NCCT BILLING AND CODING EXAM WITH ALL CORRECT
& 100% VERIFIED ANSWERS|ACTUAL COMPLETE EXAM
|ALREADY GRADED A+
It is important to make the patient aware of the mailing address, interest rates, and length of
agreement when setting up a ✔Correct Answer-payment arrangement.
What is the correct term for a doctor who enters into an agreement with a third party payer on
charges, discounts, and services rendered to their policyholders within the network? ✔Correct
Answer-PAR (participating provider) a physician who enters into an agreement with a payer to offer
discounts on charges rendered to their policy holders.
What should a practice's financial policy always explain? ✔Correct Answer-what is required from
the patient and when payment is due
A patient had a procedure which was billed at $200.00. The allowed amount was $150.00 and he has
$50.00 left to meet of his deductible. His co-insurance is 20%. How much does the patient owe?
✔Correct Answer-$80
The patient in this question is responsible for 20%. $150 allowed amount. 20% of $150 allowed is
$30. Patient still owes $50 deductible. Patient would owe $80 total.
The physician charges $100 for a visit. The insurer allowable amount is $80. The patient has a $200
deductible, which has not been met. Which of the following will happen? ✔Correct Answer-The
patient will be billed $80.
The allowed amount is now the cost of the service, so since the deductible is not met, the patient
will be responsible for the entire $80.
Which of the following documents from the insurance carrier should the payment poster read and
post the payments or contractual adjustments to the patient account? ✔Correct Answer-
remittance advice.
A remittance advice is used to post payments from insurance carriers.
The insurance and coding specialist received an EOB and is posting the payments to the patient
accounts. According to the following information below, how much does the patient still owe for this
service?
Non-participating provider
Copay: $20, paid at time of service
Deductible amount that patient paid: $100
Accepted fee for service: $250
Insurance payment: $75 ✔Correct Answer-$55
Total charges are $250.00 of which the patient has paid $20.00 and $100.00. This now leaves a
balance of $130.00, of which the insurance company paid $75.00. This now leaves a balance due
from the patient of $55.00.
Which of the following are the steps to posting a Medicare payment to the patient's account?
✔Correct Answer-Review the EOB., Adjust any contractual agreements., Send the billing statement if
there is a balance.
,First the EOB should be reviewed to make sure all the information is correct and the correct patient is
credited. Any payments are posted and all the adjustments are made. Once these tasks are finished,
the system will generate a statement of any balances due to send to the patient. There is no need to
check the copay since the system will automatically have this information on the statement to the
patient.
Which of the following does a thorough understanding of the Explanation of Benefits (EOB) supplied
by the payer allow the insurance and coding specialist to do? ✔Correct Answer-Apply write-offs.,
Bill patients correctly., Resolve payment issues.
Which of the following information will the insurance and coding specialist need to apply the
payment correctly when in receipt of an insurance EOB and check for payment? ✔Correct Answer-
account number, date of service, patient name
The difference between the billed amount and the allowed amount for services from a participating
provider is ✔Correct Answer-adjusted by the provider.
When a patient sees a participating provider, he receives a discount. This discounted amount is called
the allowed amount. The difference between the billed amount and the allowed amount cannot be
charged to the patient when seeing a participating provider.
The patient makes a co-payment of $50. To which section of the patient's account should the
payment be applied? ✔Correct Answer-Credit
Which of the following is used to post patient payments in provider offices, electronically or
manually? ✔Correct Answer-ledgers
The ledger keeps track of all payments and outstanding balances for the patients
A third party payer sent a report to the hospital explaining the payments of multiple claims
submitted for ten patients in the month of November. Which of the following is the title of that
document? ✔Correct Answer-remittance advice
A remittance advice is used to post payments from insurance carriers. It will explain the reasons for
payments or denials, the allowable amounts, copayments, patient balances, etc. A remittance advice
is sent monthly and includes all of the patients seen by that practice, with that insurance.
What is the correct process for posting the electronic remittance advice and Explanation of Benefits
to the patient's account? ✔Correct Answer-Upload information from the carrier file, adjust and
save
The payer provided the following information on a patient's account:
Charge - $189.00
Discounted Amount - $74.59
Patient Responsibility - $30.00
Amount Paid to Provider - $84.41
What is the payer allowed amount for this claim? ✔Correct Answer-$114.41
The allowed amount in this scenario can be found using one of two methods. The first is to take the
charge amount ($189) and subtract the discounted amount ($74.59), which would be $189- $74.59 =
$114.41. The second is to take the patient's responsibility ($30) and add it to the amount paid to the
provider ($84.41), which would be $30 + $84.41 = $114.41.
, Which of the following managed care payer denials indicates front end user error? ✔Correct
Answer-incorrect insurance information
When dealing with a Medicare denied claim, it is appropriate to write off the amount denied when
the claim was submitted ✔Correct Answer-for experimental procedures.
What will help prevent a denied claim? ✔Correct Answer-verifying frequency limitations,
determining the need for prior approval, verifying coverage of a chosen diagnosis
A claim which has not been adjudicated due to errors is ✔Correct Answer-rejected.
A rejected claim is one that has not been processed (adjudicated) because there are errors.
Which of the following is the correct term for an insurance claim submitted with errors? ✔Correct
Answer-dirty.
A dirty claim is a claim that is submitted with errors, such as missing information or information
entered into the wrong fields.
What are typical reasons for a claim to be rejected by a clearinghouse? ✔Correct Answer-invalid
ICD code(s), invalid CLIA number
A Medicare patient received service on January 10th. The claim was rejected for reason: Patient not
eligible for benefits for submitted dates. What should the insurance and coding specialist do first?
✔Correct Answer-Review the claim against registration materials for accuracy.
When a Medicare beneficiary receives services that may not be payable, the Insurance Billing
Specialist must always check to see if there is an Advance Beneficiary Notice (of Noncoverage) on file
and signed by the patient for the services rendered.
The rejected claim report identified two errors which require immediate attention. What errors
should the billing and coding specialist expect to find on this report? ✔Correct Answer-The
beneficiary's name is incomplete or missing., The insurance identification number is invalid.
A rejection report identifies claims that have not been processed. These claims require correction
and resubmission.
What are legitimate reasons for a claim to be rejected? ✔Correct Answer-Physician's credentials
are not valid., Diagnostic pointers are missing., The billing location is missing.
What are likely reasons for a claim to be rejected? ✔Correct Answer-preauthorization not
obtained, incorrect DOB, incorrect insurance information
What are the most common reasons for a claim to be rejected? ✔Correct Answer-transposed
numbers, invalid POS, incorrect DOB
A method of payment in which the carrier pays the provider a fixed amount per patient, regardless of
the number of visits or types of services? ✔Correct Answer-capitation
Capitation is used with HMO insurance companies. The PCP is paid a flat fee per patient within the
plan. It does not matter if the patient is seen several times per month or not at all.
In order to ensure that all monies owed to the practice are collected, the insurance and coding
specialist should sort ✔Correct Answer-aging reports.
Aging reports are used to keep track of all money that is owed to the practice and the length of time
it has been outstanding.
& 100% VERIFIED ANSWERS|ACTUAL COMPLETE EXAM
|ALREADY GRADED A+
It is important to make the patient aware of the mailing address, interest rates, and length of
agreement when setting up a ✔Correct Answer-payment arrangement.
What is the correct term for a doctor who enters into an agreement with a third party payer on
charges, discounts, and services rendered to their policyholders within the network? ✔Correct
Answer-PAR (participating provider) a physician who enters into an agreement with a payer to offer
discounts on charges rendered to their policy holders.
What should a practice's financial policy always explain? ✔Correct Answer-what is required from
the patient and when payment is due
A patient had a procedure which was billed at $200.00. The allowed amount was $150.00 and he has
$50.00 left to meet of his deductible. His co-insurance is 20%. How much does the patient owe?
✔Correct Answer-$80
The patient in this question is responsible for 20%. $150 allowed amount. 20% of $150 allowed is
$30. Patient still owes $50 deductible. Patient would owe $80 total.
The physician charges $100 for a visit. The insurer allowable amount is $80. The patient has a $200
deductible, which has not been met. Which of the following will happen? ✔Correct Answer-The
patient will be billed $80.
The allowed amount is now the cost of the service, so since the deductible is not met, the patient
will be responsible for the entire $80.
Which of the following documents from the insurance carrier should the payment poster read and
post the payments or contractual adjustments to the patient account? ✔Correct Answer-
remittance advice.
A remittance advice is used to post payments from insurance carriers.
The insurance and coding specialist received an EOB and is posting the payments to the patient
accounts. According to the following information below, how much does the patient still owe for this
service?
Non-participating provider
Copay: $20, paid at time of service
Deductible amount that patient paid: $100
Accepted fee for service: $250
Insurance payment: $75 ✔Correct Answer-$55
Total charges are $250.00 of which the patient has paid $20.00 and $100.00. This now leaves a
balance of $130.00, of which the insurance company paid $75.00. This now leaves a balance due
from the patient of $55.00.
Which of the following are the steps to posting a Medicare payment to the patient's account?
✔Correct Answer-Review the EOB., Adjust any contractual agreements., Send the billing statement if
there is a balance.
,First the EOB should be reviewed to make sure all the information is correct and the correct patient is
credited. Any payments are posted and all the adjustments are made. Once these tasks are finished,
the system will generate a statement of any balances due to send to the patient. There is no need to
check the copay since the system will automatically have this information on the statement to the
patient.
Which of the following does a thorough understanding of the Explanation of Benefits (EOB) supplied
by the payer allow the insurance and coding specialist to do? ✔Correct Answer-Apply write-offs.,
Bill patients correctly., Resolve payment issues.
Which of the following information will the insurance and coding specialist need to apply the
payment correctly when in receipt of an insurance EOB and check for payment? ✔Correct Answer-
account number, date of service, patient name
The difference between the billed amount and the allowed amount for services from a participating
provider is ✔Correct Answer-adjusted by the provider.
When a patient sees a participating provider, he receives a discount. This discounted amount is called
the allowed amount. The difference between the billed amount and the allowed amount cannot be
charged to the patient when seeing a participating provider.
The patient makes a co-payment of $50. To which section of the patient's account should the
payment be applied? ✔Correct Answer-Credit
Which of the following is used to post patient payments in provider offices, electronically or
manually? ✔Correct Answer-ledgers
The ledger keeps track of all payments and outstanding balances for the patients
A third party payer sent a report to the hospital explaining the payments of multiple claims
submitted for ten patients in the month of November. Which of the following is the title of that
document? ✔Correct Answer-remittance advice
A remittance advice is used to post payments from insurance carriers. It will explain the reasons for
payments or denials, the allowable amounts, copayments, patient balances, etc. A remittance advice
is sent monthly and includes all of the patients seen by that practice, with that insurance.
What is the correct process for posting the electronic remittance advice and Explanation of Benefits
to the patient's account? ✔Correct Answer-Upload information from the carrier file, adjust and
save
The payer provided the following information on a patient's account:
Charge - $189.00
Discounted Amount - $74.59
Patient Responsibility - $30.00
Amount Paid to Provider - $84.41
What is the payer allowed amount for this claim? ✔Correct Answer-$114.41
The allowed amount in this scenario can be found using one of two methods. The first is to take the
charge amount ($189) and subtract the discounted amount ($74.59), which would be $189- $74.59 =
$114.41. The second is to take the patient's responsibility ($30) and add it to the amount paid to the
provider ($84.41), which would be $30 + $84.41 = $114.41.
, Which of the following managed care payer denials indicates front end user error? ✔Correct
Answer-incorrect insurance information
When dealing with a Medicare denied claim, it is appropriate to write off the amount denied when
the claim was submitted ✔Correct Answer-for experimental procedures.
What will help prevent a denied claim? ✔Correct Answer-verifying frequency limitations,
determining the need for prior approval, verifying coverage of a chosen diagnosis
A claim which has not been adjudicated due to errors is ✔Correct Answer-rejected.
A rejected claim is one that has not been processed (adjudicated) because there are errors.
Which of the following is the correct term for an insurance claim submitted with errors? ✔Correct
Answer-dirty.
A dirty claim is a claim that is submitted with errors, such as missing information or information
entered into the wrong fields.
What are typical reasons for a claim to be rejected by a clearinghouse? ✔Correct Answer-invalid
ICD code(s), invalid CLIA number
A Medicare patient received service on January 10th. The claim was rejected for reason: Patient not
eligible for benefits for submitted dates. What should the insurance and coding specialist do first?
✔Correct Answer-Review the claim against registration materials for accuracy.
When a Medicare beneficiary receives services that may not be payable, the Insurance Billing
Specialist must always check to see if there is an Advance Beneficiary Notice (of Noncoverage) on file
and signed by the patient for the services rendered.
The rejected claim report identified two errors which require immediate attention. What errors
should the billing and coding specialist expect to find on this report? ✔Correct Answer-The
beneficiary's name is incomplete or missing., The insurance identification number is invalid.
A rejection report identifies claims that have not been processed. These claims require correction
and resubmission.
What are legitimate reasons for a claim to be rejected? ✔Correct Answer-Physician's credentials
are not valid., Diagnostic pointers are missing., The billing location is missing.
What are likely reasons for a claim to be rejected? ✔Correct Answer-preauthorization not
obtained, incorrect DOB, incorrect insurance information
What are the most common reasons for a claim to be rejected? ✔Correct Answer-transposed
numbers, invalid POS, incorrect DOB
A method of payment in which the carrier pays the provider a fixed amount per patient, regardless of
the number of visits or types of services? ✔Correct Answer-capitation
Capitation is used with HMO insurance companies. The PCP is paid a flat fee per patient within the
plan. It does not matter if the patient is seen several times per month or not at all.
In order to ensure that all monies owed to the practice are collected, the insurance and coding
specialist should sort ✔Correct Answer-aging reports.
Aging reports are used to keep track of all money that is owed to the practice and the length of time
it has been outstanding.
