Nha Cbcs 3.0 Practice Test

A child is brought into a facility by their mother. The child is covered under both parents' 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? - correct answer 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 divorced 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? - correct answer Biologic mother Which of the following is the purpose of running an insurance aging report each month? - correct answer To determine which claims are outstanding from third-party payers A billing and coding specialist observes a colleague perform an unethical act. Which of the following actions should the specialist take? - correct answer Report the incident to a supervisor Which of the following statements is true regarding the release of patients records? - correct answer Patient access to psychotherapy notes is restricted A billing and coding specialist is preparing a claim for a patient who had a procedure performed on their left index finger. Which of the following modifiers indicates the correct digit? - correct answer -F1 -FA: used for left thumb -F6: used for right index finger -F4: used for the left pinky 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 arm 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? - correct answer Temporary disability Based on the CPT integumentary coding guidelines, Mohs micrographic surgery involves the provider filling which of the following roles? - correct answer Both the surgeon and pathologist A billing and coding specialist is preparing a claim for a provider. The operative note indicates the surgeon performed a CABG. The specialist should identify that CABG stands for which of the following? - correct answer Coronary Artery Bypass Graft A billing and coding specialist is arranging a payment plan with a patient who wants to leave postdated checks with the office. The patient proposes leaving one check postdated for 3 months, one for 4 months, and another one for 5 months in the future. According to federal collection law, which of the following actions should the specialist take? - correct answer Notify the patient between 3 and 10 days prior to depositing each check on the indicated date. Which of the following qualifies a patient for eligibility under Medicare as the primary third-party payer? - correct answer Individuals who are under age 65 and have a disability Which of the following is an example of a diagnostic category code? - correct answer I10 (Diagnostic category codes contains three characters) A billing and coding specialist is determining third-party payer responsibilities for a 70-year-old patient who has Medicare coverage. The patient's spouse has insurance with Blue Cross Blue Shield through their employer. Which of the following actions should the specialist take? - correct answer Establish coordination of benefits When a patient has a condition that is both acute and chronic, how should it be coded? - correct answer Code both the acute and chronic conditions, sequencing the acute condition first. When reviewing an established patient's insurance card, a billing and coding specialist notices a minor change from the existing card on file. Which of the following actions should the specialist take? - correct answer Photocopy both sides of the new card On a remittance advice form, which of the following is responsible for writing off the difference between the amount billed and the amount allowed by the agreement? - correct answer Provider A provider's office receives a subpoena requesting medical documentation from a patient's medical record. After confirming the correct authorization, which of the following actions should a billing and coding specialist take? - correct answer Send the medical information pertaining to the dates of service requested. A billing and coding specialist is working on a claim in which reimbursement was reduced due to services being bundled. Which of the following types of modifiers should be assigned to indicate multiple procedures were performed to prevent bundling? - correct answer Category I modifier (category I modifier provides the means to report or indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code). A billing and coding specialist is reviewing an encounter note that indicates a biopsy was performed. The specialist requires which of the following additional details to fully code this procedure? - correct answer Benign vs. malignant status A billing and coding specialist is determining the level of service for an office visit for a new patient. Which of the following codes represents a detailed history and detailed exam with moderate medical decision-making? - correct answer 99204 Which of the following is true regarding Medicaid eligibility? - correct answer Patient eligibility is determined at each visit. Which of the following pieces of guarantor information is required when establishing a patient's financial record? - correct answer Phone number A billing and coding specialist is reviewing a delinquent claim. Which of the following actions should the specialist take first? - correct answer Verify the age of the account. When a patient signs an Acknowledgement of Notice of Privacy Practice, it indicates which of the following? - correct answer The patient accepts the policies and procedures regarding how protected health information (PHI) is handled. Which of the following should a billing and coding specialist complete to be reimbursed for a provider's outpatient services? - correct answer CMS-1500 claim form A billing and coding specialist is preparing a claim for an appendectomy and reports it with two units. The claim is then denied. Which of the following coding edits should the specialist have reviewed prior to submitting the claim? - correct answer Medically unlikely edits (MUEs) A billing and coding specialist identifies a CPT code that is routinely being denied by a third-party payer. Which of the following types of review should the specialist perform? - correct answer Retrospective review In which of the following sections of the SOAP note does a provider indicate a patient's reported level of pain? - correct answer Subjective (where the patient describes the chief of complaint; including the patient's reported level of pain) A billing and coding specialist is preparing an appeal letter in response to a denial by a third-party payer for lack of medical necessity. Which of the following should the specialist include with the letter to indicate medical necessity? - correct answer Medical record documentation A billing and coding specialist is reviewing delinquent claims and discovers that a third-party payer paid a claim but applied it to the incorrect provider. The third-party payer will reimburse the payment once the improperly paid funds are recouped. Which of the following terms is used to describe this claim? - correct answer Suspended -Payment error: payment for a claim that was sent directly to the patient -Rejected (soft denial): often in response to a technical error -Denied: claim has been adjudicated and the third-party payer has determined that no payment will be made. Which of the following is the purpose of an internal review in a provider's office? - correct answer To verify that the medical records and the billing record match. A billing and coding specialist is reviewing a remittance advice and encounters a denial of payment for CPT code 44950 (appendectomy). The specialist discovers the ICD-10-CM code assigned to the claim was J32.1 (chronic frontal sinusitis). Which of the following is the reason for this claim denial? - correct answer Incorrectly linked codes were reported on the claim A billing and coding specialist is reviewing a claim that was denied for services provided during the postoperative period. The patient was diagnosed with pneumonia during a postoperative encounter for a knee joint replacement 2 weeks ago. Which or the following modifiers should the specialist add to the claim resubmiting? - correct answer -24 -55: used for postoperative management care -25: used for separately significant E/M services by the same provider on the same day of service. -79: used for unrelated procedures or services by the same provider during the postoperative period. Which of the following actions should a billing and coding specialist take to assign a diagnosis code to the highest level of specificity? - correct answer Apply characters four through seven to a claim. Which of the following information is required on a patient account record? - correct answer Name and address of guarantor A patient wants to see an endocrinologist for a consultation about their diabetes mellitus, but they must see their primary care provider (PCP) for a referral to an in-network specialist first. Which of the following types of insurance does the patient have? - correct answer HMO (health maintenance organization) Which of the following is a federal government health insurance program? - correct answer TRICARE Which of the following is a valid ICD-10-CM principle? - correct answer Code signs and symptoms in the absence of a definitive diagnosis. The star symbol in the CPT coding manual is used to indicate which of the following? - correct answer Telemedicine A billing and coding specialist is determining the coordination of benefits for a patient who has health insurance coverage from both parents. The patient's father's birthday is May 18, 1982 and their mother's birthday is May 18, 1984. Which of the following statements is correct for determining coverage? - correct answer The parent whose insurance policy has been active the longest will be the primary insurer. Which of the following links the ICD-10-CM and CPT codes for claims processing? - correct answer Diagnosis pointer A provider's office fee is $100 and the Medicare Part B allowed amount is $85. Assuming the beneficiary has not met their annual deductible, the patient should be billed for which of the following amounts? - correct answer $85 (If the patient has not met their annual deductible, they will pay the Medicare allowed amount, $85) A billing and coding specialist is preparing a claim for a procedure with a prolonged operative time that has modifier -22 attached. Which of the following actions should the specialist take? - correct answer Send a copy of the operative report with the claim. A patient presents to a provider's office with a difficulty speaking, facial drooping, and an inability to close their left eye. They are diagnosed with Bell's palsy. A billing and coding specialist should report which of the following ICD-10-CM codes? - correct answer G51.0 (index: "Bell's," then "palsy"; next to palsy is paralysis, followed by the default code G51.0. Bell's palsy can be located also by going to "palsy" in the index, then searching for "Bell's."; common signs and symptoms of Bell's Palsy: facial drooping and difficulty speaking; not reported separately with a confirmed or definitive diagnosis)