NHA CBCS Practice Exam 2 Questions and
Answers Latest () 100% Verified
Answers
Which of the following is used to communicate why a claim line item was denied or paid differently
than it was billed?
Claim adjustment reason codes
.
A billing and coding specialist is reviewing a claim edit report and identifies a rejection for missing
patient demographic information. Which of the following missing pieces of patient demographic
information would cause a rejection from the clearinghouse?
DOB
A billing and coding specialist is reviewing paperwork that indicates overpayment by Medicare for six
patients over the past year. Which of the following describes this process ?
Audit
Which of the following describes an insurance company that offers plans that pay health care
providers who render services to patients?
Third party payer
Which of the following sections of the CPT® manual lists the code for WBC with differential,
automated?
Pathology and laboratory
A billing and coding specialist is reviewing provider notes to complete a claim. They need clarification
on whether the procedure performed was on the left side, right side, or bilaterally. The specialist
queries the provider and the provider confirms it was a bilateral procedure. Which of the following
modifiers should be billed?
50
A provider orders a comprehensive metabolic panel for a 70-year-old patient who has Medicare as
their primary insurance. Which of the following is required to inform the patient they may be
responsible for payment?
Advanced beneficiary notice
A billing and coding specialist is appealing a Medicare denial. Which of the following is the first step in
the appeals process?
Redetermination
Which of the following are used to code provider and outpatient services?
CPT codes
Which of the following is a covered entity affected by HIPAA security rules?
Health care clearinghouses
, Which of the following actions by a billing and coding specialist is an example of fraud ?
Billing for services not provided to obtain higher reimbursement
Which of the following should be included on a claim form that is sent from a specialist to a managed
health care organization?
The referring providers NPI
Which of the following is a document used to analyze accounts receivable based on dates of service?
Aging report
A provider accepts assignment for a patient who has a $10 copayment and has already met 100 of
their $150 deductible. The office charge is $100 and the allowed amount is 70. How much should the
provider's office adjust off the patient's account?
$30
A patient has a new diagnosis of hypothyroidism. In which of the following body systems is the
thyroid gland located?
Endocrine system
A patient's portion of the bill should be discussed with the patient before a procedure is performed
for which of the following reasons?
To ensure the patient understands his portion of the bill
Which of the following introduced documentation guidelines to Medicare carriers to ensure that
services paid for have been provided and were medically necessary?
CMS
A billing and coding specialist is reviewing a remittance advice for a claim that was denied for medical
necessity. which of the following is an example of this type of error?
The ICD-10-CM code for tonsillitis was listed with the CPT code for an appendectomy
Which of the following physical status modifiers should a billing and coding specialist use for
anesthesia services performed on a healthy 4-year old patient ?
-P1
Claims that are submitted without an NPI number will delay payment to the provider due to which of
the following?
The number is needed to identify the provider
A billing and coding specialist is posting a payment received from Medicare. The specialist should
identify that which part of Medicare covers prescrition costs?
Part D
Answers Latest () 100% Verified
Answers
Which of the following is used to communicate why a claim line item was denied or paid differently
than it was billed?
Claim adjustment reason codes
.
A billing and coding specialist is reviewing a claim edit report and identifies a rejection for missing
patient demographic information. Which of the following missing pieces of patient demographic
information would cause a rejection from the clearinghouse?
DOB
A billing and coding specialist is reviewing paperwork that indicates overpayment by Medicare for six
patients over the past year. Which of the following describes this process ?
Audit
Which of the following describes an insurance company that offers plans that pay health care
providers who render services to patients?
Third party payer
Which of the following sections of the CPT® manual lists the code for WBC with differential,
automated?
Pathology and laboratory
A billing and coding specialist is reviewing provider notes to complete a claim. They need clarification
on whether the procedure performed was on the left side, right side, or bilaterally. The specialist
queries the provider and the provider confirms it was a bilateral procedure. Which of the following
modifiers should be billed?
50
A provider orders a comprehensive metabolic panel for a 70-year-old patient who has Medicare as
their primary insurance. Which of the following is required to inform the patient they may be
responsible for payment?
Advanced beneficiary notice
A billing and coding specialist is appealing a Medicare denial. Which of the following is the first step in
the appeals process?
Redetermination
Which of the following are used to code provider and outpatient services?
CPT codes
Which of the following is a covered entity affected by HIPAA security rules?
Health care clearinghouses
, Which of the following actions by a billing and coding specialist is an example of fraud ?
Billing for services not provided to obtain higher reimbursement
Which of the following should be included on a claim form that is sent from a specialist to a managed
health care organization?
The referring providers NPI
Which of the following is a document used to analyze accounts receivable based on dates of service?
Aging report
A provider accepts assignment for a patient who has a $10 copayment and has already met 100 of
their $150 deductible. The office charge is $100 and the allowed amount is 70. How much should the
provider's office adjust off the patient's account?
$30
A patient has a new diagnosis of hypothyroidism. In which of the following body systems is the
thyroid gland located?
Endocrine system
A patient's portion of the bill should be discussed with the patient before a procedure is performed
for which of the following reasons?
To ensure the patient understands his portion of the bill
Which of the following introduced documentation guidelines to Medicare carriers to ensure that
services paid for have been provided and were medically necessary?
CMS
A billing and coding specialist is reviewing a remittance advice for a claim that was denied for medical
necessity. which of the following is an example of this type of error?
The ICD-10-CM code for tonsillitis was listed with the CPT code for an appendectomy
Which of the following physical status modifiers should a billing and coding specialist use for
anesthesia services performed on a healthy 4-year old patient ?
-P1
Claims that are submitted without an NPI number will delay payment to the provider due to which of
the following?
The number is needed to identify the provider
A billing and coding specialist is posting a payment received from Medicare. The specialist should
identify that which part of Medicare covers prescrition costs?
Part D
