The attending physician - CORRECT Ans=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 nurs
...
The attending physician - CORRECT Ans=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?
The patients condition and the providers information - CORRECT Ans=On the CMS-1500 Claims for, blocks 14 through 33 contain information about which of the following?
Problem focused examination - CORRECT Ans=A provider performs an examination of a patient's throat during an office visit. Which of the following describes the level of the examination?
Reinstated or recycled code - CORRECT Ans=The symbol "O" in the Current Procedural Terminology reference is used to indicate which of the following?
Coinsurance - CORRECT Ans=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?
Place of service - CORRECT Ans=The billing and coding specialist should divide the evaluation and management code by which of the following?
Cardiovascular system - CORRECT Ans=The standard medical abbreviation "ECG" refers to a test used to access which of the following body systems?
add on codes - CORRECT Ans=In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances?
12 - CORRECT Ans=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?
Nephrolithiasis - CORRECT Ans=When submitting a clean claim with a diagnosis of kidney stones, which of the following procedure names is correct?
Verifying that the medical records and the billing record match - CORRECT Ans=Which of the following is one of the purposes of an internal auditing program in a physician's office?
The DOB is entered incorrectly - CORRECT Ans=Patient: Jane Austin; Social Security # 555-22-1111; Medicare ID: 555-33-2222A; DOB: 05/22/1945. Claim information entered: Austin, Jane; Social Security #.: 555-22-1111; Medicare ID No.: 555-33-2222A; DOB: 052245. Which of the following is a reason this claim was rejected?
Operative report - CORRECT Ans=Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures?
Verify the age of the account - CORRECT Ans=Which of the following actions should be taken first when reviewing delinquent claims?
Claim control number - CORRECT Ans=Which of the following components of an explanation of benefits expedites the process of a phone appeal?
Bloc 24D contains the diagnosis code - CORRECT Ans=A claim can be denied or rejected for which of the following reasons?
Privacy officer - CORRECT Ans=To be compliant with HIPAA, which of the following positions should be assigned in each office?
encrypted - CORRECT Ans=All e-mail correspondence to a third party payer containing patients' protected health information (PHI) should be
patient ledger account - CORRECT Ans=A billing and coding specialist should understand that the financial record source that is generated by a provider's office is called a
Coding compliance plan - CORRECT Ans=Which of the following includes procedures and best practices for correct coding?
Health care clearinghouses - CORRECT Ans=HIPAA transaction standards apply to which of the following entities?
Appeal the decision with a provider's report - CORRECT Ans=Which of the following actions should be taken if an insurance company denies a service as not medically necessary?
Accommodate the request and send the records - CORRECT Ans=A patient with a past due balance requests that his records be sent to another provider. Which of the following actions should be taken?
$48 - CORRECT Ans=A participating BlueCross/ BlueShield (BC/BS) provider receives an explanation of benefits for a patient account. The 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?
Deductible - CORRECT Ans=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.
International Classification of Disease (ICD) - CORRECT Ans=Which of the following is used to code diseases, injuries, impairments, and other health related problems?
Ureters - CORRECT Ans=Urine moves from the kidneys to the bladder through which of the following parts of the body?
Angioplasty - CORRECT Ans=Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes which of the following procedures?
To ensure the patient understands his portion of the bill - CORRECT Ans=A patient's portion of the bill should be discussed with the patient before a procedure is performed for which of the following reasons?
Performing periodic audits - CORRECT Ans=Which of the following actions by the billing and coding specialists prevents fraud?
Name and address of guarantor - CORRECT Ans=Which of the following information is required on a patient account record?
Invalid - CORRECT Ans=A claim is submitted with a transposed insurance member ID number and returned to the provider. Which of the following describes the status that should be assigned to the claim by the carrier?
CMS-1500 claim form - CORRECT Ans=Which of the following should the billing and coding specialist complete to be reimbursed for the provider's services?
The electronic transmission and code set standards require every provider to use the healthcare transactions, code sets, and identifiers. - CORRECT Ans=Which of the following is HIPAA compliance guideline affecting electronic health records?
Verification of coverage. - CORRECT Ans=Which of the following is the purpose of precertification
The entity to whom the information is to be released - CORRECT Ans=Which of the following should the billing and coding specialist include in an authorization to release information?
Report the incident to a supervisor - CORRECT Ans=Which of the following actions should the billing and coding specialist take if he observes a colleague in an unethical situation?
Patient's responsibility - CORRECT Ans=When posting payment accurately, which of the following items should the billing and coding specialist include?
The parent whose birthdate comes first in the calendar year - CORRECT Ans=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 policy is primary. Which of the following describes the birthday rule?
Patient access to psychotherapy notes may be restricted - CORRECT Ans=Which of the following statements is true regarding the release of patient records?
Denied - CORRECT Ans=A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer?
Clearinghouse - CORRECT Ans=Which of the following do physicians use to electronically submit claims?
principal diagnosis - CORRECT Ans=When coding on the UB-04 form, the billing and coding specialist must sequence the diagnosis codes according to the ICD guidelines. Which of the following is the first listed diagnosis code?
Block 9 - CORRECT Ans=A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500 claim form should this information be entered?
NPI - CORRECT Ans=According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500 claim form in Block 24j?
Oxygenating blood cells - CORRECT Ans=Which of the following is the function of the respiratory system?
Coordination of benefits - CORRECT Ans=Which of the following provisions ensures that an insured's benefits from all insurance companies do not exceed 100% of allowable medical expenses?
Consent agreement - CORRECT Ans=Which of the following is the verbal or written agreement that gives approval to some action, situation, or statement, and allows the release of patient information?
Fraud - CORRECT Ans=A deductible of $100 is applied to a patient's remittance advice. The provider requests the account personnel write it off. Which of the following terms describes this scenario?
Gross examination - CORRECT Ans=A coroner's autopsy is comprised of which of the following examinations?
Claims are expedited - CORRECT Ans=Which of the following is the advantage of electronic claim submission?
Title 2 - CORRECT Ans=A patient presents to the provider with chest pain and SOB. After an unexpected ECG result, the provider calls 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?
Advanced beneficiary notice - CORRECT Ans=A physician ordered a comprehensive metabolic panel for a 70 year old patient who has Medicare as her primary insurance. Which of the following forms is required so the patient knows she may be responsible for payment?
Assignment of benefits - CORRECT Ans=Which of the following does a patient sign to allow payment of claims directly to the provider?
Military identification - CORRECT Ans=All dependents 10 year of age or older are required to have which of the following for TRICARE?
Private 3rd party payers - CORRECT
[Show More]
