CBCS Practice Exam #3
A billing and coding specialist can ensure appropriate insurance coverage for an outpatient
procedure by first using which of the following processes? - ANS-Precertification
\A billing and coding specialist has four past-due charges: $400 that is 10 weeks past due;
$800 that is 6 weeks past due; $1,000 that is 4 weeks past due; and $2,000 that is 8 weeks
past due. Which of the following charges should be sent to collections first? - ANS-$2,000
\A billing and coding specialist is preparing a claim form for a provider from a group practice.
The billing and coding specialist should enter the rendering provider's national provider
identifier (NPI) into which of the following blocks on the CMS-1500 form? - ANS-Block 24J
\A billing and coding specialist should routinely analyze which of the following to determine
the number of outstanding claims? - ANS-Aging report
\A billing and coding specialist submitted a claim to Medicare electronically. No errors were
found by the billing software or clearinghouse. Which of the following describes this claim? -
ANS-Clean claim
\A claim is denied due to termination of coverage. Which of the following actions should the
billing and coding specialist take next? - ANS-Follow up with the patient to determine current
primary care provider for resubmission
\A husband and wife have group insurance through their employers. The wife has an
appointment with her provider. Which insurance should be used as primary for the
appointment? - ANS-The wife's insurance
\A Medicare non-participating (non-PAR) provider's approval payment amount is for $200 for
a lobectomy and the deductible has not been met. Which of the following amounts is the
limiting charge for this procedure? - ANS-$230
\A patient has AARP as secondary insurance. In which of the following blocks on the
CMS-1500 claim form should this information be entered? - ANS-Block 9
\A patient has laboratory work done in the emergency department after an inhalation of toxic
fumes from a faulty exhaust fan at her place of employment. Which of the following is
responsible for the charges? - ANS-Workers' Compensation
\A patient is preauthorized to receive Vitamin B12 injections from January 1 to May 31. On
June 2, the provider orders an additional 6 months of injections. In order for the patient to
continue with coverage of care, which of the following should occur? - ANS-The provider
should contact the patient's insurance carrier to obtain new authorization
\A patient who has a primary malignant neoplasm of the lung should be referred to which of
the following specialist? - ANS-Pulmonary oncologist
\A patient who has an HMO insurance plan needs to see a specialist for a specific problem.
From which of the following should the patient obtain a referral? - ANS-Primary care provider
\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 HIPPA violation? - ANS-The billing and coding
specialist sends the patient's records to the patient's partner
\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? - ANS-Denied
, \A physician's office fee is $100 and the Medicare Part B allowed amount is $85. Assuming
the beneficiary has not met his annual deductible, the office should bill the patient for which
of the following amounts? - ANS-$85
\A provider performs an examination of a patient's knee joint via small incisions and an
optical device. - ANS-Arthroscopy
\A provider surgically punctures through the space between the patient's ribs using an
aspirating needle to withdraw fluid from the chest cavity. Which of the following is the name
of this procedure? - ANS-Pleurocentesis
\A provider's office receives a subpoena requesting medical documentation form a patient's
medical record. After confirming the correct authorization, which of the following actions
should the billing and coding specialist take? - ANS-Send the medical information pertaining
to the dates of service requested
\As of April 1, 2014 what is the maximum number of diagnoses that can be reported on the
CMS-1500 claim form before a further claim is required? - ANS-12
\For non-crossover claims, the billing and coding specialist should prepare an additional
claim for the secondary payer and send it with a copy of which of the following? -
ANS-Remittance advice
\If both parents have coverage for a dependent child, which of the following is considered to
be the primary insurance holder? - ANS-The parent whose birthday comes first in the
calendar year is the primary insurance holder
\In 1996, CMS implemented which of the following to detect inappropriate and improper
codes? - ANS-National Correct Code Initiative (NCCI)
\In the anesthesia section of the CPT manual, which of the following are considered
qualifying circumstances? - ANS-Add-on codes
\On a CMS-1500 claim form , which of the following information should should the billing and
coding specialist enter in Block 32? - ANS-Service facility location information
\On a remittance advice form , which of the following is responsible for writing off the
difference between the amount billed an the amount allowed by the agreement? -
ANS-Provider
\On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the
following? - ANS-The patient's condition and the provider's information
\The "><" is used to indicate new and revised text other than which of the following? -
ANS-Procedure descriptors
\The authorization number for a service that was approved before the service was rendered
is indicated in which of the following blocks on the CMS-1500 form? - ANS-Block 23
\The billing and coding specialist should follow the guidelines in the CPT manual for which of
the following reasons? - ANS-The guidelines define items that are necessary to accurately
code
\The explanation of benefits states the amount billed was $170. However, the allowed
amount is $150. The patient has an unmet deductible of $50 and a copayment of $20. Which
of the following amounts is the patient's responsibility? - ANS-$70
\The explanation of benefits states the amount billed was $80. The allowed amount is $60,
and the patient is required to pay a $20 copayment. Which of the following describes the
insurance check amount to be posted? - ANS-$40
\The unlisted codes can be found in which of the following locations in the CPT manual? -
ANS-Guidelines prior to each section
\Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries
describes which of the following procedures? - ANS-Angioplasty
A billing and coding specialist can ensure appropriate insurance coverage for an outpatient
procedure by first using which of the following processes? - ANS-Precertification
\A billing and coding specialist has four past-due charges: $400 that is 10 weeks past due;
$800 that is 6 weeks past due; $1,000 that is 4 weeks past due; and $2,000 that is 8 weeks
past due. Which of the following charges should be sent to collections first? - ANS-$2,000
\A billing and coding specialist is preparing a claim form for a provider from a group practice.
The billing and coding specialist should enter the rendering provider's national provider
identifier (NPI) into which of the following blocks on the CMS-1500 form? - ANS-Block 24J
\A billing and coding specialist should routinely analyze which of the following to determine
the number of outstanding claims? - ANS-Aging report
\A billing and coding specialist submitted a claim to Medicare electronically. No errors were
found by the billing software or clearinghouse. Which of the following describes this claim? -
ANS-Clean claim
\A claim is denied due to termination of coverage. Which of the following actions should the
billing and coding specialist take next? - ANS-Follow up with the patient to determine current
primary care provider for resubmission
\A husband and wife have group insurance through their employers. The wife has an
appointment with her provider. Which insurance should be used as primary for the
appointment? - ANS-The wife's insurance
\A Medicare non-participating (non-PAR) provider's approval payment amount is for $200 for
a lobectomy and the deductible has not been met. Which of the following amounts is the
limiting charge for this procedure? - ANS-$230
\A patient has AARP as secondary insurance. In which of the following blocks on the
CMS-1500 claim form should this information be entered? - ANS-Block 9
\A patient has laboratory work done in the emergency department after an inhalation of toxic
fumes from a faulty exhaust fan at her place of employment. Which of the following is
responsible for the charges? - ANS-Workers' Compensation
\A patient is preauthorized to receive Vitamin B12 injections from January 1 to May 31. On
June 2, the provider orders an additional 6 months of injections. In order for the patient to
continue with coverage of care, which of the following should occur? - ANS-The provider
should contact the patient's insurance carrier to obtain new authorization
\A patient who has a primary malignant neoplasm of the lung should be referred to which of
the following specialist? - ANS-Pulmonary oncologist
\A patient who has an HMO insurance plan needs to see a specialist for a specific problem.
From which of the following should the patient obtain a referral? - ANS-Primary care provider
\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 HIPPA violation? - ANS-The billing and coding
specialist sends the patient's records to the patient's partner
\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? - ANS-Denied
, \A physician's office fee is $100 and the Medicare Part B allowed amount is $85. Assuming
the beneficiary has not met his annual deductible, the office should bill the patient for which
of the following amounts? - ANS-$85
\A provider performs an examination of a patient's knee joint via small incisions and an
optical device. - ANS-Arthroscopy
\A provider surgically punctures through the space between the patient's ribs using an
aspirating needle to withdraw fluid from the chest cavity. Which of the following is the name
of this procedure? - ANS-Pleurocentesis
\A provider's office receives a subpoena requesting medical documentation form a patient's
medical record. After confirming the correct authorization, which of the following actions
should the billing and coding specialist take? - ANS-Send the medical information pertaining
to the dates of service requested
\As of April 1, 2014 what is the maximum number of diagnoses that can be reported on the
CMS-1500 claim form before a further claim is required? - ANS-12
\For non-crossover claims, the billing and coding specialist should prepare an additional
claim for the secondary payer and send it with a copy of which of the following? -
ANS-Remittance advice
\If both parents have coverage for a dependent child, which of the following is considered to
be the primary insurance holder? - ANS-The parent whose birthday comes first in the
calendar year is the primary insurance holder
\In 1996, CMS implemented which of the following to detect inappropriate and improper
codes? - ANS-National Correct Code Initiative (NCCI)
\In the anesthesia section of the CPT manual, which of the following are considered
qualifying circumstances? - ANS-Add-on codes
\On a CMS-1500 claim form , which of the following information should should the billing and
coding specialist enter in Block 32? - ANS-Service facility location information
\On a remittance advice form , which of the following is responsible for writing off the
difference between the amount billed an the amount allowed by the agreement? -
ANS-Provider
\On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the
following? - ANS-The patient's condition and the provider's information
\The "><" is used to indicate new and revised text other than which of the following? -
ANS-Procedure descriptors
\The authorization number for a service that was approved before the service was rendered
is indicated in which of the following blocks on the CMS-1500 form? - ANS-Block 23
\The billing and coding specialist should follow the guidelines in the CPT manual for which of
the following reasons? - ANS-The guidelines define items that are necessary to accurately
code
\The explanation of benefits states the amount billed was $170. However, the allowed
amount is $150. The patient has an unmet deductible of $50 and a copayment of $20. Which
of the following amounts is the patient's responsibility? - ANS-$70
\The explanation of benefits states the amount billed was $80. The allowed amount is $60,
and the patient is required to pay a $20 copayment. Which of the following describes the
insurance check amount to be posted? - ANS-$40
\The unlisted codes can be found in which of the following locations in the CPT manual? -
ANS-Guidelines prior to each section
\Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries
describes which of the following procedures? - ANS-Angioplasty
