NHA
2024-2025
CBCS
Practice
Questions
(Set 2)
,Terms in this set (150)
Original
Which of the following is considered Protected Health Information (PHI) under the
Health Insurance Portability and Accountability Act (HIPPA)?
Patient's email address
Emily, a 45-year old patient, has recently been diagnosed with a chronic condition that
requires ongoing treatment. Her primary insurance is through her employer, but she
also has a secondary insurance through her spouse's employer. When submitting
claims for Emily's treatment, what is the correct order of billing to ensure proper
coordination of benefits?
Submit the claim to the primary insurance first, then the secondary insurance
Dr. Smith preformed a minor surgical procedure on John Doe at an outpatient surgery
center. Which place of service code should be used for this procedure?
24- procedures performed in an ambulatory surgery center ASC)
Sarah, a medical billing specialist, is reviewing the account of a patient named John
Doe. She notices that the insurance company has a lack of pre-authorization for a
specific procedure. What is the best course of action for Sarah to take to resolve this
issue?
Obtain the necessary pre-authorization and then resubmit the claim
Dr. Smith is submitting a CMS-1500 claim form for patient named John Doe, who
received outpatient services covered by medicare. Which section of the CMS-1500 form
should Dr. Smith complete to indicate the type of insurance plan covering John Doe?
- Box 1a- insured's ID Number
- Box 11- Insured Policy Group or FECA number
- Box 1- Insurance Type
- Box 24- Service Line Information
Box 1- Insurance Type
Which of the following is a primary purpose of internal audits in the context of medical
billing and coding?
To identify the correct coding errors before claim submissions
Dr. Smith's office received a request from John Does insurance company for his medical
records to process a claim. According to HIPPA regulations, what is the most
appropriate action for Dr. Smith's office to take?
Provide only the minimum necessary information required to process the claim
When coding for Obstetrics, which of the following codes is used to indicate a routine
prenatal visit with no complications?
- Z34.00: Routine prenatal for normal first pregnancy no complications
- O09.89: Supervision of high risk pregnancy
- Z33.1: Encounter for pregnancy test
- O10.11: Pre-existing hypertension complicating pregnancy
, Z34.00: Routine prenatal for normal first pregnancy no complications
Sarah, a patient. has recently filled for bankruptcy. As a medical billing specialist, what
is the appropriate action to take regarding her outstanding medical bills?
Cease all collection activities and notify the bankruptcy court
When coding for telemedicine services, which modifier should be appended to indicate
the service was provided via Telehealth?
Modifier 95
When a patient has multiple insurance plans, which insurance plan is typically
considered the primary insurance?
The insurance plan provided by the patients employer
Sarah, a medical billing specialist, is verifying insurance eligibility for a patient named
John who has a commercial insurance plan. Which of the following is a requirement she
must fulfill to ensure that John's insurance eligibility is verified correctly?
Confirm the patient's policy number and group number
Which of the following is the most crucial step in ensuring all applicable charges are
captured for optimal reimbursement?
Reviewing patient encounter forms and progress notes
Sarah, a patient with a PPO insurance plan, needs to undergo a specialized surgery.
Her preferred surgeon is out-of-network. Which of the following steps should Sarah take
to understand her out-of-network coverage and potential costs?
Contact her insurance company to verify out-of-network benefits and obtain
pre-authorization
What is the first step in the insurance eligibility and benefits verification process?
Verifying a patient's insurance coverage
Sarah visits her primary care physician for a routine check-up. Her insurance plan has
20% coinsurance rate after meeting a $200 deductible. The total bill for the visit is $500
, and Sarah has already met her deductible for the year.How much is Sarah responsible
for paying out-of-pocket for this visit?
- $100
- $200
- $300
- $400
$100
When coding for a total knee arthroplasty in an orthopedic speciality, which of the
following CPT codes is the most appropriate?
27447
What is the primary purpose of a deductible in a health insurance policy?
To ensure the patient shares in the cost of their healthcare services
Which of the following government insurance plans primarily covers individuals aged 65
and older, as well as certain individuals with disabilities?
2024-2025
CBCS
Practice
Questions
(Set 2)
,Terms in this set (150)
Original
Which of the following is considered Protected Health Information (PHI) under the
Health Insurance Portability and Accountability Act (HIPPA)?
Patient's email address
Emily, a 45-year old patient, has recently been diagnosed with a chronic condition that
requires ongoing treatment. Her primary insurance is through her employer, but she
also has a secondary insurance through her spouse's employer. When submitting
claims for Emily's treatment, what is the correct order of billing to ensure proper
coordination of benefits?
Submit the claim to the primary insurance first, then the secondary insurance
Dr. Smith preformed a minor surgical procedure on John Doe at an outpatient surgery
center. Which place of service code should be used for this procedure?
24- procedures performed in an ambulatory surgery center ASC)
Sarah, a medical billing specialist, is reviewing the account of a patient named John
Doe. She notices that the insurance company has a lack of pre-authorization for a
specific procedure. What is the best course of action for Sarah to take to resolve this
issue?
Obtain the necessary pre-authorization and then resubmit the claim
Dr. Smith is submitting a CMS-1500 claim form for patient named John Doe, who
received outpatient services covered by medicare. Which section of the CMS-1500 form
should Dr. Smith complete to indicate the type of insurance plan covering John Doe?
- Box 1a- insured's ID Number
- Box 11- Insured Policy Group or FECA number
- Box 1- Insurance Type
- Box 24- Service Line Information
Box 1- Insurance Type
Which of the following is a primary purpose of internal audits in the context of medical
billing and coding?
To identify the correct coding errors before claim submissions
Dr. Smith's office received a request from John Does insurance company for his medical
records to process a claim. According to HIPPA regulations, what is the most
appropriate action for Dr. Smith's office to take?
Provide only the minimum necessary information required to process the claim
When coding for Obstetrics, which of the following codes is used to indicate a routine
prenatal visit with no complications?
- Z34.00: Routine prenatal for normal first pregnancy no complications
- O09.89: Supervision of high risk pregnancy
- Z33.1: Encounter for pregnancy test
- O10.11: Pre-existing hypertension complicating pregnancy
, Z34.00: Routine prenatal for normal first pregnancy no complications
Sarah, a patient. has recently filled for bankruptcy. As a medical billing specialist, what
is the appropriate action to take regarding her outstanding medical bills?
Cease all collection activities and notify the bankruptcy court
When coding for telemedicine services, which modifier should be appended to indicate
the service was provided via Telehealth?
Modifier 95
When a patient has multiple insurance plans, which insurance plan is typically
considered the primary insurance?
The insurance plan provided by the patients employer
Sarah, a medical billing specialist, is verifying insurance eligibility for a patient named
John who has a commercial insurance plan. Which of the following is a requirement she
must fulfill to ensure that John's insurance eligibility is verified correctly?
Confirm the patient's policy number and group number
Which of the following is the most crucial step in ensuring all applicable charges are
captured for optimal reimbursement?
Reviewing patient encounter forms and progress notes
Sarah, a patient with a PPO insurance plan, needs to undergo a specialized surgery.
Her preferred surgeon is out-of-network. Which of the following steps should Sarah take
to understand her out-of-network coverage and potential costs?
Contact her insurance company to verify out-of-network benefits and obtain
pre-authorization
What is the first step in the insurance eligibility and benefits verification process?
Verifying a patient's insurance coverage
Sarah visits her primary care physician for a routine check-up. Her insurance plan has
20% coinsurance rate after meeting a $200 deductible. The total bill for the visit is $500
, and Sarah has already met her deductible for the year.How much is Sarah responsible
for paying out-of-pocket for this visit?
- $100
- $200
- $300
- $400
$100
When coding for a total knee arthroplasty in an orthopedic speciality, which of the
following CPT codes is the most appropriate?
27447
What is the primary purpose of a deductible in a health insurance policy?
To ensure the patient shares in the cost of their healthcare services
Which of the following government insurance plans primarily covers individuals aged 65
and older, as well as certain individuals with disabilities?
