NHA Medical Coding and Billing Exam Questions and Answers

Billing and coding specialists should first divide the E & M Code by - Place of Service Compliant with HIPPA the following position should be assigned in each office - Privacy Officer Coding on the UB-04 Form, must sequence the diagnosis code. Which is the first listed diagnosis? - Principal Diagnosis Obstruction of the urethra is - Urethratresia Ambulatory surgery centers, home health center, and hospice use what form? - UB04 Forms Form that contains of DOS, CPT, ICD codes, fees and copay information is called - Encounter forms Anesthesia section of CPT manual which are considered qualifying circumstances - Add on Codes Patient presents with chest pain & shortness of breath with abnormal ECG provider call a cardiologist. What portion of the HIPPA allows this - Title 11 HIPPA compliance guideline affecting EHR - Code set standards pertain to all providers Color formats on CMS 1500 form acceptable - Red Financial record generated by a provider office - Patient Ledger account Which of the following includes procedures and best practices for correct coding - Coding Compliance Plan Which of the following planes divides the body into left and right - Sagittal 3rd Party payer validates a claim which takes place next - Claim adjudication:( The term used in the industry to refer to the process of paying claims submitted on denying them after comparing claims to the benefit or coverage requirements) Developed to reduced Medicare Program expenditure by detecting in appropriate codes & eliminating improper coding - NCCI ( National Correct Coding Initiative) Beneficiary of Medicaid/ Medicare crossover claim is responsible for the percentage - 0% Which of the following steps would be part of a physicians practice compliance program - Internal monitoring and auditing Which of the following acts applies to the administrative simplification guidelines? - HIPPA Patient charges that have not been paid will appear in which of the following - Accounts recievable Which of the following is considered the final determination of the issues involving settlement of an insurance claim - adjudication A prospective billing account audit prevents fraud by reviewing & comparing a completed claim for with which of the following documents - A billing worksheet from the patient account Which of the following parts of the body system regulates immunity - Lymphatic system Which of the following is allowed when billing procedural codes - Billing using 2- digit CPT Modifiers to indicate a procedure as preformed differs from its usual 5 digit code A biller will electronically submit a claim to the carrier via which of the following? - Direct Data entry Medicare enforces mandatory submission of electronic claims for most providers. Which of the providers is allowed to submit paper claims to Medicare? - A Providers office with fewer than 10 fulltime employees Which of the following organizations identifies improper payments made on CMS claims - (RAC) Recovery audit Contractor IF a patient has osteomyelitis he has problems with which of the following areas? - Bone and bone marrow Which of the following is a requirement of some third-party payers before a procedure is performed? - Preauthorization form Ensure appropriate insurance coverage for an outpatient procedure by first using the following process - Precertification Key component if an evaluation and management service - History Format used to submit electronic claims and 3rd Party payer - 837 Entity that defines the essential element of a comprehensive compliance program - Office of the Inspector General (OIG) Medicare Policy determines if a particular item or service is covered - National Coverage Determination Location of the stomach, spleen, part of the pancreas and liver - Left upper quadrant Coding a front torso burn, what % should be used? - 18% Result of a claim being denied - An italicized code used as the 1st listed diagnosis Example of Medicare abuse - Charging excessive fees Diagnostic codes in Block 21 of the CMS form - Codes must correspond to the diagnosis pointer in block 24E Soap note to indicate patient level of pain to provider - (S) Subjective Standardized format used in electronic filing of claims - HIPPA Standard transaction Insurance Carrier is a - 3rd Party Payer When send a claim to a 2nd payer you need to send a copy of - Remittance Advice (RA)- A letter sent to a patient from insurance provider stating that their invoice is paid Remark code from a EOB document-(EOB)- statement sent by a health insurance company covered individual explaining what medical treatments and/ or services were paid for on their behalf - Contractual allowance- difference between what hospitals bill and what they receive in payment from 3rd Party Payers CPT code used to indicate provider supervised and interpreted - Professional component- Provided by a physician, may include supervision, interpretation, and writer report Providers explain medical or diagnostic procedures, surgical interventions, and the benefits and risks involved, giving the patients opportunity to ask questions before medical intervention is provided. Signature is required - Informed consent A patient presents for treatment, such as extending an arm to all venipuncture to be performed. Signature is NOT required - Implied consent Agency, that converts claims into standardized electronic format, looks for errors, and formats them according to HIPPA and insurance standards - Clearinghouse Information that does not identify and individual because unique and personal characteristics have been removed - De- identifiable information