1. A./billing./and./coding./specialist./discovers./that./one./private./payer./has./not./reim
bursed./the./provider./for./any./claims./submitted./in./the./past./year../Clean./claims./ha
ve./been./submitted./to./the./payer./and./have./been./acknowledged../Which. / of./the./foll
owing./entities./should./the./specialist./contact./to./report./the./payer's./failure./to./su
bmit./timely./reimbursement?
- Department. / of. / Health. / and. / Human. / Services
- Bureau. / of. / Health. / Workforce
- State./ Insurnace. / Comissioner's./ Office
- Federal./ Insurance./ Office:./ State./Insurnace./Comissioner's./Oflce
2. Which./of./the./following./is./a./ICD-10-CM./category./code?
- A./3-character./code
- A./5-character./code
- A./7-character./code
- A. / 6-character. / code:. / A./3-character./code
3. CPT. / Evaluation. / and. / Management. / codes. / are. / used. / for. / which. / of. / the. / following?
- Physical. / therapy. / modalities
- Outpatient. / hemodialysis
- Medical./nutrition./therapy
- Critical./care./services:./Critical./care./services
4. Which. / of. / the. / following. / is. / an. / advantage. / of. / electronic. / claim. / submission?
- Claims. / are. / expedited
- Claims. / are. / scrubbed
- Claims. / are. / clean
- Claims./are./paid:./Claims./are./expedited
5. When. / should. / a. / billing. / and. / coding. / specialist. / initiate. / the. / collection. / of. / t
he./information./needed./to./process./a./patient's./insurance./claim./form?
- when. / the. / patient. / signs. / the. / HIPPA. / form. / at. / check. / in
- when. / the. / patient. / contacts. / the. / providers. / office. / and. / schedules. / an. / app
oint-ment
- when. / the. / patient. / pays. / the. / copay. / or. / deductible
- when./the./patient./checks./out./of./the./provider's./office:./when./the./patient./contacts./the./
providers./oflce./and./schedules./an./appointment
,6. A./ billing. / and./ coding. / specialist. / is. / reviewing. / a./ modifier. / use. / with. / a. / new./ employ-
ee.. / Which. / of. / the. / following. / scenarios. / warrants. / the. / use. / of. / a. / modifier?
- fracture. / of. / the. / left. / femur
- splinting. / of. / the. / fourth. / digit. / on. / the. / left. / foot
- recurrent. / inguinal. / hernia
- insertion./of./a./drug./delivery./implant:./splinting./of./the./fourth./digit./on./the./left./foot
7. Which. / of. / the. / following. / is. / a. / correct. / rule. / when. / using. / CPT. / add. / on. / codes?
- they. / are. / automatically. / reduced. / in. / value
- they. / should. / be. / sequenced. / first
- they. / are. / used. / for. / unspecified. / codes
- they./are./exempt./from./the./multiple./procedure./concept:./they./are./exempt./from./the./multiple./
procedure./concept
8. Which. / of. / the. / following. / terms. / describe. / the. / removal. / of. / the. / eye,. / adnexa,. / a
nd./bony./structure?
- Evisceration
- Enucleation
- Exenteration
-Exploration:. / Exenteration
9. A. / billing. / and. / coding. / specialist. / is. / reviewing. / delinquent. / claims. / and. / discover
s. / that./a./third-
party./payer./paid./a./claim./but./applied./it./to./the./incorrect./provider../The. / third-
party. / payer. / will. / reimburse. / the. / payment. / once. / the. / improperly. / funds. / are./reco
uped../Which./of./the./following./terms./is./used./to./described./this./claim?
- Payment./ error
- Rejected
- Denied
- Suspended:. / Suspended
10. For. / which. / reason. / should. / a. / claim. / be. / resubmitted?
- the. / software. / claims. / review. / process. / indicates. / the. / claim. / is. / not. / completed
- the. / claim. / needs. / authorization
- the. / claim. / requires. / an. / attachment. / to. / support. / medical. / necessity
- the./ claim./ has./ been./ adjudicated:./ the./claim./requires./an./attachment./to./support./medical./necessity
,11. A. / billing. / and. / coding. / specialist. / is. / preparing. / an. / accounts. / receivable. / aging. / r
e-port./.The./specialist./should./expect./the./report/.to./include./which./of./the./following?
- rejected. / claims. / organizers. / by. / payer
- lost. / claims. / organizers. / by. / payer
- paid. / balances. / organized. / by. / date
- outstanding./balances./organized./by./date:./outstanding./balances./organized./by./date
12. Which. / of. / the. / following. / pieces. / of. / guarantor. / information. / is. / required. / whe
n. / establishing./a./patient's./financial./record?
- Procedural. / codes. / used
- provider./ name
- phone./number
- diagnosis:. / Phone./number
13. Which. / of. / the. / following. / actions. / by. / a. / billing. / and. / coding. / specialist. / ensures
. / a./patient's./health./is./protected?
- confirming. / test. / results. / with. / the. / patient. / over. / the. / phone. / at. / the. / reception. / area
- asking. / patients. / the. / reason. / for. / their. / visit. / during. / check-in
- using. / data. / encryption. / software. / on. / office. / workstations
- leaving. / the. / workstation. / unlocked. / while. / stepping. / away. / to. / assist. / anothe
r. / patient:./using./data./encryption./software./on./oflce./workstations
14. A./billing./and./coding./specialist./is./preparing./for./an./appeal./letter./in./response./t
o./a./denial./by./a./third./party./payer./for./lack./of./medical./necessity../Which./of
the. / following. / should. / the. / specialist. / include. / with. / the. / letter. / to. / indicate. / medical.
/necessity?
- patient. / employer. / information
- medical. / record. / documentation
- release. / of. / information. / authorization
- retrospective./review./request:./Medical./record./documentation
15. A./child./is./brought./into./the./facility./by./their./mother../The./child./is./covered./under./b
oth./parents'./insurance./policies../The./child's./father./was./born./on./10/1/1980./and./the
ir./mother./was./born./on./10/2/1981../Which./of./the./following./statements./is./true./regar
ding./the./primary./policy./holder./for./the./child?:./the./father./is./the./primary./holder./because./his./bir
thday./falls./first./in./the./calendar./year
, 16. A./billing./and./coding./specialist./is./processing./a./claim./for./patient./who./broke./t
heir. / arm. / while. / repairing. / cars. / at. / their. / workplace.. / There. / is. / no. / nerve. / damag
e,./the./arm./is./placed./in./a./cast./for./6./weeks../Which./of./the./following./types./of./worker
s'./compensation./applies./to./this./patient?
- temporary. / disability
- third-party. / subrogation
- permanent. / disability
- non./disability:./Temporary./disability
17. Which. / of. / the. / following. / information. / is. / required. / on. / a. / patient. / account. / record?
- name. / and. / address. / of. / guarantor
- procedures. / performed
- family./history./of./the./guarantor. /
Diagnosis:./name./and./address./of./guarantor
18. A. / billing. / and. / coding. / specialist. / is. / reviewing. / a. / delinquent. / claim.. / Which. / of. /
the./following./actions./should./the./specialist./take./first?
- verifying. / the. / age. / of. / the. / account
- query. / the. / provider
- obtain. / the. / claims. / status
- resubmit./the./claim:./Verify./the./age./of./the./account
19. A./patient./presents./to./a./provider's./office./with./difficulty./speaking,./facial./dro
oping,. / and. / inability. / to. / close. / their. / left. / eye.. / They. / are. / diagnosed. / with. / Bell's./
palsy../A./billing./and./coding./specialist./should./report./which./of./the./following./IC
D-10-CM./codes?
- R29.810. / (facial. / weakness),. / R47.81. / (slurred. / speech)
- G51.0./(./Bell's./Palsy)
- G51.0. / (Bell's. / Palsy),. / R29.810. / (facial. / weakness),. / R47.81. / (slurred. / speech)
- P11.3./(birth./injury./to./facial./nerve):./G51.0./(./Bell's./Palsy)
20. A./patient./has./a./breast./biopsy./with./placement./of./a./clip../After./the./biopsy./is./de
termined. / to. / be. / malignant,. / the. / patient. / elects. / for. / a. / mastectomy. / during. / the./
global./period./of./the./biopsy../Which./of./the./following./modifiers./should./a./billing./a
nd./coding./specialist./use./to./report./the./mastectomy?
bursed./the./provider./for./any./claims./submitted./in./the./past./year../Clean./claims./ha
ve./been./submitted./to./the./payer./and./have./been./acknowledged../Which. / of./the./foll
owing./entities./should./the./specialist./contact./to./report./the./payer's./failure./to./su
bmit./timely./reimbursement?
- Department. / of. / Health. / and. / Human. / Services
- Bureau. / of. / Health. / Workforce
- State./ Insurnace. / Comissioner's./ Office
- Federal./ Insurance./ Office:./ State./Insurnace./Comissioner's./Oflce
2. Which./of./the./following./is./a./ICD-10-CM./category./code?
- A./3-character./code
- A./5-character./code
- A./7-character./code
- A. / 6-character. / code:. / A./3-character./code
3. CPT. / Evaluation. / and. / Management. / codes. / are. / used. / for. / which. / of. / the. / following?
- Physical. / therapy. / modalities
- Outpatient. / hemodialysis
- Medical./nutrition./therapy
- Critical./care./services:./Critical./care./services
4. Which. / of. / the. / following. / is. / an. / advantage. / of. / electronic. / claim. / submission?
- Claims. / are. / expedited
- Claims. / are. / scrubbed
- Claims. / are. / clean
- Claims./are./paid:./Claims./are./expedited
5. When. / should. / a. / billing. / and. / coding. / specialist. / initiate. / the. / collection. / of. / t
he./information./needed./to./process./a./patient's./insurance./claim./form?
- when. / the. / patient. / signs. / the. / HIPPA. / form. / at. / check. / in
- when. / the. / patient. / contacts. / the. / providers. / office. / and. / schedules. / an. / app
oint-ment
- when. / the. / patient. / pays. / the. / copay. / or. / deductible
- when./the./patient./checks./out./of./the./provider's./office:./when./the./patient./contacts./the./
providers./oflce./and./schedules./an./appointment
,6. A./ billing. / and./ coding. / specialist. / is. / reviewing. / a./ modifier. / use. / with. / a. / new./ employ-
ee.. / Which. / of. / the. / following. / scenarios. / warrants. / the. / use. / of. / a. / modifier?
- fracture. / of. / the. / left. / femur
- splinting. / of. / the. / fourth. / digit. / on. / the. / left. / foot
- recurrent. / inguinal. / hernia
- insertion./of./a./drug./delivery./implant:./splinting./of./the./fourth./digit./on./the./left./foot
7. Which. / of. / the. / following. / is. / a. / correct. / rule. / when. / using. / CPT. / add. / on. / codes?
- they. / are. / automatically. / reduced. / in. / value
- they. / should. / be. / sequenced. / first
- they. / are. / used. / for. / unspecified. / codes
- they./are./exempt./from./the./multiple./procedure./concept:./they./are./exempt./from./the./multiple./
procedure./concept
8. Which. / of. / the. / following. / terms. / describe. / the. / removal. / of. / the. / eye,. / adnexa,. / a
nd./bony./structure?
- Evisceration
- Enucleation
- Exenteration
-Exploration:. / Exenteration
9. A. / billing. / and. / coding. / specialist. / is. / reviewing. / delinquent. / claims. / and. / discover
s. / that./a./third-
party./payer./paid./a./claim./but./applied./it./to./the./incorrect./provider../The. / third-
party. / payer. / will. / reimburse. / the. / payment. / once. / the. / improperly. / funds. / are./reco
uped../Which./of./the./following./terms./is./used./to./described./this./claim?
- Payment./ error
- Rejected
- Denied
- Suspended:. / Suspended
10. For. / which. / reason. / should. / a. / claim. / be. / resubmitted?
- the. / software. / claims. / review. / process. / indicates. / the. / claim. / is. / not. / completed
- the. / claim. / needs. / authorization
- the. / claim. / requires. / an. / attachment. / to. / support. / medical. / necessity
- the./ claim./ has./ been./ adjudicated:./ the./claim./requires./an./attachment./to./support./medical./necessity
,11. A. / billing. / and. / coding. / specialist. / is. / preparing. / an. / accounts. / receivable. / aging. / r
e-port./.The./specialist./should./expect./the./report/.to./include./which./of./the./following?
- rejected. / claims. / organizers. / by. / payer
- lost. / claims. / organizers. / by. / payer
- paid. / balances. / organized. / by. / date
- outstanding./balances./organized./by./date:./outstanding./balances./organized./by./date
12. Which. / of. / the. / following. / pieces. / of. / guarantor. / information. / is. / required. / whe
n. / establishing./a./patient's./financial./record?
- Procedural. / codes. / used
- provider./ name
- phone./number
- diagnosis:. / Phone./number
13. Which. / of. / the. / following. / actions. / by. / a. / billing. / and. / coding. / specialist. / ensures
. / a./patient's./health./is./protected?
- confirming. / test. / results. / with. / the. / patient. / over. / the. / phone. / at. / the. / reception. / area
- asking. / patients. / the. / reason. / for. / their. / visit. / during. / check-in
- using. / data. / encryption. / software. / on. / office. / workstations
- leaving. / the. / workstation. / unlocked. / while. / stepping. / away. / to. / assist. / anothe
r. / patient:./using./data./encryption./software./on./oflce./workstations
14. A./billing./and./coding./specialist./is./preparing./for./an./appeal./letter./in./response./t
o./a./denial./by./a./third./party./payer./for./lack./of./medical./necessity../Which./of
the. / following. / should. / the. / specialist. / include. / with. / the. / letter. / to. / indicate. / medical.
/necessity?
- patient. / employer. / information
- medical. / record. / documentation
- release. / of. / information. / authorization
- retrospective./review./request:./Medical./record./documentation
15. A./child./is./brought./into./the./facility./by./their./mother../The./child./is./covered./under./b
oth./parents'./insurance./policies../The./child's./father./was./born./on./10/1/1980./and./the
ir./mother./was./born./on./10/2/1981../Which./of./the./following./statements./is./true./regar
ding./the./primary./policy./holder./for./the./child?:./the./father./is./the./primary./holder./because./his./bir
thday./falls./first./in./the./calendar./year
, 16. A./billing./and./coding./specialist./is./processing./a./claim./for./patient./who./broke./t
heir. / arm. / while. / repairing. / cars. / at. / their. / workplace.. / There. / is. / no. / nerve. / damag
e,./the./arm./is./placed./in./a./cast./for./6./weeks../Which./of./the./following./types./of./worker
s'./compensation./applies./to./this./patient?
- temporary. / disability
- third-party. / subrogation
- permanent. / disability
- non./disability:./Temporary./disability
17. Which. / of. / the. / following. / information. / is. / required. / on. / a. / patient. / account. / record?
- name. / and. / address. / of. / guarantor
- procedures. / performed
- family./history./of./the./guarantor. /
Diagnosis:./name./and./address./of./guarantor
18. A. / billing. / and. / coding. / specialist. / is. / reviewing. / a. / delinquent. / claim.. / Which. / of. /
the./following./actions./should./the./specialist./take./first?
- verifying. / the. / age. / of. / the. / account
- query. / the. / provider
- obtain. / the. / claims. / status
- resubmit./the./claim:./Verify./the./age./of./the./account
19. A./patient./presents./to./a./provider's./office./with./difficulty./speaking,./facial./dro
oping,. / and. / inability. / to. / close. / their. / left. / eye.. / They. / are. / diagnosed. / with. / Bell's./
palsy../A./billing./and./coding./specialist./should./report./which./of./the./following./IC
D-10-CM./codes?
- R29.810. / (facial. / weakness),. / R47.81. / (slurred. / speech)
- G51.0./(./Bell's./Palsy)
- G51.0. / (Bell's. / Palsy),. / R29.810. / (facial. / weakness),. / R47.81. / (slurred. / speech)
- P11.3./(birth./injury./to./facial./nerve):./G51.0./(./Bell's./Palsy)
20. A./patient./has./a./breast./biopsy./with./placement./of./a./clip../After./the./biopsy./is./de
termined. / to. / be. / malignant,. / the. / patient. / elects. / for. / a. / mastectomy. / during. / the./
global./period./of./the./biopsy../Which./of./the./following./modifiers./should./a./billing./a
nd./coding./specialist./use./to./report./the./mastectomy?
