NHA CBCS Certification Practice Exam A

Which of the following is considered the final determination of the issues involving the settlement of an insurance claim? - correct answer Adjudication - is the process of putting an insurance claim through a series of edits for final determination. Chapter 4 A form that contains charges, DOS, CPT codes, fees, and copayment information is called which of the following? - correct answer Encounter form is a form that contains charges, DOS, CPT code, ICD codes, fees, and copayment information. page 67 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 these duties clerk has Chapter 3 Which of the following privacy measures ensures protected health information (PHI)? - correct answer Using data encryption software on office workstations - encryption software ensures that electronically transmitted health information cannot be read by third parties. This privacy measure guarantees PHI. Chapter 1 Which of the following planes divide the body into left and right? - correct answer Sagittal plane divides the body into right and left sections 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 ensures that the insured benefits from all insured companies do not exceed 100% of allowable medical expenses. page 16 Which of the following actions should be taken first when reviewing a delinquent claim? - correct answer Verify the age of the account is the first action. page 45 Which of the following is the advantage of electronic claim submission? - correct answer Claims are expedited - submitting claims electronically is faster than submitting paper claims. page 15 Which of the following components of an explanation of benefits expedites the process of a phone appeal? - correct answer Claim control number expedites the process of a phone appeal. Chapter 4 The standard medical abbreviation "ECG" refers to a test used to assess which of the following body systems? - correct answer Cardiovascular system- which is a test that checks for problems with the electrical activity of the heart. Chapter 5 Which of the following actions by a billing coding specialist (bcs) would be considered fraud? - correct answer Billing for a service not provided is considered fraud and can result in fines for the bcs and the physician page 6 The " " symbol is used to indicate new and revised text other than which of the following? - correct answer Procedures descriptors Chapter 5 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 are found on the CMS-1500 at blocks 14 - 33 page 21 Which of the following includes procedures and best practices for correct coding? - correct answer Coding Compliance Plan contains rules, procedures, and best practices to ensure accurate coding. Chapter 5 When completing a CMS-1500 paper claim form, which of the following is an acceptable action for the bcs to take? - correct answer Use Arial size 10 font or OCR size 10-, or 12-point for paper claims. Chapter 2 A participating BCBS provider received an explanation of benefits for a patient account. The charge 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 page 38-39 Which of the following indicates a claim should be submitted on paper instead of electronically? - correct answer The claim requires an attachment - should submit a paper form if the claim requires an attachment. Chapter 2 According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500 claim form in Block 24J? - correct answer NPI Page 23 Which of the following blocks should the bcs complete on the CMS-1500 form for procedures, services, or supplies? - correct answer Block 24D. Page 23 Which of the following terms describes when a plan pays 70% of the allowed and the patient pays 30%? - correct answer Coinsurance is a percentage of the cost for covered services that is approved by the insurance company. Page 39 A provider charges $500 to a claim that had an allowable amount of $400. In which of the following columns should the bcs apply the non-allowed charge? - correct answer The adjustment column of the credits is where adjustments are recorded. page 47 Which of the following is a HIPAA compliance guideline affecting electronic health records? - correct answer The Health Information Technology for Economic and Clinical (HITECH) Act encrypts provider - protected health information page 1 & 3 Patient: Justin Austin; Social Security NO.: ; Medicare ID NO.: A; DOB: 05/22/1945. Claim information entered: Austin, Jane; Social Security No.: ; Medicare ID No.: A; DOB: 052245. Which of the following is a reason the claim was rejected? - correct answer The DOB is entered incorrectly - the format is two digits for the month and four digits for the year. page 18 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 - encounter forms allow a provider to summarize services rendered by code, which reduces time spent by bcs when posting charges. Page 18 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 is the health plan that is referred to as the "payor of last resort." All of the patient's health plans must meet their obligations before Medicaid will pay. page 30 Which of the following color formats allows optical scanning of the CMS-1500 claim form? - correct answer Red ink allows optical scanning of the CMS-1500. Chapter 2 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. Page 5 In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? - correct answer Add-on codes are listed after the primary procedure code, and cannot ever be listed as a primary, or be coded as the only procedure code. Ambulatory surgery centers, home health care, and hospice organizations use the_____? - correct answer UB-04 claim form which is the appropriate claim form for reimbursement of services from ambulatory surgery centers, home health care, and hospice organizations Which of the following is a private insurance carrier? - correct answer BC/BS is a private insurance carrier. Page 35 Which of the following shows outstanding balances? - correct answer Aging report lists the status of outstanding claims from each payer. Page 44 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 record and the billing record match - the purpose of internal auditing is to verify that the medical records and the billing record march, which protects from sanctions or fines. Chapter 1 The star symbol in the CPT code book is used to indicate which of the following? - correct answer Telemedicine has the star code symbol Chapter 5 Medigap coverage is offered to Medicare beneficiaries by which of the following? - correct answer Private third-party payers offer supplement coverage to Medicare beneficiaries who pay their Medicare premium. Page 32 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 bill should be discussed prior to the procedure to ensure the patient understands how much the procedure will cost and how much the patient is responsible. Chapter 4 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 the year. This amount is called which of the following? - correct answer Deductible is the amount for which the patient is financially responsible before an insurance policy providers coverage page 29 & 38 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 bcs sends the patient's records to the patient's partner page 4 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 for the denial page 52 A patient presents to the provider with chest pain and shortness of breath. After an unexpected ECG result, the provider calls a cardiologist and summarizes the patient's symptoms. What portions of HIPAA allows the provider to speak to the cardiologist prior to obtaining the patient's consent? - correct answer Title II deals with administrative simplifications, which include communication with parties involved in the patient's care. The patient signs an agreement and is given a copy of the HIPAA standards upon becoming a patient page 15 on ASCA but nothing about 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 is a form that is required for Medicare recipients page 48 Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? - correct answer Improper code combinations - Medicare NCCI edits will trigger a claim rejection for improper code combinations Chapter 4 Which of the following is the purpose of running an aging report each month? - correct answer It indicates which claims are outstanding with a status of all page 44