NHA Billing and Coding practice test (CBCS 2023 with complete solution

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? The patients condition and the providers information On the CMS-1500 Claims for, blocks 14 through 33 contain information about which of the following? Problem focused examination 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 The symbol "O" in the Current Procedural Terminology reference is used to indicate which of the following? 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? Place of service The billing and coding specialist should divide the evaluation and management code by which of the following? Cardiovascular system The standard medical abbreviation "ECG" refers to a test used to access which of the following body systems? add on codes In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? 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? Nephrolithiasis 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 Which of the following is one of the purposes of an internal auditing program in a physician's office? The DOB is entered incorrectly Patient: Jane Austin; Social Security # ; Medicare ID: A; DOB: 05/22/1945. Claim information entered: Austin, Jane; Social Security #.: ; Medicare ID No.: A; DOB: . Which of the following is a reason this claim was rejected? Operative report 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 Which of the following actions should be taken first when reviewing delinquent claims? Claim control number Which of the following components of an explanation of benefits expedites the process of a phone appeal? Bloc 24D contains the diagnosis code A claim can be denied or rejected for which of the following reasons? Privacy officer To be compliant with HIPAA, which of the following positions should be assigned in each office? encrypted All e-mail correspondence to a third party payer containing patients' protected health information (PHI) should be 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 Coding compliance plan Which of the following includes procedures and best practices for correct coding? Health care clearinghouses HIPAA transaction standards apply to which of the following entities? 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? 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? $48 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 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) Which of the following is used to code diseases, injuries, impairments, and other health related problems? Ureters Urine moves from the kidneys to the bladder through which of the following parts of the body? Angioplasty 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 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 Which of the following actions by the billing and coding specialists prevents fraud? Name and address of guarantor Which of the following information is required on a patient account record? Invalid 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 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. Which of the following is HIPAA compliance guideline affecting electronic health records? Verification of coverage. Which of the following is the purpose of precertification The entity to whom the information is to be released Which of the following should the billing and coding specialist include in an authorization to release information? Report the incident to a supervisor Which of the following actions should the billing and coding specialist take if he observes a colleague in an unethical situation? Patient's responsibility 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 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 Which of the following statements is true regarding the release of patient records? Denied 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 Which of the following do physicians use to electronically submit claims? principal diagnosis 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 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 According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500 claim form in Block 24j? Oxygenating blood cells Which of the following is the function of the respiratory system? Coordination of benefits 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 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 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 A coroner's autopsy is comprised of which of the following examinations? Claims are expedited Which of the following is the advantage of electronic claim submission? Title 2 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 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 Which of the following does a patient sign to allow payment of claims directly to the provider? Military identification All dependents 10 year of age or older are required to have which of the following for TRICARE? Private 3rd party payers Medigap coverage is offered to Medicare beneficiaries by which of the following? Follow up of insurance claims by date An insurance claims register (aged insurance report) facilitates which of the following? Urethratresia Which of the following describes an obstruction of the urethra? Admitting clerk 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 On the CMS-1500 claim form, Blocks 1 through 13 include which of the following Pumping blood in the circulatory system Which of the following is the primary function of the heart? Submit an appeal to the carrier with the supporting documentation 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 Which of the following types of claims is 120 days old? Aging report Which of the following shows outstanding balances? Part D Which part of Medicare covers prescriptions? Dermatology In which of the following departments should a patient be seen for psoriasis? Patient information was disclosed to the patient's parent without consent. Which of the following is an example of a violation of an adult patient's confidentiality? Improper code combinations Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? History and physical 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 Which of the following is a private insurance carrier? National provider identification number Which of the following information should the billing and coding specialist input into Block 33a on the CMS-1500 claim form? UB-04 Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? Pulmonary oncologist 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 Why does correct claim processing rely on accurately completed encounter forms? Sagittal Which of the following planes divides the body into left and right? Inform the patient of the reason of the denial 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 Which of the following describes a delinquent claim? Use Arial size 10 font 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 Which of the following medical terms refers to the sac that encloses the heart? Adjudication Which of the following is considered the final determination of the issues involving settlement of an insurance claim? Encounter form A form that contains charges, DOS, CPT codes, ICD codes, fees, and copayment information is called which of the following? Using data encryption software on office workstations Which of the following privacy measures ensures protected health information (PHI)? It indicates which claims are outstanding Which of the following is the purpose of running an aging report each month? Billing for services not provided Which of the following actions by a billing and coding specialist would be considered fraud? Paper claim Which of the following claims is submitted and then optically scanned by the insurance carrier and converted to an electronic form? Block 12 Which of the following blocks requires the patient's authorization to release medical information to process a claim? Block 24D Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim form for procedures, services, or supplies? Guidelines prior to each section The unlisted codes can be found in which of the following locations in the CPT manual? $40 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 been met. How much should the physician write off the patient's account? Provider On a remittance advice form, which of the following is responsible for writing off the difference between the amount billed and the amount allowed by the agreement? Procedure descriptors The "" symbol is used to indicate new and revised text other than which of the following? The claim requires an attachment Which of the following indicates a claim should be submitted on paper instead of electronically? Coinsurance Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays 30%? The number is needed to identify the provider Claims that are submitted without an NPI number will delay payment to the provider because UB-04 claim form Ambulatory surgery centers, home health care, and hospice organizations use the Red Which of the following color formats is acceptable on the CMS-1500 claim form? The deductible is the patient's responsibility Which of the following statements is correct regarding a deductible? Adjustment column of the credits A provider charged $500 to a claim that had an allowable amount of $400. In which of the following columns should the billing and coding specialist apply the non-allowed charge? The billing and coding specialist sends the patient's records to the patient's partner. 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 designated with power of attorney. Which of the following is considered a HIPAA violation? Medicaid A patient's health plan is referred to as the "payer of last resort." The patient is covered by which of the following health plans? Claim adjudication After a 3rd party payer validates a claim, which of the following takes place next? Health care clearinghouse HIPAA transaction standards apply to which of the following entities? First report of injury Which of the following is the initial step in processing a workers' compensation claim? Coordination of benefits The provision of health insurance policies that specifies which coverage is considered primary or secondary is called which of the following? A provider's office with fewer than 10 full-time employees Medicare enforces mandatory submission of electronic claims for most providers. Which of the following providers is allowed to submit paper claims to medicare? The 3rd party payer reimburses the patient, and the patient is responsible for reimbursing the provider. When submitting claims, which of the following is the outcome if block 13 is left blank? accounts receivable Patient charges that have not been paid will appear in which of the following? Remittance advice A billing and coding specialist needs to know how much Medicare paid on a claim before billing secondary insurance. To which of the following should the specialist refer? A bilateral procedure A billing and coding specialist should add modifier -50 to codes when reporting which of the following? CMS In 1995 and 1997, which of the following introduced documentation guidelines to Medicare carriers to ensure that services paid for have been provided and were medically necessary? Billing using 2 digit CPT modifiers to indicate a procedure as performed differs from its usual 5 digit code Which of the following is allowed when billing procedural codes? Cold treatment The destruction of lesions using cryosurgery would use which of the following treatments? Code both acute and chronic sequencing the acute first When a patient has a condition that is both acute and chronic how should it be reported? An overview of the practice's outstanding claims Which of the following describes the content of a medical practice aging report? Fraud After reading a provider's notes about a new patient, a coding specialist decides to code for a longer length of time than the actual office visit. Which of the following describes the specialist's action? The claim will not be re submitted and the patient will be sent a bill A claim is denied because the service was not covered by the insurance company. Upon confirmation of no errors on the claim, which of the following describes the process that will follow the denial? A billing worksheet from the patient account A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which of the following documents? Encryption Which of the following security features is required during transmission of protected health information and medical claims to third party payers? HIPAA Which of the following acts applies to the Administrative Simplification guidelines? Immunizations Z codes are used to identify which of the following? -53 Which of the following modifiers should be used to indicate a professional service has been discontinued prior to completion? Complete the information and re transmit according to the 3rd party standards When an electronic claim is rejected due to incomplete information, which of the following should the medical billing specialist take? Claims submitted via a secure network Which of the following is an example of electronic claim submission? EEG Test results indicated that no abnormalities were found in the brain and the brain's electrical activity patterns are normal. Which of the following tests was used to conduct this exam? 9a When billing a secondary insurance company, which block should the billing and coding specialist fill out on the CMS-1500 claim form? Collect copayment from the patient at the time of service Which of the following actions should the billing and coding specialist take to effectively manage accounts receivable? 12 What is the maximum number of ICD codes that can be entered on a CMS-1500 claim form as of February 2012? Internal monitoring and audting Which of the following actions should the billing and coding specialist take to prevent fraud and abuse in the medical office? 30 days For which of the following time periods should the billing and coding specialist track unpaid claims before taking follow up action 0% A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is responsible for which of the following percentages? Direct data entry A biller will electronically submit a claim to the carrier via which of the following? Review of systems When a physician documents a patient's response to symptoms and various body systems, the results are documented as which of the following? 150 00 Which of the following is a correct entry of a charge of $140 in Block 24F of the CMS-1500 claim form? Services rendered by a physician whose opinion or advice is requested by another physician or agency Which of the following situations constitutes a consultation? Bones and bone marrow If a patient has osteomyelitis he has a problem with which of the following areas? An authorization Which of the following forms must the patient or representative sign to allow the release of protected health information? Referring physician's national provider identifier (NPI) number Block 17b on the CMS-1500 claim form should list which of the following information? NCCI Which of the following was developed to reduce Medicare program expenditures by detecting inappropriate codes and eliminating improper coding practices? Denied Which of the following describes the status of a claim that does not include required preauthorization for a service? Lymphatic system Which of the following parts of the body system regulates immunity? Clearinghouse Which of the following is used by providers to remove errors from claims before they are submitted to 3rd party payers? Explanation of benefits A provider receives reimbursement from a 3rd party payer accompanied by which of the following documents? Claims adjudication Which of the following is the 3rd stage of the life cycle of a claim? Block 10a Which of the following blocks on the CMS-1500 claim form is required to indicate a workers' compensation claim? Duplication of services 2 providers from the same practice visit a patient in the emergency department using the same CPT code. The claim may be denied due to which of the following reasons? The patient was out of town during the emergency A patient has an emergency appendectomy while on vacation. The claim is rejected due to the patient obtaining services out of network. Which of the following information should be included in the claim appeal? Incomplete claim Which of the following is a type of claim that will be denied by the 3rd party payer? Internal monitoring and auditing Which of the following steps would be part of a physician's practice compliance program? $120 A patient has met a Medicare deductible of $150. The patient's coinsurance is 20% and the allowed amount is $600. Which of the following is the patient's out of pocket expense? The age of the account Which of the following is the primary information used to determine the priority of collection letters to patients?