(Correct Answers)
A patient's health plan is referred to as the payer of last resort. The patient is covered by which of the
w w w w w w w w w w w w w w w w w w w w w
following health plans? w w
Medicaid
CHAMPA
Medicare
TRICARE - correct answer Medicaid
w w w w
A provider charged $500 to a claim that had an allowable amount of $400. In which of the following columns
w w w w w w w w w w w w w w w w w w w w
should the CBCS apply the non allowed charge?
w w w w w w w
-Reference column (For notations) w w w
-Description column w
-Payment column w
-Adjustment column of the credits - correct answer Adjustment column of the credits
w w w w w w w w w w w w
Which of the following statements is correct regarding a deductible?
w w w w w w w w w
-Coinsurance is a type of deductible w w w w w
-The physician should write off the deductible
w w w w w w
,-The insurance company pays for the deductible
w w w w w w
-The deductible is the patient's responsibility - correct answer The deductible is the patient's responsibility
w w w w w w w w w w w w w w
Which of the following color formats allows optical scanning of the CMS-1500 claim form?
w w w w w w w w w w w w w
-Red
-Blue
-Green
-black - correct answer red
w w w w
Ambulatory surgery centers, home health and hospice organizations use the ______.
w w w w w w w w w w
-CMS-1500 claim form w w
-UB-04 claim form w w
-Advance Beneficiary notice w w
-First report of injury form - correct answer UB-04
w w w w w w w w
Claims that are submitted without an NPI number will delay payment to the provider because ______.
w w w w w w w w w w w w w w w
-The number is the patient' id number
w w w w w w
-The number is needed to identify the provider
w w w w w w w
-Is is used as a claim number
w w w w w w
-It is used as a pre authorization number - correct answer The number is needed to identify the provider
w w w w w w w w w w w w w w w w w w
Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays
w w w w w w w w w w w w w w w w w w w
30%?
-Coinsurance
-Deductible
-Premium
-copayment - correct answer coinsurance w w w w
Which of the following indicates a claim should be submitted on paper instead of electronically?
w w w w w w w w w w w w w w
,-The software claims review process indicates the claim is not complete
w w w w w w w w w w
-The claim needs authorization
w w w
-The claim requires an attachment
w w w w
-The practice management software is non functional. - correct answer the claim requires an attachment
w w w w w w w w w w w w w w
On a remittance advice form, which of the following is responsible for writing off the difference between the
w w w w w w w w w w w w w w w w w w
amount billed and the amount allowed by the agreement?
w w w w w w w w
-Provider
-Insurance company w
-Patient
-Third party payer - correct answer provider
w w w w w w
A physician is contracted with an insurance company to accept the amount. The insurance company allows
w w w w w w w w w w w w w w w w
$80 of a $120 billed amount, and $50 of the deductible has not been met. How much should the physician
w w w w w w w w w w w w w w w w w w w w
write off the patient's account?
w w w w
-$40
-$15
-$0
-$50 - correct answer $40
w w w w
The unlisted codes can be found in which of the following locations in the CPT manual?
w w w w w w w w w w w w w w w
-Appendix L w
-Guidelines prior to each section w w w w
-End of each body system
w w w w
-Table of contents - correct answer Guidelines prior to each section
w w w w w w w w w w
Which of the following blocks should the billing and coding specialist complete the CMS 1500 claims form for
w w w w w w w w w w w w w w w w w w
procedure, services or supplies? w w w
-Block 12 w w
-Block 2 w w
, -Block 24D w
-Block 24J - correct answer Block 24D
w w w w w w
-Block 12 (patient's authorization block
w w w w
-Block 2 ( patient's name)
w w w w
-Block 24J ( for the rendering provider)
w w w w w w
Which of the following blocks requires the patient's authorization to release medical information to process
w w w w w w w w w w w w w w w
a claim?
w
Block 12w
Block 13w w
Block 27w w
Block 31 - correct answer Block 12
w w w w w w
- Block 13 patient authorization for benefits required for third party payer
w w w w w w w w w w w
- Block 27 accepting assignment of benefits
w w w w w w
- Block 31 (treating physician)
w w w w
Which of the following steps would be part of a physician's practice compliance program?
w w w w w w w w w w w w w
-HIPAA compliance audit
w w
-Physician recruitment w
-Internal monitoring and auditing w w w
-Notice of privacy practice - correct answer Internal monitoring and auditing
w w w w w w w w w w
Behavior plays an important part of being a team player in a medical practice. Which of the following is an
w w w w w w w w w w w w w w w w w w w w
appropriate action for the CBCS to take? w w w w w w
-Reprimanding another staff member during a team meeting for displaying a bad attitude toward a patient
w w w w w w w w w w w w w w w
-Looking in the medical record of a friend who receives services at the office
w w w w w w w w w w w w w
-Communicating with the front desk staff during a team meeting about missing information in patient files
w w w w w w w w w w w w w w w
-Questioning the nurse about the provider documentation in the medical record - correct answer
w w w w w w w w w w w w w w
Communicating with the front desk staff during a team meeting about missing information in patient files
w w w w w w w w w w w w w w w