MEDICAL BILLING AND CODING EXAM
QUESTIONS WITH 100% CORRECT
ANSWERS
Denials of outpatient claims are often generated from all of the following edits
EXCEPT:
a. NCCI [National Correct Coding Initiative]
b. OCE [Outpatient code editor]
c. OCE [ outpatient claims editor]
d. National and local policies - Answer-c. OCE [Outpatient claims editor]
In processing a Medicare payment for outpatient radiology examinations, a hospital
outpatient services department would receive payment under which of the following?
a. DRGs
b. HHRGs
c. OASIS
d. OPPS - Answer-d. OPPS
Which of the following would a health record technician use to perform the billing
function for a physician's office?
a. CMS-1500
b. UB-04
c. UB-92
d. CMS 1450 - Answer-a. CMS-1500
Which of the following is NOT an essential data element for a healthcare insurance
claim?
a. Revenue code
b. Procedure code
c. Provider name
d. Procedure name - Answer-d. Procedure name
Common errors that delay, rather than prevent, payment, include all of the following
EXCEPT:
a. Patient name or certificate number
b. Claims out of sequence
c. Illogical demographic data
d. Inaccurate or deleted codes - Answer-a. patient name or certificate number
The MS-DRG system creates a hospital's case-mix index [types of categories of
patients treated by the hospital] based on the relative weights of the MS-DRG. The
case mix can be figured by multiplying the relative weight of each MS-DRG by the
number of within that MS-DRG.
a. Admissions
b. Discharges
c. CCs
d. MCCs - Answer-b. Discharges
,A health information technician is processing payments for hospital outpatients
services to be reimbursed by Medicare for patient who had two physician visits,
underwent examinations, clinical laboratory tests, and who received take-home
surgical dressings. Which of the following services is reimbursed under the
outpatient prospective payment system?
a. Clinical laboratory tests
b. Physician office visits
c. Radiology examinations
d. Take-home surgical dressings - Answer-c. Radiology examinations
When a provider accepts assignment, this means that the:
a. patient authorizes payment to be made directly to the provider
b. The provider agrees to accept as payment in full the allowed charge from the fee
schedule
c. Balance billing is allowed on patient accounts, but at a limited rate.
d. participating provider receives a fee-for-service reimbursment - Answer-b. The
provider agrees to accept as payment in full the allowed charge from the fee
schedule
If a patient's total outpatient bill is $500, and the patient's healthcare insurance plan
pays 80% of the allowable charges, what is the amount for which the patient is
responsible?
a. $10
b. $40
c. $100
d. $400 - Answer-c. 100
In processing a bill under the Medicare outpatient prospective payment services
system [OPPS] in which a patient had three surgical procedures performed during
the same operative session, which of the following would apply?
a. Bundling of services
b. Outlier adjustment
c. Pass-through payment
d. Discounting of procedures - Answer-d. Discounting of procedures
Sometimes hospital departments must work together to solve claims issue errors to
prevent them form happening over and over again. What departments would need to
work together if an audit found that the claim did not contain the procedure code or
charge for a pacemaker insertion?
a. Health Information and Business office
b. Health information and Materials Management
c. Health information, Business office, and Cardiac department
d. Health information and Radiology - Answer-c. Health information, business office,
and cardiac
Which of the following contains the physician's findings based on examination of the
patient?
a. Physical examination
b. Discharge summary
,c. Medical history
d. Patient instructions - Answer-a. Physical examination
The following is documented in an acute-care record: "Atrial fibrillation with rapid
ventricular response, left axis deviation, left bundle branch block." In which of the
following would this documentation appear?
a. admission order
b. clinical laboratory report
c. ECG report
d. radiology reports - Answer-c. ECG report
Which of the following elements is NOT a component of most patients records?
a. patient identification
b. clinical history
c. financial information
d. test results - Answer-c. financial information
Effective October 16, 2003, under the Administrative Simplification Compliance
section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA),
all healthcare providers must electronically submit claims to Medicare. Which is the
electronic format for hospital technical fees?
a. 837I
b. 837P
c. UB-04
d. 1500 - Answer-a. 837I
The sum of a hospital's total relative DRG weights for a year was 15,192 and the
hospital had 10,471 total discharges for the year. What would be the hospital's case-
mix index for that year?
a. 0.689
b. 1.59
c. 1.45x100
d. 1.45 - Answer-1.45
What system assigns each service a value representing the true resources involved
in producing it, including the time and intensity of work, the expenses of practice, and
the risk of malpractice?
a. DRGs
b. RVUs
c. CPT
d. SVR - Answer-b. RVUs
The NCCI editing system used in processing OPPS claims is referred to as:
a. Outpatient code editor [OCE]
b. Outpatient national editor [ONE]
c. Outpatient perspective payment editor [OPPE]
, d. Outpatient claims editor [OCE] - Answer-a. Outpatient code editor [OCE]
The goal of coding compliance programs is to prevent:
a. Accusations of fraud and abuse
b. Delays in claims processing
c. Billing errors
d. Inaccurate code assignments - Answer-a. accusations of fraud and abuse
Which of the following best describes the type of coding utilized when a CPT/HCPCS
code is assigned directly through the charge description master for claim submission
and bypasses the record review and code assignment by the facility coding staff?
a. hard coding
b. soft coding
c. encoder coding
d. natural- language processing coding - Answer-a. hard coding
the next generation of consumer-directed healthcare will be driven by a design
where copayments are set based on the value of the clinical services rather than the
traditional practices that focus only on costs of clinical services. What new design will
focus on both the benefit and cost?
a. Value-based insurance design [VBID]
b. Cost-based reimbursement [CBR]
c. Pay for performance design [PPD]
d. Prospective payment system [PPS] - Answer-a. Value-based insurance design
[VBID]
A denial of a claim is possible for all of the following reasons except:
a. Not meeting medical necessity
b. Billing too many units of a specific service
c. Unbundling
d. Approved pre-certification - Answer-d. Approved pre-certification
Medicaid is a government-sponsored healthcare insurance program that became
effective in 1966 as Title 19 of the Social Security Act. Medicaid is administered by:
a. The federal government
b. The state government
c. The federal and state government
d. Third-party administrators - Answer-c. The federal and state government
What statement is NOT reflective of meeting medical necessity requirements?
a. A service or supply provided for the diagnosis, treatment, cure, or relief of a health
condition, illness, injury, or disease.
QUESTIONS WITH 100% CORRECT
ANSWERS
Denials of outpatient claims are often generated from all of the following edits
EXCEPT:
a. NCCI [National Correct Coding Initiative]
b. OCE [Outpatient code editor]
c. OCE [ outpatient claims editor]
d. National and local policies - Answer-c. OCE [Outpatient claims editor]
In processing a Medicare payment for outpatient radiology examinations, a hospital
outpatient services department would receive payment under which of the following?
a. DRGs
b. HHRGs
c. OASIS
d. OPPS - Answer-d. OPPS
Which of the following would a health record technician use to perform the billing
function for a physician's office?
a. CMS-1500
b. UB-04
c. UB-92
d. CMS 1450 - Answer-a. CMS-1500
Which of the following is NOT an essential data element for a healthcare insurance
claim?
a. Revenue code
b. Procedure code
c. Provider name
d. Procedure name - Answer-d. Procedure name
Common errors that delay, rather than prevent, payment, include all of the following
EXCEPT:
a. Patient name or certificate number
b. Claims out of sequence
c. Illogical demographic data
d. Inaccurate or deleted codes - Answer-a. patient name or certificate number
The MS-DRG system creates a hospital's case-mix index [types of categories of
patients treated by the hospital] based on the relative weights of the MS-DRG. The
case mix can be figured by multiplying the relative weight of each MS-DRG by the
number of within that MS-DRG.
a. Admissions
b. Discharges
c. CCs
d. MCCs - Answer-b. Discharges
,A health information technician is processing payments for hospital outpatients
services to be reimbursed by Medicare for patient who had two physician visits,
underwent examinations, clinical laboratory tests, and who received take-home
surgical dressings. Which of the following services is reimbursed under the
outpatient prospective payment system?
a. Clinical laboratory tests
b. Physician office visits
c. Radiology examinations
d. Take-home surgical dressings - Answer-c. Radiology examinations
When a provider accepts assignment, this means that the:
a. patient authorizes payment to be made directly to the provider
b. The provider agrees to accept as payment in full the allowed charge from the fee
schedule
c. Balance billing is allowed on patient accounts, but at a limited rate.
d. participating provider receives a fee-for-service reimbursment - Answer-b. The
provider agrees to accept as payment in full the allowed charge from the fee
schedule
If a patient's total outpatient bill is $500, and the patient's healthcare insurance plan
pays 80% of the allowable charges, what is the amount for which the patient is
responsible?
a. $10
b. $40
c. $100
d. $400 - Answer-c. 100
In processing a bill under the Medicare outpatient prospective payment services
system [OPPS] in which a patient had three surgical procedures performed during
the same operative session, which of the following would apply?
a. Bundling of services
b. Outlier adjustment
c. Pass-through payment
d. Discounting of procedures - Answer-d. Discounting of procedures
Sometimes hospital departments must work together to solve claims issue errors to
prevent them form happening over and over again. What departments would need to
work together if an audit found that the claim did not contain the procedure code or
charge for a pacemaker insertion?
a. Health Information and Business office
b. Health information and Materials Management
c. Health information, Business office, and Cardiac department
d. Health information and Radiology - Answer-c. Health information, business office,
and cardiac
Which of the following contains the physician's findings based on examination of the
patient?
a. Physical examination
b. Discharge summary
,c. Medical history
d. Patient instructions - Answer-a. Physical examination
The following is documented in an acute-care record: "Atrial fibrillation with rapid
ventricular response, left axis deviation, left bundle branch block." In which of the
following would this documentation appear?
a. admission order
b. clinical laboratory report
c. ECG report
d. radiology reports - Answer-c. ECG report
Which of the following elements is NOT a component of most patients records?
a. patient identification
b. clinical history
c. financial information
d. test results - Answer-c. financial information
Effective October 16, 2003, under the Administrative Simplification Compliance
section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA),
all healthcare providers must electronically submit claims to Medicare. Which is the
electronic format for hospital technical fees?
a. 837I
b. 837P
c. UB-04
d. 1500 - Answer-a. 837I
The sum of a hospital's total relative DRG weights for a year was 15,192 and the
hospital had 10,471 total discharges for the year. What would be the hospital's case-
mix index for that year?
a. 0.689
b. 1.59
c. 1.45x100
d. 1.45 - Answer-1.45
What system assigns each service a value representing the true resources involved
in producing it, including the time and intensity of work, the expenses of practice, and
the risk of malpractice?
a. DRGs
b. RVUs
c. CPT
d. SVR - Answer-b. RVUs
The NCCI editing system used in processing OPPS claims is referred to as:
a. Outpatient code editor [OCE]
b. Outpatient national editor [ONE]
c. Outpatient perspective payment editor [OPPE]
, d. Outpatient claims editor [OCE] - Answer-a. Outpatient code editor [OCE]
The goal of coding compliance programs is to prevent:
a. Accusations of fraud and abuse
b. Delays in claims processing
c. Billing errors
d. Inaccurate code assignments - Answer-a. accusations of fraud and abuse
Which of the following best describes the type of coding utilized when a CPT/HCPCS
code is assigned directly through the charge description master for claim submission
and bypasses the record review and code assignment by the facility coding staff?
a. hard coding
b. soft coding
c. encoder coding
d. natural- language processing coding - Answer-a. hard coding
the next generation of consumer-directed healthcare will be driven by a design
where copayments are set based on the value of the clinical services rather than the
traditional practices that focus only on costs of clinical services. What new design will
focus on both the benefit and cost?
a. Value-based insurance design [VBID]
b. Cost-based reimbursement [CBR]
c. Pay for performance design [PPD]
d. Prospective payment system [PPS] - Answer-a. Value-based insurance design
[VBID]
A denial of a claim is possible for all of the following reasons except:
a. Not meeting medical necessity
b. Billing too many units of a specific service
c. Unbundling
d. Approved pre-certification - Answer-d. Approved pre-certification
Medicaid is a government-sponsored healthcare insurance program that became
effective in 1966 as Title 19 of the Social Security Act. Medicaid is administered by:
a. The federal government
b. The state government
c. The federal and state government
d. Third-party administrators - Answer-c. The federal and state government
What statement is NOT reflective of meeting medical necessity requirements?
a. A service or supply provided for the diagnosis, treatment, cure, or relief of a health
condition, illness, injury, or disease.
