NHA CBCS practice test #1

Which of the following electronic forms is used to post payments? - correct answer Electronic remittance advice (ERA) If a clean claim is received March 1 of this year, which of the following is the allowable last day of payment in order to meet Medicare compliance requirements? - correct answer March 30 Threading a catheter with balloon into a coronary artery and expanding it to repair arteries describes which of the following procedures? - correct answer Angioplasty The authorization number for a service that was approved before the service was rendered is indicated in which of the following blocks on the CMS-1500 claim form? - correct answer Block 23 Which of the following blocks of the CMS-1500 claim form indicates an ICD diagnosis code? - correct answer Block 21 A patient who has an HMO insurance plan needs to see a specialist for a specific problem. From which of the following should the patient obtain an referral? - correct answer Primary Care Provider A provider surgically punctures through the space between the patient's ribs using an aspirating needle to withdraw fluid from the chest cavity. Which of the following is the name of this procedure? - correct answer Pleurocentesis Which of the following standardized formats are used in the electronic filing of claims? - correct answer HIPAA standard transactions Which of the following blocks on the CMS-1500 claim form is used to accept assignment of benefit? - correct answer Block 27 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 The explanation of benefits states the amount billed was $80. The allowed amount is $60, and the patient is required to pay a $20 copayment. Which of the following describes the insurance check amount to be posted? - correct answer $40 Which of the following should a billing coding specialist use to submit a claim with supporting documents? - correct answer Claims Attachment 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? - correct answer Photo copy both sides of the card Which of the following accurately describes code symbols found in the CPT manual? - correct answer A product pending FDA approval is indicated as a lightning-bolt symbol Which of the following Medicare policies determines if a particular item or service is covered by Medicare? - correct answer National Coverage Determination (NCD) 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 is an example of a remark code from an explanation of benefits document? - correct 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? - correct answer UB-04 A claim is denied due to termination of coverage. Which of the following actions should the billing and coding specialist take next? - correct answer Follow up with the patient to determine current name, address, and insurance carrier for resubmission Which of the following national provider identifiers (NPIs) is required in Block 33a of a CMS-1500 claim form? - correct answer Billing provider Which of the following is a reason a claim would be denied? - correct answer Incorrectly linked codes The unlisted codes can be found in which locations in the CPT manual? - correct answer The guidelines prior to each section 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? - correct answer Ensure proper payment has been made Which of the following symbols indicates a revised code? - correct answer Triangle Which of the following terms is used to describe the location of the stomach, the spleen, part of the pancreas, part of the liver, and part of the small and large intestines? - correct answer Left Upper Quadrant When coding a front torso burn, which of the following percentages should be coded? - correct answer 18% Which of the following is true regarding Medicaid eligibility? - correct answer Patient eligibility is determined monthly Which of the following describes a key component of an evaluation and management service? - correct answer History Which of the following is considered fraud? - correct answer The billing and coding specialist unbundles a code to receive higher reimbursement Which of the following is an example of Medicare abuse? - correct answer Charging Excessive fees Which of the following privacy measures ensures protected health information (PHI)? - correct answer Using data encryption software on office workstations Which of the following organizations fights waste, fraud, and abuse in Medicare and Medicaid? - correct answer Office of Inspector General (OIG) A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? - correct answer Aging Report Which of the following parts of the Medicare insurance program is managed by private, third-party insurance providers that have been approved by Medicare? - correct answer Part C A patient's st 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 should the billing and coding specialist complete on the CMS-1500 claim form for procedures, services or supplies? - correct answer Block 24 D Which of the following forms does a third-party payer require for physician services? - correct answer CMS-1500 Which of the following reports is used to arrange the accounts receivable from the date of service? - correct answer Aging Report 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 A physician's office fee is $100 and the Medicare Part B allowed amount is $85. Assuming the beneficiary has not met his annual deductible, the office should bill the patient for which of the following amounts? - correct answer $85