NHA CBCS study guide Questions and
Answers () (Verified Answers)
When submitting claims, which of the following is the outcome if Block 13 is left blank?
The third-party payer reimburses the patient, and the patient is responsible for reimbursing the
provider
Which of the following do physicians use to electronically submit claims?
clearinghouse
When billing a secondary insurance company, which block should the billing and coding specialist fill
out on the CMS-1500 claim form?
Block 9a
A physician is contracted with an insurance company to accept the allowed amount. The insurance
company $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 is a requirement of some third-party payers before a procedure is performed?
Preauthorization
A prospective billing account audit prevents fraud by reviewing and comparing a completed claim
form with which of the following documents?
a billing worksheet from the patient account
Which of the following documents is required to disclose an adult patient's information?
a signed release from the patient
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?
fraud
Two 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?
duplication of services
Which of the following security features is required during transmission of protected health
information and medical claims to third-party payers?
encryption
Which of the following billing patterns is a best-practice action?
documenting the patient's chief complaint, history, exam, assessment and plan for care
A provider receives a reimbursement from a third-party payer accompanied by which of the following
documents?
,explanation of benefits
Which of the following is a correct entry of a charge of $150 in Block 24F of the CMS-1500 claim form?
150 00
A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is
responsible for which of the following percentages?
0%
Which of the following coding manuals is used primarily to identify products, supplies, and services?
HCPCS level II manual
A billing and coding specialist needs to know how much Medicare paid on a claim before billing the
secondary insurance. To which of the following should the specialist refer?
Remittance advice
Which of the following is allowed when billing procedural codes?
billing using two-digit CPT modifiers to indicate a procedure as performed differs from its usual five-
digit code
Which of the following types of health insurance plans best describes a government-sponsored
benefit program?
TRICARE Prime
Which of the following is the correct term for an amount that has been determined to be
uncollectable?
bad debt
Which of the following is a type of claim that will be denied by the third-party payers?
incomplete claim
If a patient has osteomyelitis, he has problems with which of the following areas?
bones and bone marrow
Block 17b on the CMS-1500 claim form should list which of the following information?
referring physician's national provider identifier (NPI) number
Which of the following actions should the billing and coding specialist take to effectively manage
accounts receivable?
collect copayment from the patient at the time of service
Which of the following acts applies to the Administrative Simplification guidelines?
Health Insurance Portability and Accountability Act (HIPAA)
, Which of the following is the primary information used to determine the priority of collection letters
to patients?
the age of the account
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 full-time employees
In 1995 and 1997, which of the following introduced documentation guidelines to Medicare carriers
to ensure that services paid for have been provided and we medically necessary?
CMS
Z codes are used to identify which of the following?
immunizations
Which of the following claims would appear on an aging report?
a claim that is delinquent for 60 days
When a physician documents a patient's response to symptoms and various body systems the results
are documented as which of the following?
review of systems
In an outpatient setting, which of the following forms is used as a financial report of all services
provided to patients?
patient account record
Which of the following is used by providers to remove errors from claims before they are submitted
to third-party payers?
clearinghouse
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?
$120
Which of the following modifiers should be used to indicate a professional service has been
discontinued prior to completion?
-53
The explanation of payments received from the insurance company is often referred to or called the:
remittance advice
A diseased condition or state is known as:
morbidity
Answers () (Verified Answers)
When submitting claims, which of the following is the outcome if Block 13 is left blank?
The third-party payer reimburses the patient, and the patient is responsible for reimbursing the
provider
Which of the following do physicians use to electronically submit claims?
clearinghouse
When billing a secondary insurance company, which block should the billing and coding specialist fill
out on the CMS-1500 claim form?
Block 9a
A physician is contracted with an insurance company to accept the allowed amount. The insurance
company $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 is a requirement of some third-party payers before a procedure is performed?
Preauthorization
A prospective billing account audit prevents fraud by reviewing and comparing a completed claim
form with which of the following documents?
a billing worksheet from the patient account
Which of the following documents is required to disclose an adult patient's information?
a signed release from the patient
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?
fraud
Two 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?
duplication of services
Which of the following security features is required during transmission of protected health
information and medical claims to third-party payers?
encryption
Which of the following billing patterns is a best-practice action?
documenting the patient's chief complaint, history, exam, assessment and plan for care
A provider receives a reimbursement from a third-party payer accompanied by which of the following
documents?
,explanation of benefits
Which of the following is a correct entry of a charge of $150 in Block 24F of the CMS-1500 claim form?
150 00
A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is
responsible for which of the following percentages?
0%
Which of the following coding manuals is used primarily to identify products, supplies, and services?
HCPCS level II manual
A billing and coding specialist needs to know how much Medicare paid on a claim before billing the
secondary insurance. To which of the following should the specialist refer?
Remittance advice
Which of the following is allowed when billing procedural codes?
billing using two-digit CPT modifiers to indicate a procedure as performed differs from its usual five-
digit code
Which of the following types of health insurance plans best describes a government-sponsored
benefit program?
TRICARE Prime
Which of the following is the correct term for an amount that has been determined to be
uncollectable?
bad debt
Which of the following is a type of claim that will be denied by the third-party payers?
incomplete claim
If a patient has osteomyelitis, he has problems with which of the following areas?
bones and bone marrow
Block 17b on the CMS-1500 claim form should list which of the following information?
referring physician's national provider identifier (NPI) number
Which of the following actions should the billing and coding specialist take to effectively manage
accounts receivable?
collect copayment from the patient at the time of service
Which of the following acts applies to the Administrative Simplification guidelines?
Health Insurance Portability and Accountability Act (HIPAA)
, Which of the following is the primary information used to determine the priority of collection letters
to patients?
the age of the account
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 full-time employees
In 1995 and 1997, which of the following introduced documentation guidelines to Medicare carriers
to ensure that services paid for have been provided and we medically necessary?
CMS
Z codes are used to identify which of the following?
immunizations
Which of the following claims would appear on an aging report?
a claim that is delinquent for 60 days
When a physician documents a patient's response to symptoms and various body systems the results
are documented as which of the following?
review of systems
In an outpatient setting, which of the following forms is used as a financial report of all services
provided to patients?
patient account record
Which of the following is used by providers to remove errors from claims before they are submitted
to third-party payers?
clearinghouse
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?
$120
Which of the following modifiers should be used to indicate a professional service has been
discontinued prior to completion?
-53
The explanation of payments received from the insurance company is often referred to or called the:
remittance advice
A diseased condition or state is known as:
morbidity
