NHA Medical Coding and billing exam
(RAC) Recovery audit Contractor - ANS-Which of the following organizations identifies
improper payments made on CMS claims
\(S) Subjective - ANS-Soap note to indicate patient level of pain to provider
\0% - ANS-Beneficiary of Medicaid/ Medicare crossover claim is responsible for the
percentage
\18% - ANS-Coding a front torso burn, what % should be used?
\2 Pieces of Information that need to be collected from patients - ANS-Patients name and
date of birth
\2 reasons a claim may be denied - ANS-Invalid subscriber name was given or coding error
was made
\3rd Party Payer - ANS-Insurance Carrier is a
\837 - ANS-Format used to submit electronic claims and 3rd Party payer
\A bilateral procedure - ANS-A billing and coding specialists should add modifier -50 when
reporting which procedure
\A billing worksheet from the patient account - ANS-A prospective billing account audit
prevents fraud by reviewing & comparing a completed claim for with which of the following
documents
\A patient's signature authorizing the release of any medical information necessary to
process the claim. - ANS-Block 12
\A Providers office with fewer than 10 full-time employees - ANS-Medicare enforces
mandatory submission of electronic claims for most providers. Which of the providers is
allowed to submit paper claims to Medicare?
\Abuse - ANS-Practices that directly or indirectly result in unnecessary cost to the Medicare
program
\Accounts recievable - ANS-Patient charges that have not been paid will appear in which of
the following
\Add on Codes - ANS-Anesthesia section of CPT manual which are considered qualifying
circumstances
\adjudication - ANS-Which of the following is considered the final determination of the issues
involving settlement of an insurance claim
\Advance Beneficiary Notice (ABN) - ANS-Advanced beneficiary notice, or ABN is a form
that is required for Medicare recipients.
\An italicized code used as the 1st listed diagnosis - ANS-Result of a claim being denied
\APC Grouper - ANS-Determine the appropriate ambulatory payment classification for
outpatient encounter
\Assignment of Benefits - ANS-Contract in which the provider directly bills the payer and
accepts the allowable charge.
\Auditing - ANS-Review of claims for accuracy and completeness
\Authorization - ANS-Permission granted by the patient or the patients representative to
release information for reasons other than treatment, payment, or health care operations
\Billing provider NPI number is on what block on the CMS 1500 form? - ANS-Block 33a
\Billing using 2- digit CPT Modifiers to indicate a procedure as preformed differs from its
usual 5 digit code - ANS-Which of the following is allowed when billing procedural codes
, \Birthday Rule - ANS-Parent whose birthday comes 1st in the calendar year is considered
primary
\Block 23 - ANS-A billing and coding specialists should enter the prior the authorization
number on the following blocks.
\Bone and bone marrow - ANS-IF a patient has osteomyelitis he has problems with which of
the following areas?
\Charge Description Master (CDM) - ANS-Information about health care services that
patients have received and financial transactions that have taken place.
\Charging excessive fees - ANS-Example of Medicare abuse
\Claim adjudication:( The term used in the industry to refer to the process of paying claims
submitted on denying them after comparing claims to the benefit or coverage requirements) -
ANS-3rd Party payer validates a claim which takes place next
\Claims submitted via a secure network - ANS-Which of the following is an example of
electronic claim submission
\Clean claim - ANS-Claim that is accurate and complete
\Clearinghouse - ANS-Agency, that converts claims into standardized electronic format,
looks for errors, and formats them according to HIPPA and insurance standards
\Code set standards pertain to all providers - ANS-HIPPA compliance guideline affecting
EHR
\Codes must correspond to the diagnosis pointer in block 24E - ANS-Diagnostic codes in
Block 21 of the CMS form
\Coding Compliance Plan - ANS-Which of the following includes procedures and best
practices for correct coding
\Coinsurance - ANS-Pre established percentage of expenses paid by the insurance
company after the deductible has been met
\Conditional Payment - ANS-Medicare payment that is recovered after primary insurance
pays.
\Consent - ANS-A patients permission evidenced by signature
\Contractual allowance- difference between what hospitals bill and what they receive in
payment from 3rd Party Payers - ANS-Remark code from a EOB document-(EOB)-
statement sent by a health insurance company covered individual explaining what medical
treatments and/ or services were paid for on their behalf
\Coordination of Benefit rules - ANS-Determines which insurance plan is primary and which
is secondary
\Coordination of benefits rule - ANS-Determines which insurance plan is primary and which
is secondary insurance .
\Copayment - ANS-A fixed dollar amount that must be paid each time a patient visits a
provider.
\Cost sharing - ANS-The balance the policyholder must pay to the provider.
\CPT Category 1 Codes - ANS-Primarily cover physicians services but are used for hospital
outpatient. Modifiers are used
\CPT Category II Codes - ANS-Designed to serve as supplemental tracking codes that can
be used for performance measurement. Modifiers are used
\CPT Category III - ANS-Temporary coding for new technology and services that have not
met the requirements needed
\Crossover claim - ANS-Claim submitted by people covered by primary and secondary
insurance plan
\Date of current injury, illness, or LMP - ANS-Block 14
(RAC) Recovery audit Contractor - ANS-Which of the following organizations identifies
improper payments made on CMS claims
\(S) Subjective - ANS-Soap note to indicate patient level of pain to provider
\0% - ANS-Beneficiary of Medicaid/ Medicare crossover claim is responsible for the
percentage
\18% - ANS-Coding a front torso burn, what % should be used?
\2 Pieces of Information that need to be collected from patients - ANS-Patients name and
date of birth
\2 reasons a claim may be denied - ANS-Invalid subscriber name was given or coding error
was made
\3rd Party Payer - ANS-Insurance Carrier is a
\837 - ANS-Format used to submit electronic claims and 3rd Party payer
\A bilateral procedure - ANS-A billing and coding specialists should add modifier -50 when
reporting which procedure
\A billing worksheet from the patient account - ANS-A prospective billing account audit
prevents fraud by reviewing & comparing a completed claim for with which of the following
documents
\A patient's signature authorizing the release of any medical information necessary to
process the claim. - ANS-Block 12
\A Providers office with fewer than 10 full-time employees - ANS-Medicare enforces
mandatory submission of electronic claims for most providers. Which of the providers is
allowed to submit paper claims to Medicare?
\Abuse - ANS-Practices that directly or indirectly result in unnecessary cost to the Medicare
program
\Accounts recievable - ANS-Patient charges that have not been paid will appear in which of
the following
\Add on Codes - ANS-Anesthesia section of CPT manual which are considered qualifying
circumstances
\adjudication - ANS-Which of the following is considered the final determination of the issues
involving settlement of an insurance claim
\Advance Beneficiary Notice (ABN) - ANS-Advanced beneficiary notice, or ABN is a form
that is required for Medicare recipients.
\An italicized code used as the 1st listed diagnosis - ANS-Result of a claim being denied
\APC Grouper - ANS-Determine the appropriate ambulatory payment classification for
outpatient encounter
\Assignment of Benefits - ANS-Contract in which the provider directly bills the payer and
accepts the allowable charge.
\Auditing - ANS-Review of claims for accuracy and completeness
\Authorization - ANS-Permission granted by the patient or the patients representative to
release information for reasons other than treatment, payment, or health care operations
\Billing provider NPI number is on what block on the CMS 1500 form? - ANS-Block 33a
\Billing using 2- digit CPT Modifiers to indicate a procedure as preformed differs from its
usual 5 digit code - ANS-Which of the following is allowed when billing procedural codes
, \Birthday Rule - ANS-Parent whose birthday comes 1st in the calendar year is considered
primary
\Block 23 - ANS-A billing and coding specialists should enter the prior the authorization
number on the following blocks.
\Bone and bone marrow - ANS-IF a patient has osteomyelitis he has problems with which of
the following areas?
\Charge Description Master (CDM) - ANS-Information about health care services that
patients have received and financial transactions that have taken place.
\Charging excessive fees - ANS-Example of Medicare abuse
\Claim adjudication:( The term used in the industry to refer to the process of paying claims
submitted on denying them after comparing claims to the benefit or coverage requirements) -
ANS-3rd Party payer validates a claim which takes place next
\Claims submitted via a secure network - ANS-Which of the following is an example of
electronic claim submission
\Clean claim - ANS-Claim that is accurate and complete
\Clearinghouse - ANS-Agency, that converts claims into standardized electronic format,
looks for errors, and formats them according to HIPPA and insurance standards
\Code set standards pertain to all providers - ANS-HIPPA compliance guideline affecting
EHR
\Codes must correspond to the diagnosis pointer in block 24E - ANS-Diagnostic codes in
Block 21 of the CMS form
\Coding Compliance Plan - ANS-Which of the following includes procedures and best
practices for correct coding
\Coinsurance - ANS-Pre established percentage of expenses paid by the insurance
company after the deductible has been met
\Conditional Payment - ANS-Medicare payment that is recovered after primary insurance
pays.
\Consent - ANS-A patients permission evidenced by signature
\Contractual allowance- difference between what hospitals bill and what they receive in
payment from 3rd Party Payers - ANS-Remark code from a EOB document-(EOB)-
statement sent by a health insurance company covered individual explaining what medical
treatments and/ or services were paid for on their behalf
\Coordination of Benefit rules - ANS-Determines which insurance plan is primary and which
is secondary
\Coordination of benefits rule - ANS-Determines which insurance plan is primary and which
is secondary insurance .
\Copayment - ANS-A fixed dollar amount that must be paid each time a patient visits a
provider.
\Cost sharing - ANS-The balance the policyholder must pay to the provider.
\CPT Category 1 Codes - ANS-Primarily cover physicians services but are used for hospital
outpatient. Modifiers are used
\CPT Category II Codes - ANS-Designed to serve as supplemental tracking codes that can
be used for performance measurement. Modifiers are used
\CPT Category III - ANS-Temporary coding for new technology and services that have not
met the requirements needed
\Crossover claim - ANS-Claim submitted by people covered by primary and secondary
insurance plan
\Date of current injury, illness, or LMP - ANS-Block 14
