NHA Practice Test Billing and Coding
-ptosis - ANS-drooping
\"><" - ANS-Revised
\270 - ANS-center for Medicare and Medicaid
\835 - ANS-health care payment and remittance advice
\A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider
is responsible for which of the following percentages? - ANS-0
\A biller will electronically submit a claim to the carrier via which of the following? -
ANS-Direct Data entry
\A billing and coding specialist is reviewing a CMS-1500 claim form. The "Assignment of
benefits box" is checked yes. The checked box indicates which of the following? - ANS-the
provider receives payment directly from the payer.
\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? -
ANS-Remittance advice
\A billing and coding specialist should add modifier -50 to codes when reporting which of the
following? - ANS-a bilateral procedure
\a billing and coding specialist should understand that the financial record source that is
generated by a provider's office is called a? - ANS-patient ledger account
\a claim is submitted with a transposed insurance member ID number and returned to the
provider. Which of the following describes that status that should be assigned to the claim by
the carrier? - ANS-invalid
\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? -
ANS-Fraud
\A lighting Bolt - ANS-pending FDA approval
\A Medicare non-participating (non-par) provider approved payment amount is $200 for a
labectomy and the deductible has been met. Which of the following amount is the limiting
charge for this procedure? - ANS-$230 %15 over
\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 demographics and
insurance information, and documenting the chief complaint? - ANS-admitting clerk
\A physician ordered a comprehensive metabolic panel of 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? - ANS-Advance Beneficiary Notice
\A prospective billing account audit prevents fraud by reviewing and comparing a completed
claim form with which of the following documents? - ANS-a billing worksheet from the patient
account
\ablation - ANS-radio frequency
\Accepting assignment on the CMS-1500 claim form indicates which of the following? -
ANS-the physician agrees to accept payment under the terms of the payers program.
\According to HIPAA standards, which of the following identifies the rendering provider on
the CMS-1500 claim form in Block 24j. - ANS-NPI
, \After a third-party payer validates a claim, which of the following takes place next? -
ANS-claim adjudication
\Assessment - ANS-provider diagnoses for patient
\behavior disorders - ANS-F codes
\Bullet - ANS-new code
\Bulls Eye - ANS-moderate sedation
\Chapter 1 - ANS-the site
\chapter 2 - ANS-the body system
\chapter 3 - ANS-the root operation
\chapter 4 - ANS-the body part
\claims adjudication - ANS-is third stage of in the life cycle of a claim
\claims payment - ANS-fourth stage of a claim life cycle
\claims processing - ANS-second stage of the life cycle of a claim
\claims submission - ANS-first stage of the life cycle of a claim
\coordination of benefits - ANS-a group health insurance provision that specifies how the
insurers will share the cost when more than one policy covers a claim, Do not exceed 100%
of allowable medical expenses
\Coordination of Benefits (COB) - ANS-exchange of information between payers when a
patient has more than one health plan.
\Coronal - ANS-anterior and posterior
\Crossover - ANS-when an insurance company transfers data to allow coordination of
benefits of a claim. (Medicare uses the term to describe payers electronically data.)
\digestive diseases - ANS-K code
\dilation - ANS-widening, stretching, expanding
\distal - ANS-farther away from the origin
\durable medical equipment - ANS-HMO managed care services requires a referral
\ECT (electroconvulsive therapy) - ANS-used to treat severe depression
\EEG electroencephalography - ANS-An amplified recording of the waves of electrical
activity that sweep across the brain's surface. These waves are measured by electrodes
placed on the scalp.
\EGD (esophagogastroduodenoscopy) - ANS-An upper GI endoscopy that investigates the
esophagus, stomach and duodenum for abnormalities like bleeding ulcers.
\Emesis - ANS-vomiting
\EMG (electromyography) - ANS-evaluating and recording the electrical activity produced by
skeletal muscles.
\encounter form - ANS-is used for billing/ DOS, CPT codes, ICD codes, fees and copayment
information
\endocardium - ANS-inside layer of the heart
\endocrine system - ANS-hormones that regulate the growth, metabolism, and general body
function
\epicardium - ANS-top layer of the heart
\Exempt from the use of modifier 51 - ANS-Circle with a line going through it
\FEE SCHUDULE - ANS-list of the provider service fees
\HCPCS Level 1 - ANS-codes consist of the AMA's CPT codes and is numeric.
\HCPCS Level II - ANS-to report services, supplies and procedures not represented in CPT
\If a patient has osteomyelitis, he has problems with which of the following? - ANS-bone and
bone marrow
-ptosis - ANS-drooping
\"><" - ANS-Revised
\270 - ANS-center for Medicare and Medicaid
\835 - ANS-health care payment and remittance advice
\A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider
is responsible for which of the following percentages? - ANS-0
\A biller will electronically submit a claim to the carrier via which of the following? -
ANS-Direct Data entry
\A billing and coding specialist is reviewing a CMS-1500 claim form. The "Assignment of
benefits box" is checked yes. The checked box indicates which of the following? - ANS-the
provider receives payment directly from the payer.
\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? -
ANS-Remittance advice
\A billing and coding specialist should add modifier -50 to codes when reporting which of the
following? - ANS-a bilateral procedure
\a billing and coding specialist should understand that the financial record source that is
generated by a provider's office is called a? - ANS-patient ledger account
\a claim is submitted with a transposed insurance member ID number and returned to the
provider. Which of the following describes that status that should be assigned to the claim by
the carrier? - ANS-invalid
\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? -
ANS-Fraud
\A lighting Bolt - ANS-pending FDA approval
\A Medicare non-participating (non-par) provider approved payment amount is $200 for a
labectomy and the deductible has been met. Which of the following amount is the limiting
charge for this procedure? - ANS-$230 %15 over
\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 demographics and
insurance information, and documenting the chief complaint? - ANS-admitting clerk
\A physician ordered a comprehensive metabolic panel of 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? - ANS-Advance Beneficiary Notice
\A prospective billing account audit prevents fraud by reviewing and comparing a completed
claim form with which of the following documents? - ANS-a billing worksheet from the patient
account
\ablation - ANS-radio frequency
\Accepting assignment on the CMS-1500 claim form indicates which of the following? -
ANS-the physician agrees to accept payment under the terms of the payers program.
\According to HIPAA standards, which of the following identifies the rendering provider on
the CMS-1500 claim form in Block 24j. - ANS-NPI
, \After a third-party payer validates a claim, which of the following takes place next? -
ANS-claim adjudication
\Assessment - ANS-provider diagnoses for patient
\behavior disorders - ANS-F codes
\Bullet - ANS-new code
\Bulls Eye - ANS-moderate sedation
\Chapter 1 - ANS-the site
\chapter 2 - ANS-the body system
\chapter 3 - ANS-the root operation
\chapter 4 - ANS-the body part
\claims adjudication - ANS-is third stage of in the life cycle of a claim
\claims payment - ANS-fourth stage of a claim life cycle
\claims processing - ANS-second stage of the life cycle of a claim
\claims submission - ANS-first stage of the life cycle of a claim
\coordination of benefits - ANS-a group health insurance provision that specifies how the
insurers will share the cost when more than one policy covers a claim, Do not exceed 100%
of allowable medical expenses
\Coordination of Benefits (COB) - ANS-exchange of information between payers when a
patient has more than one health plan.
\Coronal - ANS-anterior and posterior
\Crossover - ANS-when an insurance company transfers data to allow coordination of
benefits of a claim. (Medicare uses the term to describe payers electronically data.)
\digestive diseases - ANS-K code
\dilation - ANS-widening, stretching, expanding
\distal - ANS-farther away from the origin
\durable medical equipment - ANS-HMO managed care services requires a referral
\ECT (electroconvulsive therapy) - ANS-used to treat severe depression
\EEG electroencephalography - ANS-An amplified recording of the waves of electrical
activity that sweep across the brain's surface. These waves are measured by electrodes
placed on the scalp.
\EGD (esophagogastroduodenoscopy) - ANS-An upper GI endoscopy that investigates the
esophagus, stomach and duodenum for abnormalities like bleeding ulcers.
\Emesis - ANS-vomiting
\EMG (electromyography) - ANS-evaluating and recording the electrical activity produced by
skeletal muscles.
\encounter form - ANS-is used for billing/ DOS, CPT codes, ICD codes, fees and copayment
information
\endocardium - ANS-inside layer of the heart
\endocrine system - ANS-hormones that regulate the growth, metabolism, and general body
function
\epicardium - ANS-top layer of the heart
\Exempt from the use of modifier 51 - ANS-Circle with a line going through it
\FEE SCHUDULE - ANS-list of the provider service fees
\HCPCS Level 1 - ANS-codes consist of the AMA's CPT codes and is numeric.
\HCPCS Level II - ANS-to report services, supplies and procedures not represented in CPT
\If a patient has osteomyelitis, he has problems with which of the following? - ANS-bone and
bone marrow
