STUDY EXAM
◉ Which of the following security features is required during
transmission of protected health information and medical claims to
third party payers?
-Unique used IDs and passwords
-Role based access controls
-Electronic data interchange
-Encryption. Answer: encryption
◉ Which of the following actions should the CBCS take to effectively
manage accounts receivable?
-Collect payment from the patient at the time of service
-Have the patient pat the balance up front and wait for
reimbursement
-Delay submission until the patient pays the deductible
-Ask the patient to pay half now and bill the insurance for the
balance. Answer: Collect payment from the patient at the time of
service
◉ Which of the following insurance carriers is considered the payer
of last resort?
,-Medicaid
-Medicare
-TRICARE
-Blue cross/shield. Answer: Medicaid
◉ Which of the following blocks on the CMS-1500 claim form is
required to indicate a worker's compensation claim?
11a
21
10a
22. Answer: 10a
-11a primary injured date of birth and gender
-21 diagnosis code
-22 Medicaid resubmission number
◉ The provision of health insurance policies that specifies which
coverage is considered primary or secondary is called?
-Eligibility verification
-Explanation of benefits
-Assignment of benefits
-Coordination of benefits. Answer: coordination of benefits
,◉ A provider receives a reimbursement from a third party payer
accompanied by with document?
-Monthly statement
-Explanation of benefits
-Age analysis
-Benefit summary sheet (guideline for billing). Answer: Explanation
of benefits
◉ When submitting claims, which of the following is the outcome if
block 13 is left blank?
-The provider accepts assignment and payment as payment in full
-The provider cannot collect deductible, copayment, and coinsurance
amounts
-This has no effect on the claim processing and reimbursement
-The third party payer reimburses the patient, and the patient is
responsible for reimbursing the provider. Answer: The third party
payer reimburses the patient, and the patient is responsible for
reimbursing the provider
◉ Which of the following situations constitutes a consultation?
- Services rendered by a physician whose opinion or advice is
required by another physician or agency.
- The physician needs to meet the family and the patient to discuss
the medical condition
, - The transfer of the total or specific care of a patient from one
physician to another for known problem
- The physician has had the initial treatment and needs to follow-up
with the patient regarding the care plan. Answer: Services rendered
by a physician whose opinion or advice is required by another
physician or agency.
◉ Which of the following billing patterns is the best practice action?
- Billing for diagnostic tests without a separate report in patient's
health record
- Billing the patient for the difference between the charges and the
allowed amounts
- Documenting the patient's chief complaint, history, exam,
assessment, and plan for care
- Separating service or procedure codes to increase reimbursement.
Answer: Documenting the patient's chief complaint, history, exam,
assessment, and plan for care
◉ When billing a secondary insurance, which block should the CBCS
fill out on the CMS-1500 form?
9a
28
24J
24F. Answer: 9a