coding and billing specialist certification
A child is brought into a facility by their mother. The child is covered under both parent's
insurance policies. The child's father was born on 10/1/1980 and their mother was born on
10/2/1981. Which of the following statements is true regarding the primary policy holder for
the child? -
The father is the primary policy holder because his birthday falls first in the calendar
year.
A billing and coding specialist is submitting a claim for a school-age child who was brought
to the clinic by their maternal grandmother. The child's parents are devocied and remarried,
and the child's mother has legal custody of the child. The specialist should recognize that the
child's primary insurance coverage is provided through which of the following insured
individuals? -
Biological mother
Which of the following is the purpose of running an insurance aging report each month? -
To determine which claims are outstanding from third-party payers
A billing and coding specialist observes a colleague performing an unethical act. Which of
the following actions should the specialist take? -
Report the incident to a supervisor
A billing and coding specialist is processing a claim for a patient who broke their arm while
repairing cars at their workplace. There is no nerve damage, the arim is placed in a cast for 6
weeks, and the patient is cleared to return to work in 6 weeks. Which of the following types
of workers' compensation applies to this patient? -
Temporary disability
A provider accepts assignment for a patient who has a $10 copayment and has already met
$100 of their $150 deductible. The office charge is $100 and the allowed amount is $70. How
much should the provider's office adjust off the patient account? -
$30
1. Claims that are submitted without an NPI number will delay payment to the provider due
to which of the following? -
a. The number is needed to identify the provider
1. Which of the following describes a CPT modifier that is used to indicate a provider
supervision and interpreted a radiology procedure? -
a. Professional component
1. A billing and coding specialist is preparing a list of delinquent accounts over 300 days' old
that have received telephone calls, letters, and have been referred to a collection agency with
no results. Which of the following is the term that describes account receivable that are
deemed to be "uncollectable"? -
a. Bad debts
1|Page
, 1. Which of the following is a HIPAA compliance guideline affecting electronic health
records? -
a. The electronic transmission and code set standards require every provider to use
the health care transactions, code sets, and identifiers
1. Which of the following are used to code provider and outpatient services? -
a. CPT codes
1. Which of the following terms describes the amount the patient must pay for a service when
they have an insurance plan benefit that pays 70% of the allowed amount and the patient is
responsible for 30% of the allowed amount? -
Coinsurance
1. A billing and coding specialist is preparing to create patient statements and has been asked
to collect finance charges on any late payments. According to the Truth in Lending Act,
which of the following is the way the finance charges must be disclosed on the statement? -
a. As an annual percentage rate
1. How many behavior classifications are included in the Table of Neoplasms in the ICD-10-
CM? -
6
1. Which of the following introduced documentation guidelines to Medicare carriers to
ensure that service paid for have been provided and were medically necessary? -
CMS
1. A patient has health coverage through multiple third-party payers. A billing and coding
specialist should identify that which of the following is the payer of last result? -
Medicaid
1. A billing and coding specialist is submitting a batch of claims to the clearing house and
receives a report stating that three claims were rejected. Which of the following actions
should the specialist take? -
a. Review of scrubber report
1. A billing and coding specialist is reviewing an operative report for a patient who had a
graft. The specialist should consult the CPT coding guidelines to determine that which of the
following is a tissue transplant from one individual to another of the same species but
different genotype? -
Allograft
1. Which of the following is the filling limit for a claim submission for an outpatient service
with TRICARE? -
a. Within 1 year from the date of service
1. A billing and coding specialist in an internal medicine practice is assisting a patient who is
already collecting SS but will be turning 65 in the next year and has questions about the
Medicare will cover. -
Part A
2|Page
A child is brought into a facility by their mother. The child is covered under both parent's
insurance policies. The child's father was born on 10/1/1980 and their mother was born on
10/2/1981. Which of the following statements is true regarding the primary policy holder for
the child? -
The father is the primary policy holder because his birthday falls first in the calendar
year.
A billing and coding specialist is submitting a claim for a school-age child who was brought
to the clinic by their maternal grandmother. The child's parents are devocied and remarried,
and the child's mother has legal custody of the child. The specialist should recognize that the
child's primary insurance coverage is provided through which of the following insured
individuals? -
Biological mother
Which of the following is the purpose of running an insurance aging report each month? -
To determine which claims are outstanding from third-party payers
A billing and coding specialist observes a colleague performing an unethical act. Which of
the following actions should the specialist take? -
Report the incident to a supervisor
A billing and coding specialist is processing a claim for a patient who broke their arm while
repairing cars at their workplace. There is no nerve damage, the arim is placed in a cast for 6
weeks, and the patient is cleared to return to work in 6 weeks. Which of the following types
of workers' compensation applies to this patient? -
Temporary disability
A provider accepts assignment for a patient who has a $10 copayment and has already met
$100 of their $150 deductible. The office charge is $100 and the allowed amount is $70. How
much should the provider's office adjust off the patient account? -
$30
1. Claims that are submitted without an NPI number will delay payment to the provider due
to which of the following? -
a. The number is needed to identify the provider
1. Which of the following describes a CPT modifier that is used to indicate a provider
supervision and interpreted a radiology procedure? -
a. Professional component
1. A billing and coding specialist is preparing a list of delinquent accounts over 300 days' old
that have received telephone calls, letters, and have been referred to a collection agency with
no results. Which of the following is the term that describes account receivable that are
deemed to be "uncollectable"? -
a. Bad debts
1|Page
, 1. Which of the following is a HIPAA compliance guideline affecting electronic health
records? -
a. The electronic transmission and code set standards require every provider to use
the health care transactions, code sets, and identifiers
1. Which of the following are used to code provider and outpatient services? -
a. CPT codes
1. Which of the following terms describes the amount the patient must pay for a service when
they have an insurance plan benefit that pays 70% of the allowed amount and the patient is
responsible for 30% of the allowed amount? -
Coinsurance
1. A billing and coding specialist is preparing to create patient statements and has been asked
to collect finance charges on any late payments. According to the Truth in Lending Act,
which of the following is the way the finance charges must be disclosed on the statement? -
a. As an annual percentage rate
1. How many behavior classifications are included in the Table of Neoplasms in the ICD-10-
CM? -
6
1. Which of the following introduced documentation guidelines to Medicare carriers to
ensure that service paid for have been provided and were medically necessary? -
CMS
1. A patient has health coverage through multiple third-party payers. A billing and coding
specialist should identify that which of the following is the payer of last result? -
Medicaid
1. A billing and coding specialist is submitting a batch of claims to the clearing house and
receives a report stating that three claims were rejected. Which of the following actions
should the specialist take? -
a. Review of scrubber report
1. A billing and coding specialist is reviewing an operative report for a patient who had a
graft. The specialist should consult the CPT coding guidelines to determine that which of the
following is a tissue transplant from one individual to another of the same species but
different genotype? -
Allograft
1. Which of the following is the filling limit for a claim submission for an outpatient service
with TRICARE? -
a. Within 1 year from the date of service
1. A billing and coding specialist in an internal medicine practice is assisting a patient who is
already collecting SS but will be turning 65 in the next year and has questions about the
Medicare will cover. -
Part A
2|Page
