NHA Billing and Coding practice test (CBCS) Answered fully

The attending physician - ANSWER 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 ...

The attending physician - ANSWER 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 - ANSWER On the CMS-1500 Claims for, blocks 14 through 33 contain information about which of the following? Problem focused examination - ANSWER 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 - ANSWER The symbol "O" in the Current Procedural Terminology reference is used to indicate which of the following? Coinsurance - ANSWER 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 - ANSWER The billing and coding specialist should divide the evaluation and management code by which of the following? Cardiovascular system - ANSWER The standard medical abbreviation "ECG" refers to a test used to access which of the following body systems? add on codes - ANSWER In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? 12 - ANSWER 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 - ANSWER 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 - ANSWER Which of the following is one of the purposes of an internal auditing program in a physician's office? The DOB is entered incorrectly - ANSWER 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 - ANSWER 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 - ANSWER Which of the following actions should be taken first when reviewing delinquent claims? Claim control number - ANSWER Which of the following components of an explanation of benefits expedites the process of a phone appeal? Bloc 24D contains the diagnosis code - ANSWER A claim can be denied or rejected for which of the following reasons? Privacy officer - ANSWER To be compliant with HIPAA, which of the following positions should be assigned in each office? encrypted - ANSWER All e-mail correspondence to a third party payer containing patients' protected health information (PHI) should be patient ledger account - ANSWER 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 - ANSWER Which of the following includes procedures and best practices for correct coding? Health care clearinghouses - ANSWER HIPAA transaction standards apply to which of the following entities? Appeal the decision with a provider's report - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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) - ANSWER Which of the following is used to code diseases, injuries, impairments, and other health related problems? Ureters - ANSWER Urine moves from the kidneys to the bladder through which of the following parts of the body? Angioplasty - ANSWER 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 - ANSWER 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 - ANSWER Which of the following actions by the billing and coding specialists prevents fraud? Name and address of guarantor - ANSWER Which of the following information is required on a patient account record? Invalid - ANSWER 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 - ANSWER 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. - ANSWER Which of the following is HIPAA compliance guideline affecting electronic health records? Verification of coverage. - ANSWER Which of the following is the purpose of precertification The entity to whom the information is to be released - ANSWER Which of the following should the billing and coding specialist include in an authorization to release information? Report the incident to a supervisor - ANSWER Which of the following actions should the billing and coding specialist take if he observes a colleague in an unethical situation? Patient's responsibility - ANSWER 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 - ANSWER 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 - ANSWER Which of the following statements is true regarding the release of patient records? Denied - ANSWER 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 - ANSWER Which of the following do physicians use to electronically submit claims? principal diagnosis - ANSWER 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 - ANSWER 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 - ANSWER According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500 claim form in Block 24j? Oxygenating blood cells - ANSWER Which of the following is the function of the respiratory system? Coordination of benefits - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER A coroner's autopsy is comprised of which of the following examinations? Claims are expedited - ANSWER Which of the following is the advantage of electronic claim submission? Title 2 - ANSWER 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 - ANSWER 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 - ANSWER Which of the following does a patient sign to allow payment of claims directly to the provider? Military identification - ANSWER All dependents 10 year of age or older are required to have which of the following for TRICARE? Private 3rd party payers - ANSWER Medigap coverage is offered to Medicare beneficiaries by which of the following? Follow up of insurance claims by date - ANSWER An insurance claims register (aged insurance report) facilitates which of the following? Urethratresia - ANSWER Which of the following describes an obstruction of the urethra? Admitting clerk - ANSWER A patient comes to the hospital for an inpatient procedure. Which of the following hospital staff members is responsible for the initial patient interview, obtaining demographic and insurance information, and documenting the chief complaint? The patient demographics - ANSWER On the CMS-1500 claim form, Blocks 1 through 13 include which of the following Pumping blood in the circulatory system - ANSWER Which of the following is the primary function of the heart? Submit an appeal to the carrier with the supporting documentation - ANSWER Which of the following actions should be taken when a claim is billed for a level four office visit and paid at a level three? Delinquent - ANSWER Which of the following types of claims is 120 days old? Aging report - ANSWER Which of the following shows outstanding balances? Part D - ANSWER Which part of Medicare covers prescriptions? Dermatology - ANSWER In which of the following departments should a patient be seen for psoriasis? Patient information was disclosed to the patient's parent without consent. - ANSWER Which of the following is an example of a violation of an adult patient's confidentiality? Improper code combinations - ANSWER Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? History and physical - ANSWER Which of the following sections of the medical record is used to determine the correct Evaluation and Management code used for billing and coding? Blue shield/ Blue cross - ANSWER Which of the following is a private insurance carrier? National provider identification number - ANSWER Which of the following information should the billing and coding specialist input into Block 33a on the CMS-1500 claim form? UB-04 - ANSWER Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? Pulmonary oncologist - ANSWER A patient who has a primary malignant neoplasm of the lung should be referred to which of the following specialists? They streamline patient billing by summarizing the services rendered for a given date of service - ANSWER Why does correct claim processing rely on accurately completed encounter forms? Sagittal - ANSWER Which of the following planes divides the body into left and right? Inform the patient of the reason of the denial - ANSWER A patient is upset about a bill she received. Her insurance company denied the claim. Which of the following actions is an appropriate way to handle the situation? The claim is overdue for payment - ANSWER Which of the following describes a delinquent claim? Use Arial size 10 font - ANSWER When completing a CMS-1500 paper claim form, which of the following is an acceptable action for the billing and coding specialist to take? Pericardium - ANSWER Which of the following medical terms refers to the sac that encloses the heart? Adjudication - ANSWER Which of the following is considered the final determination of the issues involving settlement of an insurance claim? Encounter form - ANSWER A form that contains charges, DOS, CPT codes, ICD codes, fees, and copayment information is called which of the following?