Medical Billing and Coding Practice Test 100% Correct

National Coverage Determination (NCD) - Answer Which of the following Medicare policies determines if a particular item or service is covered by Medicare? Adjudication - Answer Which of the following is considered the final determination of the issues involving settlement of an insurance claim? Encounter Form - Answer A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information Admitting clerk - Answer 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 demographic and insurance information and documenting the chief complaint. Using data encryption software on office workstations - Answer Which of the following privacy measures ensures protected health information (PHI) Sagittal - Answer Divides the body from left and right Coordination of Benefits - Answer Which of the following provisions ensures that an insured's benefits from all insurance companies do not exceed 100% of allowable medical expenses? Verify the age of the account - Answer Which of the following actions should be taken first when reviewing a delinquent claim? Claims are expedited - Answer Advantage of electronic claim submission Claim control number - Answer Which of the following components of an explanation of benefits expedites the process of a phone appeal? Billing for services not provided - Answer Which of the following actions by a billing and coding specialist is considered fraud? Blocks 14 through 33 - Answer The patient's condition and the provider's information are shown in what blocks in CMS 1500 form? Coding Compliance Plan - Answer Which of the following includes procedures and best practices for correct coding? Use Arial size 10 font - Answer When completing a CMS 1500 form which of the following is an acceptable action for the billing and coding specialist to take The claim requires an attachment - Answer Which of the following indicates a claim should be submitted on paper instead of electronically? NPI (National Provider Identifier) - Answer According to HIPAA Standards which of the following identifies the rendering provider on the CMS 1500 claim form in Block 24J? Block 32 - Answer Service facility location information in CMS 1500 Block 31 - Answer Signature of the Physician in CMS 1500 Block 27 - Answer Accept Assignment in CMS 1500 Block 26 - Answer Patient's Account Number in CMS 1500 Block 25 - Answer Federal Tax I.D. Number / SSN / EIN in CMS 1500 Block 24J - Answer Rendering Provider ID # in CMS 1500 Block 24G - Answer Days or Units in CMS 1500 Block 24F - Answer Charges in CMS 1500 Block 24E - Answer Diagnosis Pointer in CMS 1500 Block 24 D - Answer Procedures, Services or Supplies in CMS 1500 Block 24 B - Answer Place of Service in CMS 1500 Block 24 A - Answer Dates of Services in CMS 1500 Block 23 - Answer Prior Authorization Number in CMS 1500 Block 21 - Answer Diagnosis or nature of illness or injury in CMS 1500 Block 20 - Answer Outside Lab in CMS 1500 Block 22 - Answer Resubmission code in CMS 1500 Block 18 - Answer Hospitalization Dates related to current services in CMS 1500 Block 17 - Answer Name of referring provider or other source in CMS 1500 Block 17A - Answer Referring provider NPI in CMS 1500 Block 14 - Answer Date of Current Illness, Injury or Pregnancy (LMP) Block 16 - Answer Dates patient unable to work in current occupation Block 13 - Answer Insured's or authorized person's signature for payment of medical benefits to physician or supplier for services rendered. Block 9 - Answer Secondary insurance Coinsurance - Answer Term describes when a plan pays 70% of the allowed amount and the patient pays 30% Adjustment column of the credits - Answer A provider charged $500 to a claim that had an allowable amount of $400. In which of the following columns should the billing and coding specialist apply the non-allowed charge? The electronic transmission and code set standards require every provider to use the healthcare transactions, code sets and identifiers - Answer Which of the following HIPAA compliance guidelines affecting electronic health record They streamline patient billing by summarizing the services rendered for a given date of service. - Answer Why does correct claim processing rely on accurately completed encounter forms? Add-on codes - Answer In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? UB-04 claim form - Answer Ambulatory surgery centers, home health care, and hospice organizations use this form Aging report - Answer Shows outstanding balance and it is a report used to arrange the accounts receivable from the date of service Guidelines to each section - Answer The lists of unlisted codes in the CPT manual are listed in? Verifying that the medical records and the billing records match - Answer Purpose of an internal auditing program in a physician's office Private third-party payers - Answer Medigap coverage is offered to Medicare beneficiaries by which of the following? To ensure the patients understands his portion of the bill - Answer A patient's portion of the bill should be discussed with a patient before a procedure is performed for which of the following reasons Follow up insurance claims by date - Answer An insurance claim register (aged insurance report) facilitates which of the following? Patient's responsibility - Answer When posting payment accurately, which of the following items should the billing and coding specialist include? CMS-1500 claim form - Answer 1. Standard insurance form used by all government and most commercial insurance payers. 2. Which of the following should the Billing and Coding Specialist complete to be reimbursed for the patients services. Urethratresia - Answer Which of the following describes an obstruction of the urethra? Operative report - Answer Proper supportive documentation for reporting CPT and ICD codes for surgical procedures Delinquent claim - Answer A claim that is overdue for payment and is 120 days old $40 - Answer A physician is contracted with an insurance company to accept the allowed 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 patient's account? A claim that is delinquent for 60 days - Answer Which of the following claims would appear on an aging report? The age of the account - Answer The primary information used to determine the priority of collection letters to patients Phone number - Answer Which of the following pieces of guarantor information is required when establishing a patient's financial record? Patient eligibility is determined monthly - Answer Which of the following is true regarding Medicaid eligibility? Arthroscopy - Answer A provider performs an examination of a patient's knee joint via small incision and an optical device. Which of the following terms describes this procedure? The billing and coding specialist unbundles a code to receive higher reimbursement - Answer Which of the following is considered Fraud?