NHA CBCS CERTIFICATION

Which of the following is considered the final determination of the issues involving settlement of an insurance claim? - correct answer Adjudication A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called which of the following? - correct answer Encounter form 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? - correct answer Admitting clerk Which of the following privacy measures ensures protected health information (phi)? - correct answer Using data encryption software on office workstations Which of the following planes divides the body into left and right? - correct answer Sagittal Which of the following provisions ensures that an insured's benefits from all insurance companies do not exceed 100% of allowable medical expenses? - correct answer Coordination of benefits Which of the following actions should be taken first when reviewing a delinquent claim? - correct answer Verify the age of the account Which of the following is the advantage of electronic claim submission? - correct answer Claims are expedited Which of the following components of an explanation of benefits expedites the process of a phone appeal? - correct answer Claim control number The standard medical abbreviation ECG refers to a test used to assess which of the following body systems? - correct answer Cardiovascular system Which of the following actions by a billing and coding specialist would be considered fraud? - correct answer Billing for services not provided The symbol is used to indicate a new and revised test other than which of the following? - correct answer Procedure descriptors On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the following? - correct answer The patient's condition and the provider's information Which of the following includes procedures and best practices for correct coding? - correct answer Coding Compliance Plan When completing a CMS-1500 paper claim form, which of the following is an acceptable action for the billing and coding specialist to take? - correct answer Use arial size 10 font A participating blue cross/blue shield (BC/BS) provider receives an explanation of benefits for a patient account. The charged amount was $100. BC/BS allowed $80 and applied $40 to the patient's annual deductible. BC/BS paid the balance at 80%. How much should the patient expect to pay? - correct answer $48 Which of the following indicates a claim should be submitted on paper instead of electronically? - correct answer The claim requires an attachment According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500 claim form in block 24j? - correct answer NPI Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim form form for procedures, services or supplies (CPT/HCPCS)? - correct answer Block 24D Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays 30%? - correct answer Coinsurance A provider charged $500 to 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? - correct answer Adjustment column of the credits Which of the following is a HIPAA compliance guideline affecting electronic health records? - correct answer The electronic transmission and code set standards require every provider to use the healthcare transactions ,code sets and identifiers Patient: Jane Austin; Social Security # ; Medicare ID: A; DOB: 05/22/1945. Claim information entered: Austin, Jane; Social Security #.: ; Medicare ID No.: A; DOB: 052245. Which of the following is a reason this claim was rejected? - correct answer The DOB is entered incorrectly Why does correct claim processing rely on accurately completed encounter forms? - correct answer They streamline patient billing by summarizing the services rendered for a given date of service A patient's health plan is referred to as the "payer of last resort." The patient is covered by which of the following health plans? - correct answer Medicaid Which of the following color formats is acceptable on the CMS-1500 claim form? - correct answer Red Which of the following is an example of a violation of an adult patient's confidentiality? - correct answer Patient information was disclosed to the patient's parents without consent. In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? - correct answer Add-on codes Ambulatory surgery centers, home health care, and hospice organizations use the - correct answer UB-04 claim form Which of the following is a private insurance carrier? - correct answer Blue Cross/ Blue Shield Which of the following shows outstanding balances? - correct answer Aging report Which of the following is one of the purposes of an internal auditing program in a physician's office? - correct answer Verifying that the medical records and the billing record match The star symbol in the CPT code book is used to indicate which of the following? - correct answer Telemedicine Medigap coverage is offered to Medicare beneficiaries by which of the following? - correct answer Private third party payers A patient's portion of the bill should be discussed with the patient before a procedure is performed for which of the following reasons? - correct answer To ensure the patient understands his portion of the bill The physician bills $500 to a patient. After submitting the claim to the insurance company, the claim is sent back with no payment. The patient still owes $500 for this year. This amount is called - correct answer Deductible 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 HIPAA violation? - correct answer The billing and coding specialist sends the patient's records to the patient's partner. A patient is upset about a bill she received. Her insurance company denied the claim. Which of the following actions is an appropriate way to handle the situation? - correct answer Inform the patient of the reason of the denial A patient presents to the provider with chest pain and SOB. After an unexpected ECG result, the provider calls a cardiologist and summarizes the patient's symptoms. What portion of HIPAA allows the provider to speak to the cardiologist prior to obtaining the patient's consent? - correct answer TITLE II A physician ordered a comprehensive metabolic panel for 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? - correct answer Advanced Beneficiary Notice Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? - correct answer Improper code combinations Which of the following is the purpose of running an aging report each month? - correct answer It indicates which claims are outstanding Which of the following do physicians use to electronically submit claims? - correct answer Clearinghouses Which of the following should the billing and coding specialist include in an authorization to release information? - correct answer The entity to whom the information is to be released Which of the following information is required on a patient account record? - correct answer Name and address of guarantor Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? - correct answer UB-04 An insurance claims register (aged insurance report) facilitates which of the following? - correct answer Follow up of insurance claims by date When posting payment accurately, which of the following items should the billing and coding specialist include? - correct answer Patient's responsibility Which of the following should the billing and coding specialist complete to be reimbursed for the provider's services? - correct answer CMS-1500 claim form As of April 1st 2014, what is the maximum number of diagnosis that can be reported on the CMS-1500 claim form before a further claim is required? - correct answer 12 Which of the following describes an obstruction of the urethra? - correct answer Urethratresia Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - correct answer Operative report Which of the following describes a delinquent claim? - correct answer The claim is overdue for payment All dependents 10 year of age or older are required to have which of the following for TRICARE? - correct answer Military identification Which of the following types of claims is 120 days old? - correct answer Delinquent HIPAA transaction standards apply to which of the following entities? - correct answer Health care clearinghouse Which of the following actions should be taken when a claim is billed for a level four office visit and paid at a level three? - correct answer Submit an appeal to the carrier with supporting documentation When submitting a clean claim with a diagnosis of kidney stones, which of the following procedure names is correct? - correct answer Nephrolithiasis All e-mail correspondence to a third party payer containing patients' protected health information (PHI) should be - correct answer Encrypted The billing and coding specialist should divide the evaluation and management code by which of the following? - correct answer Place of service In which of the following departments should a patient be seen for psoriasis? - correct answer Dermatology A nurse is reviewing a patient's lab results prior to discharge and discovers an elevated glucose level. Which of the following health care providers should be altered before the nurse can proceed with discharge planning? - correct answer The attending physician Which of the following actions should be taken if an insurance company denies a service as not medically necessary? - correct answer Appeal the decision with a provider's report A billing and coding specialist should understand that the financial record source that is generated by a provider's office is called a - correct answer patient ledger account Which of the following is used to code diseases, injuries, impairments, and other health related problems? - correct answer International Classification of Disease (ICD) Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes which of the following procedures? - correct answer Angioplasty A coroner's autopsy is comprised of which of the following examinations? - correct answer Gross examination 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? - correct answer Denied Which of the following blocks requires the patient's authorization to release medical information to process a claim? - correct answer Block 12 The unlisted codes can be found in which of the following locations in the CPT manual? - correct answer Guidelines prior to each section Which of the following is the portion of the account balance the patient must pay after services are rendered and the annual deductible is met? - correct answer Coinsurance When coding on the UB-04 form, the billing and coding specialist must sequence the diagnosis codes according to the ICD guidelines. Which of the following is the first listed diagnosis code? - correct answer Principal diagnosis Which of the following actions by the billing and coding specialists prevents fraud? - correct answer Performing periodic audits Which of the following does a patient sign to allow payment of claims directly to the provider? - correct answer Assignment of benefits Which of the following actions should the billing and coding specialist take if he observes a colleague in an unethical situation? - correct answ