REVIEW EXAM
◉ A provider charged $500 to a claim that had an allowable amount
of $400. In which of the following columns should the CBCS apply
the non allowed charge?
-Reference column (For notations)
-Description column
-Payment column
-Adjustment column of the credits. Answer: Adjustment column of
the credits
◉ Which of the following statements is correct regarding a
deductible?
-Coinsurance is a type of deductible
-The physician should write off the deductible
-The insurance company pays for the deductible
-The deductible is the patient's responsibility. Answer: The
deductible is the patient's responsibility
◉ Which of the following color formats allows optical scanning of
the CMS-1500 claim form?
-Red
,-Blue
-Green
-black. Answer: red
◉ Ambulatory surgery centers, home health and hospice
organizations use the ______.
-CMS-1500 claim form
-UB-04 claim form
-Advance Beneficiary notice
-First report of injury form. Answer: UB-04
◉ Claims that are submitted without an NPI number will delay
payment to the provider because ______.
-The number is the patient' id number
-The number is needed to identify the provider
-Is is used as a claim number
-It is used as a pre authorization number. Answer: The number is
needed to identify the provider
◉ Which of the following terms describes when a plan pays 70% of
the allowed amount and the patient pays 30%?
-Coinsurance
-Deductible
,-Premium
-copayment. Answer: coinsurance
◉ Which of the following indicates a claim should be submitted on
paper instead of electronically?
-The software claims review process indicates the claim is not
complete
-The claim needs authorization
-The claim requires an attachment
-The practice management software is non functional.. Answer: the
claim requires an attachment
◉ On a remittance advice form, which of the following is responsible
for writing off the difference between the amount billed and the
amount allowed by the agreement?
-Provider
-Insurance company
-Patient
-Third party payer. Answer: provider
◉ A physician is contracted with an insurance company to accept
the amount. The insurance company allows $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
-$15
-$0
-$50. Answer: $40
◉ The unlisted codes can be found in which of the following
locations in the CPT manual?
-Appendix L
-Guidelines prior to each section
-End of each body system
-Table of contents. Answer: Guidelines prior to each section
◉ Which of the following blocks should the billing and coding
specialist complete the CMS 1500 claims form for procedure,
services or supplies?
-Block 12
-Block 2
-Block 24D
-Block 24J. Answer: Block 24D
-Block 12 (patient's authorization block
-Block 2 ( patient's name)
-Block 24J ( for the rendering provider)