Cbcs Practice Test

1. Missing #1 - correct answer BLANK 2. A claim is submitted with a transposed insurance member ID number & returned to the provider. This describes the status that should be assigned to the claim by the carrier? - correct answer INVALID 3. Medigap coverage is offered to Medicare beneficiaries by? - correct answer PRIVATE THIRD-PARTY PAYER 4. This provision ensures that an insured's benefits from all insurance companies does not exceed 100% of allowable medical - correct answer Coordination of benefits 5. A coroner's autopsy is comprised of which examination? - correct answer Gross examination. 6. This statement is true regarding the release of patient records? - correct answer Patient access to psychotherapy notes may be restricted. 7. Actions by a billing & coding specialist would be considered fraud? - correct answer Billing for services not provided. 8. The components of an explanation of benefits expedites the process of a phone appeal? - correct answer Claim control number. 9. On the CMS-1500 claim form, blocks 14 through 33 contain information of?. - correct answer The patient's condition & the provider's information 10. A billing & coding specialist should understand that the financial record source that is generated by a provider's office is called a? - correct answer Patient Ledger Account. 11. The medical terms refer to the sac that endoses the heart? - correct answer Pericardium. 12. HIPAA transaction standards apply to? - correct answer Health care clearinghouse. 13. All dependents 10 years of age or older are required to have which of the following for TRICARE? - correct answer Military identification. 14. The standard medical abbreviation "ECG" refers to a test used to assess? - correct answer Cardiovascular system. 15. An example of a violation of an adult patient's confidentiality? - correct answer Patient information was disclosed to the patient's parent without consent. 16. Claims that are submitted without an NPI number will delay payment to the provider because? - correct answer the number is needed to identify the provider 17. Sections of the medical record is used to determine the correct Evaluation & Management code used for billing & coding? - correct answer History & physical 18. Actions should be taken if an insurance company denies a service as not medically necessary? - correct answer Appeal the decision with a provider's report. 19. Missing #19 - correct answer misssing 20. The function of the respiratory system? - correct answer Oxygenating blood cells 21. This describes a delinquent claim? - correct answer The claim is overdue for payment. 22. What actions should the billing & coding specialist take if he observes a colleague in an unethical situation? - correct answer Report the incident to a supervisor. 23. A participating Blue Cross/Blue Shield (BC/BS) provider receives an explanation of benefits for a patient account. The charged amount was $100. BC/BS allowed $80 & applied $40 to the patient's annual deductible. BC/BS paid the balance at 80%. How much should the patient expect to pay? - correct answer $48. 24. This statement is correct regarding a deductible? - correct answer The deductible is the patient's responsibility. 25. A physician ordered a comprehensive metabolic panel for a 70-year-old patient who has Medicare as her primary insurance. This form is required so the patient knows she may be responsible for payment? - correct answer Advance Beneficiary Notice. 26. What is the purpose of precertification? - correct answer Verification of coverage. 27. What claims is submitted & then optically scanned by the insurance carrier & converted to an electronic form? - correct answer Paper claim 28. What information is required on a patient account record? - correct answer Name & address of guarantor. 29. This includes procedures & best practices for correct coding? - correct answer Coding Compliance Plan. 30. A patient who has a primary malignant neoplasm of the lung should be referred to ? - correct answer Pulmonary oncologist 31. ICD-9-CM codes describes the circumstances of a patient who sustained an accidental fracture of the proximal tibia? - correct answer E887 Fracture, cause unspecified. 32. To be compliant with HIPAA, what position should be assigned in each office? - correct answer Privacy Officer. 33. This indicates a claim should be submitted on paper instead of electronically? - correct answer The claim requires an attachment. 34. Billing & coding specialist include in an authorization to release information? - correct answer The entity whom the information is to be released. 35. Missing #35 - correct answer blank 36. When submitting a clean claim with a diagnosis of kidney stones, the name of the procedure is correct? - correct answer Nephrolithiasis. 37. Ambulatory surgery center, home health care, and hospice organizations use the? - correct answer UB-04 claim form. 38. This describes an obstruction of the urethra? - correct answer Urethratresia. 39. The "" symbol is used to indicate new & revised text other than? - correct answer Procedure descriptors 40. A patient's health plan is referred to as the "payer of last resort" . The patient is covered by this health plan? - correct answer Medicaid. 41. Part of Medicare covers prescriptions? - correct answer Medicare Part D 42. Which action by the billing & coding specialist prevents fraud? - correct answer performing periodic audits 43. A patient who is an active member of the military recently returned from overseas & is in need of specialty care. The patient does not have anyone designated with power of attorney. This is considered a HIPAA violation? - correct answer The billing & coding specialist sends the patient's records to the patient's partner 44. What is used to code diseases, injuries, impairments, & other health-related problems? - correct answer International Classification of Diseases ICD. 45. An insurance claims register (aged insurance report) facilitates? - correct answer Follow up insurance claims by date 46. The verbal or written agreement that gives approval to some action, situation, or statement, & allows the release of patient information? - correct answer Consent agreement 47. A dependent child whose parents both have insurance coverage comes to the clinic. The billing & coding specialist uses the birhday rule to determine which insurance policy is primary. Describe the birthday rule? - correct answer The parent whose birth date come first in the calendar year. 48. Patient: Jane Austin, Social Security No: ; Medicare ID No: A; DOB: 05/22/1945. Claim information entered: Austin, Jane; Social Security No: ; Medicare ID No.: A; DOB: 052245. What is the reason the claim was rejected? - correct answer The DOB is entered incorrectly. 49. The symbol "O" in the Current Procedural Terminology reference is used to indicate? - correct answer Reinstate or recycled code. 50. A patient's portion of the bill should be discussed with the patient before a procedure is performed for what reason? - correct answer To ensure the patient understands his portion of the bill. 51. A deductible of $100 is applied to a patient's remittance advice. The provider requests the account personnel write it off. What terms describe this scenario? - correct answer Fraud. 52. When posting payment accurately, which items should the billing & coding specialist include? - correct answer Patient's responsibility. 53. On the CMS-1500 claim form, Block 1 through 13 include? - correct answer The patient's demographics. 54. Which blocks should the billing & coding specialist complete on the CMS-1500 claim form for procedures, services, or supplies? - correct answer Block 24D 55. What is the primary function of the heart? - correct answer Pumping blood in the circulatory system. 56. A patient's employer has not submitted a premium payment. The claim statuses should the provider receive from the thrid-party payer? - correct answer Denied. 57. Which types of claims is 120 days old? - correct answer Delinquent. 58. A nurse is reviewing a patient's lab results prior to discharge & discovers an elevated glucose level. - correct answer The attending physician. 59. What is considered the final determination of the issues involving settlement of an insurance claim? - correct answer Adjudication. 60. Urine moves from the Kidneys to the bladder through which part of the body? - correct answer Ureters. 61. A provider charged $500 to a claim that had an allowable amount of $400. In which columns should the billing & coding specialist apply the non-allowed charge? - correct answer Adjustment column of the credits 62. This block requires the patient's authorization to release medical information to process a claim? - correct answer Block 12. 63. The options is considered proper supportive documentation for reporting CPT & ICD-9 codes for surgical procedures? - correct answer Operative report. 64. This privacy measures ensures protected health information (PHI). - correct answer Using data encryption software on office workstations. 65. As of April 1, 2014, what is the maximum number of diagnoses that can be reported on the CMS-1500 claim form before a further claim is required? - correct answer 12 66. Why does correct claim processing rely on accurately encounter forms? - correct answer They streamline patient billing by summarizing the services rendered for a given date of service. 67. What is the advantage of electronic claim submission? - correct answer Claims are expedited. 68. This is a private insurance carrier? - correct answer Blue Cross/Blue Shield. 69. The tabular list of the ICD-9-CM is broken down by disease. This is the correct classification for 185. - correct answer Category. 70. A claim can be denied or rejected for what reason? - correct answer Block 24D contains the diagnosis code 71. What color formats is acceptable on the CMS-1500 claim form? - correct answer RED 72. What actions should be taken first when reviewing a delinquent claim? - correct answer Verify the age of the account. 73. Threading a catheter with a balloon into a coronary artery & expanding it to repair arteries, is what procedure? - correct answer Angioplasty.