codes to increase payment
9.A provider charges $30 for a treatment that has an allowed of $25.
Which of the following statements regarding this $5 difference between
the two amounts is correct✔✔✔✔The insurance payer pays the $5 if
the provider is a par- ticipating provider.
10.A patient who has coinsurance and has met their deductible has
which of the following third-party payers✔✔✔✔Preferred provider
organization(PPO)
11.If a patient does not sign box 13 on the CMS-1500 form. Which of
the following will receive payment✔✔✔✔Provider
12.Which is the correct form✔✔✔✔Thomas Jr. Martin F
13.A patient has a diagnosis of chest pain. The billing and coding
specialist should link the diagnosis to the procedure in which of the
following blocks on the CMS- 1500 form✔✔✔✔24D
14.A provider’s office is being investigated for fraud. Which of the
following processes will be reviewed first✔✔✔✔Compliance Plan
3 / 9
15.Which of the following entities works with Centers for Medicare and
Medicaid services to prevent overpayment✔✔✔✔Medicaid Integrity
contractors
16.Which of the following actions by a billing and coding specialist is
insurance abuse✔✔✔✔Using a health insurance identification number
other than the patients to ensure payments
17.Which of the following refers to payers electronically transferring date
in order to facilitate coordination of benefits on a clean
claim✔✔✔✔Crossover
- Which of the following is responsible for the health care of its
policyhold- ers and identifies health insurance, facilities, providers, or
health systems?-
: Managed care Organization
19.A patient who has TRICARE is seen in the office for a diagnostic test.
The test is $500, and the allowable amount is $250. The patient has a 20%
cost share, a deductible of $1000, and a catastrophic cap benefit that have
all been met. How much should the billing specialist adjust on this
visit✔✔✔✔$200
20.Which of the following is the amount that the patient is financially
respon- sible for before the insurance policy provides
coverage✔✔✔✔Deductible
21.The balances listed on an insurance aging report represent which of
the following✔✔✔✔Outstanding amounts owed to the practice
1 / 13
CBCS Exam Questions & Answers
2022/2023(Verified Answers by Expert)1.What describes the reason for a claim rejection because of Medicare
NCCI edits✔✔✔✔Improper code combinations
2.A claim is submitted with a transposed insurance member ID number
and returned to the provider.✔✔✔✔Invalid
3.Medigap coverage is offered to Medicare beneficiaries by
whom✔✔✔✔Private third-party payers
4.What provision assures that an insured’s benefits from all insurance
com- panies do not exceed 100% of the allowable medical
expense✔✔✔✔Coordination of benefits
5.A coroner’s autopsy is comprised of what examination✔✔✔✔Gross
Examination
6.What is true regarding the release of a patient records✔✔✔✔Patient
access to psychotherapy notes is restricted
7.What is considered fraud✔✔✔✔Billing for services not provided
8.What component of an explanation of benefit expedites the process of
a phone appeal✔✔✔✔Claim control number
2 / 13
9.On the CMS-1500 claim form, item number 14 – 33 contain
information about✔✔✔✔The patient’s condition and the provider’s
information
10.The financial record source that is generated by a provider’s office
is called a✔✔✔✔Patients ledger account
11.A medical term refers to the sac that encloses the
heart✔✔✔✔Pericardium
12.HIPPA transaction standards apply to which entities✔✔✔✔Health care
clearing- houses
13.All dependents 10 yrs of age or older are required to have what
for TRICARE✔✔✔✔Military identification
14.The standard medical abbreviation ” ECG ” refers to a test used to
assess what body system✔✔✔✔Cardiovascular system
15.Claims that are submitted without an NPI number will delay payment
to the provider because✔✔✔✔It is used as a preauthorization number
16.An example of a violation of patient confidentiality✔✔✔✔A billing
and coding specialist queries the physician about a diagnosis in a
patient’s medical record
17.What section of the medical record is used to determine the correct
E&M code used for billing and coding✔✔✔✔History and Physical
3 / 13
18.What action should be taken if an insurance company denies a
service as not medically necessary✔✔✔✔Appeal the decision with a
provider’s report
19.What is the name of the portion of the account balance for which the
patient id responsible after service have been rendered and the yearly
de- ductible has been met✔✔✔✔Coinsurance
20.What is the function of the respiratory system✔✔✔✔Oxygenating
blood cells
21.What describes a delinquent claim✔✔✔✔The claim is overdue for
payment
22.What action should taken if he or she observes a colleague in an unethical situation✔✔✔✔Report the incident to a supervisor
23.A participating Blue Cross/Blue Shield ( BC/BS ) 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.
They paid the balance at 80%. How much should the patient expect to
pay✔✔✔✔$48
24.What statement is correct regarding a deductible✔✔✔✔The
deductible is the patient’s responsibility
25.A physician ordered a comprehensive metabolic panel for a 70-yr old
pa- tient who has Medicare as her primary insurance. What forms is
required so the patient knows she may be responsible for
payment✔✔✔✔Advanced Beneficiary Notice
1 / 10
NHA – Certified Billing and Coding Specialist (CBCS) Study Guide
2022/2023(Verified Answers by Expert)
1.The symbol “O” in the Current Procedural Terminology reference is used
to indicate what✔✔✔✔ Reinstated or recycled code
2.In the anesthesia section of the CPT manual, what are considered
qualify- ing circumstances✔✔✔✔ Add-on codes
3.As of April 1, 2014 what is the maximum number of diagnoses that can
be reported on the CMS-1500 claim form before a further claim is
required✔✔✔✔ 12
4.What is considered proper supportive documentation for reporting CPT
and ICD codes for surgical procedures✔✔✔✔ Operative report
5.What action should be taken first when reviewing a delinquent
claim✔✔✔✔ Ver- ify the age of the account
- A claim can be denied or rejected for which of the following
reasons✔✔✔✔ –
Block 24D contains the diagnosis code
7.A coroner’s autopsy is comprised of what examinations✔✔✔✔ Gross
Examina- tion
8.Medigap coverage is offered to Medicare beneficiaries by whom✔✔✔✔
Private third-party payers
9.What part of Medicare covers prescriptions✔✔✔✔ Part C
2 / 10
10.What plane divides the body into left and right✔✔✔✔ Sagittal
11.Where can unlisted codes be found in the CPT manual✔✔✔✔
Guidelines prior to each section
12.Ambulatory surgery centers, home health care, and hospice
organiza- tions use which form to submit claims✔✔✔✔ UB-04 Claim
Form
13.What color format is acceptable on the CMS-1500 claim form✔✔✔✔ Red14.Who is responsible to pay the deductible✔✔✔✔ Patient
15.A patient’s health plan is referred to as the “payer of last resort.” What
is the name of that health plan✔✔✔✔ Medicaid
16.Informed Consent: Providers explain medical or diagnostic
procedures, surgi- cal interventions, and the benefits and risks
involved, giving patients an opportunity to ask questions before
medical intervention is provided.
17.Implied Consent: A patient presents for treatment, such as
extending an arm to allow a venipuncture to be performed.
3 / 10
18.Clearinghouse: Agency that converts claims into standardized
electronic for- mat, looks for errors, and formats them according to
HIPAA and insurance stan- dards.
19.Individually Identifiable: Documents that identify the person or
provide enough information so that the person can be identified.
20.De-identified Information: Information that does not identify an
individual because unique and personal characteristics have been
removed.
21.Consent: A patient’s permission evidenced by signature.
22.Authorizations: Permission granted by the patient or the patient’s
represen- tative to release information for reasons other than
treatment, payment, or health care operations.
23.Reimbursement: Payment for services rendered from a third-partypayer.
24.Auditing: Review of claims for accuracy and completeness.
25.Fraud: Making false statements of representations of material facts
to obtain some benefit or payment for which no entitlement would
otherwise exist.
26.Upcoding: Assigning a diagnosis or procedure code at a higher level
than the documentation supports, such as coding bronchitis as
pneumonia.
27.Unbundling: Using multiple codes that describe different
components of a treatment instead of using a single code that
1 / 16
NHA Billing and Coding Practice Test (CBCS)
2022/2023(Verified Answers by Expert)
1.The attending physician✔✔ A nurse is reviewing a patients lab
results prior to discharge and discovers an elevated glucose level.
Which of the following health care providers should be altered before
the nurse can proceed with discharge planning?
2.The patients condition and the providers information✔✔ On the CMS1500 Claims for, blocks 14 through 33 contain information about which
of the following?
3.Problem focused examination✔✔ A provider performs an examination
of a pa- tient’s throat during an office visit. Which of the following
describes the level of the examination?
4.Reinstated or recycled code✔✔ The symbol “O” in the Current
Procedural Ter- minology reference is used to indicate which of the
following?
5.Coinsurance✔✔ Which of the following is the portion of the account
balance the patient must pay after services are rendered and the
annual deductible is met?
6.Place of service✔✔ The billing and coding specialist should divide the
evaluation and management code by which of the following?
7.Cardiovascular system✔✔ The standard medical abbreviation “ECG”
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refers to a test used to access which of the following body systems?
8.add on codes✔✔ In the anesthesia section of the CPT manual,
which of the following are considered qualifying circumstances?
9.12✔✔ As of April 1st 2014, what is the maximum number of
diagnosis that can be reported on the CMS-1500 claim form before a
further claim is required?
10.Nephrolithiasis✔✔ When submitting a clean claim with a
diagnosis of kidney stones, which of the following procedure names
is correct?
11.Verifying that the medical records and the billing record match✔✔
Which of the following is one of the purposes of an internal auditing
program in a physician’s office?
12.The DOB is entered incorrectly✔✔ Patient Jane Austin; Social
Security # 555-22-1111; Medicare ID 555-33-2222A; DOB
05/22/1945. Claim informa- tion enteredAustin, Jane; Social Security
.555-22-1111; Medicare ID No. 555-33-2222A; DOB052245. Which
of the following is a reason this claim was rejected?
13.Operative report✔✔ Which of the following options is considered
proper support- ive documentation for reporting CPT and ICD codes for
surgical procedures?
14.Verify the age of the account✔✔ Which of the following actions
should be taken first when reviewing delinquent claims?
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15.Claim control number✔✔ Which of the following components of an
explanation of benefits expedites the process of a phone appeal?
16.Bloc 24D contains the diagnosis code✔✔ A claim can be denied or
rejected for which of the following reasons?
17.Privacy officer✔✔ To be compliant with HIPAA, which of the
following positions should be assigned in each office?
18.encrypted✔✔ All e-mail correspondence to a third party payer
containing pa- tients’ protected health information (PHI) should be
19.patient ledger account✔✔ A billing and coding specialist should
understand that the financial record source that is generated by a
provider’s office is called a
20.Coding compliance plan✔✔ Which of the following includes
procedures and best practices for correct coding?
21.Health care clearinghouses✔✔ HIPAA transaction standards apply to
which of the following entities?
22.Appeal the decision with a provider’s report✔✔ Which of the following
actions should be taken if an insurance company denies a service as
not medically necessary?
23.Accommodate the request and send the records✔✔ A patient with a
past due balance requests that his records be sent to another
provider. Which of the following actions should be taken?
24.$48✔✔ A participating BlueCross/ BlueShield (BC/BS) provider
receives an ex- planation of benefits for a patient account. The
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charged amount was $100. BC/BS allowed $40 to the patients annual
deductible. BC/BS paid the balance at 80%. How much should the
patient expect to pay?
25.Deductible✔✔ The 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 this year.
26.International Classification of Disease (ICD)✔✔ Which of the following
is used to code diseases, injuries, impairments, and other health
related problems?
27.Ureters✔✔ Urine moves from the kidneys to the bladder through
which of the following parts of the body?
28.Angioplasty✔✔ Threading a catheter with a balloon into a coronary
artery and expanding it to repair arteries describes which of the
following procedures?