CBCS Exam Review 2023 Questions and Answers Complete Solution

CBCS Exam Review 2023 Questions and Answers What is the maximum number of ICD codes that can be entered on a CMS-1500 claim form as of February 2012? - ANSWER-12 Which of the following is considered the final determination of the issues involving settlement of an insurance claim? - ANSWER-Adjudication Which of the following qualifies as an exception to the HIPAA Privacy rule? - ANSWERPsychotherapy notes When reviewing an established patient's insurance card, the billing and coding specialist notices a minor change from the existing card on file. Which of the following actions should the billing and coding specialist take? - ANSWER-Photocopy both sides of the new card Which of the following is an example of a remark code from an explanation of benefits document? - ANSWER-Contractual allowance Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? - ANSWER-UB-04 When the remittance advice is sent from the third-party payer to the provider, which of the following actions should the billing and coding specialist perform first? - ANSWEREnsure proper payment has been made Which of the following is true regarding Medicaid eligibility? - ANSWER-Patient eligibility is determined monthly Which of the following describes a key component of an evaluation and management service? - ANSWER-History Which of the following is considered fraud? - ANSWER-The billing and coding specialist unbundles a code to receive higher reimbursement Which of the following is an example of Medicare abuse? - ANSWER-Charging excessive fees Which of the following privacy measures ensures protected health information (PHI)? - ANSWER-Using data encryption software on office workstations Which of the following organizations fights waste, fraud, and abuse in Medicare and Medicaid? - ANSWER-Office of Inspector General (OIG) Which of the following forms does a third-party payer require for physician services? - ANSWER-CMS-1500 Which of the following reports is used to arrange the accounts receivable from the date of service? - ANSWER-Aging report A patient has laboratory work done in the emergency department after an inhalation of toxic fumes from a faulty exhaust fan at her place of employment. Which of the following is responsible for the charges? - ANSWER-Workers' compensation If both parents have full coverage for a dependent child, which of the following is considered to be the primary insurance? - ANSWER-The parent whose birthdate comes first in the calendar year is the primary insurance holder Which of the following describes the organization of an aging report? - ANSWER-By date Which of the following actions by the billing and coding specialist prevents fraud? - ANSWER-Performing periodic audits Which of the following is a federal government health insurance program? - ANSWERTRICARE 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? - ANSWER-The billing and coding specialist sends the patient's records to the patient's partner Which of the following is the primary function of the heart? - ANSWER-Pumping blood in the circulatory system Which of the following is the deadline for Medicare claim submission? - ANSWER-12 months from the date of service Which of the following terms refers to the difference between the billed and allowed amounts? - ANSWER-Adjustment Which of the following would result in a claim being denied? - ANSWER-An italicized code used as the first listed diagnosis The billing and coding specialist should follow the guidelines in the CPT manual for which of the following reasons? - ANSWER-The guidelines define items that are necessary to accurately code A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called which of the following? - 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? - ANSWER-Admitting clerk Which of the following planes divides the body into left and right? - 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? - ANSWERCoordination of benefits The standard medical abbreviation "ECG" refers to a test used to assess which of the following body systems? - ANSWER-Cardiovascular Which of the following actions by a billing and coding specialist would be considered fraud? - ANSWER-Billing for services not provided Which of the following includes procedures and best practices for correct coding? - 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? - ANSWER-Use Arial size 10 font. According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500 claim form in block 24J? - ANSWER-NPI Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim form for procedures, services, or supplies? - ANSWER-Block 24D Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays 30%? - ANSWER-Coinsurance 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? - ANSWER-Adjustment column of the credits Patient: Jane Austin; SSN: ; Medicare ID No.: A; DOB: 05/22/1945. Claim information entered: Austin, Jane; SSN: ; Medicare ID No.: A; DOB:. Which of the following is a reason the claim was rejected? - ANSWER-The DOB is entered incorrectly. In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? - ANSWER-Add-on codes Ambulatory surgery centers, home health care, and hospice organization use the - ANSWER-UB-04 claim form Which of the following is one of the purposes of an internal auditing program in a physician's office? - ANSWER-Verifying that the medical records and the billing record match Medigap coverage is offered to Medicare beneficiaries by which of the following? - ANSWER-Private third-party payers 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? - ANSWER-Deductible 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? - ANSWER-Inform the patient of the reason for the denial. 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 portion of HIPAA allows the provider to speak to the cardiologist prior to obtaining the patient's consent? - 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? - ANSWER-Advanced Beneficiary Notice Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? - ANSWER-Improper code combinations Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - ANSWER-Operative report Which of the following describes a delinquent claim? - ANSWER-The claim is overdue for payment. When submitting a clean claim with a diagnosis of kidney stones, which of the following procedure names is correct? - ANSWER-Nephrolithiasis All e-mail correspondence to a third-party payer containing patients' protected health information (PHI) should be - ANSWER-encrypted