NHA Medical Coding and billing (Actual) Exam
(S) Subjective - ANSWER-Soap note to indicate patient level of pain to provider
0% - ANSWER-Beneficiary of Medicaid/ Medicare crossover claim is responsible for the
percentage
18% - ANSWER-Coding a front torso burn, what % should be used?
2 Pieces of Information that need to be collected from patients - ANSWER-Patients
name and date of birth
2 reasons a claim may be denied - ANSWER-Invalid subscriber name was given or
coding error was made
3rd Party Payer - ANSWER-Insurance Carrier is a
837 - ANSWER-Format used to submit electronic claims and 3rd Party payer
A bilateral procedure - ANSWER-A billing and coding specialists should add modifier -
50 when reporting which procedure
A billing worksheet from the patient account - ANSWER-A prospective billing account
audit prevents fraud by reviewing & comparing a completed claim for with which of the
following documents
A patients signature authorizing the release of any medical information necessary to
process the claim. - ANSWER-Block 12
A Providers office with fewer than 10 fulltime employees - ANSWER-Medicare enforces
mandatory submission of electronic claims for most providers. Which of the providers is
allowed to submit paper claims to Medicare?
Abuse - ANSWER-Practices that directly or indirectly result in unnecessary cost to the
Medicare program
Accounts recievable - ANSWER-Patient charges that have not been paid will appear in
which of the following
Add on Codes - ANSWER-Anesthesia section of CPT manual which are considered
qualifying circumstances
adjudication - ANSWER-Which of the following is considered the final determination of
the issues involving settlement of an insurance claim
, Advance Beneficiary Notice (ABN) - ANSWER-Advanced beneficiary notice, or ABN is a
form that is required for Medicare recipients.
An italicized code used as the 1st listed diagnosis - ANSWER-Result of a claim being
denied
APC Grouper - ANSWER-Determine the appropriate ambulatory payment classification
for outpatient encounter
Assignment of Benefits - ANSWER-Contract in which the provider directly bills the payer
and accepts the allowable charge.
Auditing - ANSWER-Review of claims for accuracy and completeness
Authorization - ANSWER-Permission granted by the patient or the patients
representative to release information for reasons other than treatment, payment, or
health care operations
Billing provider NPI number is on what block on the CMS 1500 form? - ANSWER-Block
33a
Billing using 2- digit CPT Modifiers to indicate a procedure as preformed differs from its
usual 5 digit code - ANSWER-Which of the following is allowed when billing procedural
codes
Birthday Rule - ANSWER-Parent whose birthday comes 1st in the calendar year is
considered primary
Block 23 - ANSWER-A billing and coding specialists should enter the prior the
authorization number on the following blocks.
Bone and bone marrow - ANSWER-IF a patient has osteomyelitis he has problems with
which of the following areas?
Charge Description Master (CDM) - ANSWER-Information about health care services
that patients have received and financial transactions that have taken place.
Charging excessive fees - ANSWER-Example of Medicare abuse
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) - ANSWER-3rd Party payer validates a claim which takes place next
Claims submitted via a secure network - ANSWER-Which of the following is an example
of electronic claim submission
(S) Subjective - ANSWER-Soap note to indicate patient level of pain to provider
0% - ANSWER-Beneficiary of Medicaid/ Medicare crossover claim is responsible for the
percentage
18% - ANSWER-Coding a front torso burn, what % should be used?
2 Pieces of Information that need to be collected from patients - ANSWER-Patients
name and date of birth
2 reasons a claim may be denied - ANSWER-Invalid subscriber name was given or
coding error was made
3rd Party Payer - ANSWER-Insurance Carrier is a
837 - ANSWER-Format used to submit electronic claims and 3rd Party payer
A bilateral procedure - ANSWER-A billing and coding specialists should add modifier -
50 when reporting which procedure
A billing worksheet from the patient account - ANSWER-A prospective billing account
audit prevents fraud by reviewing & comparing a completed claim for with which of the
following documents
A patients signature authorizing the release of any medical information necessary to
process the claim. - ANSWER-Block 12
A Providers office with fewer than 10 fulltime employees - ANSWER-Medicare enforces
mandatory submission of electronic claims for most providers. Which of the providers is
allowed to submit paper claims to Medicare?
Abuse - ANSWER-Practices that directly or indirectly result in unnecessary cost to the
Medicare program
Accounts recievable - ANSWER-Patient charges that have not been paid will appear in
which of the following
Add on Codes - ANSWER-Anesthesia section of CPT manual which are considered
qualifying circumstances
adjudication - ANSWER-Which of the following is considered the final determination of
the issues involving settlement of an insurance claim
, Advance Beneficiary Notice (ABN) - ANSWER-Advanced beneficiary notice, or ABN is a
form that is required for Medicare recipients.
An italicized code used as the 1st listed diagnosis - ANSWER-Result of a claim being
denied
APC Grouper - ANSWER-Determine the appropriate ambulatory payment classification
for outpatient encounter
Assignment of Benefits - ANSWER-Contract in which the provider directly bills the payer
and accepts the allowable charge.
Auditing - ANSWER-Review of claims for accuracy and completeness
Authorization - ANSWER-Permission granted by the patient or the patients
representative to release information for reasons other than treatment, payment, or
health care operations
Billing provider NPI number is on what block on the CMS 1500 form? - ANSWER-Block
33a
Billing using 2- digit CPT Modifiers to indicate a procedure as preformed differs from its
usual 5 digit code - ANSWER-Which of the following is allowed when billing procedural
codes
Birthday Rule - ANSWER-Parent whose birthday comes 1st in the calendar year is
considered primary
Block 23 - ANSWER-A billing and coding specialists should enter the prior the
authorization number on the following blocks.
Bone and bone marrow - ANSWER-IF a patient has osteomyelitis he has problems with
which of the following areas?
Charge Description Master (CDM) - ANSWER-Information about health care services
that patients have received and financial transactions that have taken place.
Charging excessive fees - ANSWER-Example of Medicare abuse
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) - ANSWER-3rd Party payer validates a claim which takes place next
Claims submitted via a secure network - ANSWER-Which of the following is an example
of electronic claim submission
