Billing and Coding Pretest 2022 COMPLETE SOLUTION, Graded A+

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Billing and Coding Pretest 2022 COMPLETE SOLUTION 107. Which of the following styles should a billing and coding specialist use to format a patient's date of birth on a CMS-1500 claim form? - ✔�... �O MMDDYYYY 106. A Medicare provider submits a CMS-1500 claim form that is rejected for payment. Which of the following should be a reason for the form's rejection? - ✔✔O Medical coverage was cancelled In which of the following locations should a billing and coding specialist find the contract information to appeal a claim? - ✔✔O Insurance company file A patient takes his medication as prescribed and experiences swollen lips. The billing and coding specialist should refer to which of the following sections of ICD-10-CM to identify the appropriate code? - ✔✔O Adverse effect A billing and coding specialist is reviewing a signed release of information form that does not have a date. Which of the following is correct regarding this release? - ✔✔O This release is not valid A patient's progress notes indicate that she is primigravida. Which of the following describes the patient's condition? - ✔✔O Pregnant for the first time A remittance advice states a denial of payment due to lack of preauthorization. Which of the following of actions should the billing and coding specialist take if the appendectomy was an emergency procedure? - ✔✔File an Appeal A clearinghouse rejects a claim that is missing the patient's date of birth. Which of the following actions should the billing and coding specialist take next? - ✔✔O Add the missing information and resubmit 74. Under the Health Insurance Portability and Accountability Act (HIPAA), which of the following scenarios requires patients authorization for the release of health information? - ✔✔O Using patient information for marketingAn omission clean claim from which of the following submission to a third party payer? blocks on the CMS-1500 claim form can prevent - ✔✔Diagnosis Which of the following procedures is an example of a code for removing cancer? - ✔✔O Excision of a fibrosarcoma O Aspiration of a breast cyst O Debridement of a pressure ulcer O Destruction of a benign lesion Which of the following medical terms is a procedure that is found on the fee schedule? - ✔✔Carpal tunnel syndrome O Laparoscopy O Endometriosis O Psoriasis On the CMS-1500 form, populating Block 6 with "Other" would indicate that the patient is the: - ✔✔O Insured O Guarantor O Dependent O Subscriber In the CPT-4 coding convention, the + is used to indicate which of the following? - ✔✔O An add-on code O A revised code O A resequenced code O A recycled CPT code The False Claims Act (FCA) was passed to penalize contractors who knowingly file false claims. Which of the following is considered a false claim? - ✔✔O Assigning diagnosis code to show medical necessity O Assigning procedure codes for reimbursement O Assigning an add-on procedure code for treatment rendered O Assigning diagnosis codes for increasing reimbursement of patient claims Which of the following reports should a billing and coding specialist use tor review and track balances from an insurance company by date of service? - ✔✔O Credit report O Claims report O Aging report O Audit report Which of the following forms is required to bill for a service that is not likely to be covered by Medicare? - ✔✔O Provider attestation form O Advance Beneficiary Notice O HIPAA privacy notice O Informed consent form Which of the following claims are submitted to the payer and await processing? - ✔✔O Unassigned claims O Claim appeals O Open claims O Closed claimsA family member of a patient calls requesting information. Prior to discussing anything related to the patient, the billing and coding specialist must ensure that which of the following documents is on file in the patient's chart? - ✔✔O Notice of Privacy Practices O Records release authorization O Treatment consent O Advance Beneficiary Notice Which of the following mandates the retention of patient records and health insurance claims for a minimum of 6 years unless state law specifies a longer period? - ✔✔O Tax Relief and Health Care Act O Office of Inspector General O Health Insurance Portability and Accountability Act O American Medical Billing ASsociation When a billing and coding specialist is filing a CMS-1500 claim form, the date must be in which of the following formats? - ✔✔O MMDDCC O MMDDYYYY O CCYYMMDD O YYMMDD Medicaid, Medicare, and Tricare are examples of which of the following types of health insurance? O Individual O Federally funded O Group O Privately funded - ✔✔O Federally funded When submitting a worker's following on the CMS-1500 form? compensation claim, the billing and coding specialist should populate which of the O Block 23 and 30 O Blocks 8 and 22 O Blocks 10 and 14 OBlocks 19 and 29 - ✔✔O Blocks 10 and 14 If the contracted rate for the office visit is $200, A patient has a coinsurance of 10%, a $20 copayment, what is the total out-of-pocket fee for this and has met annual deductible. patient? O $38 O $40 O $20 O $36 - ✔✔O $40 Which of the following describes the amount to collect at the time of service from a patient who has a health maintenance organization (HMO) plan? O Deductible O Copay O Fee for service O Coinsurance - ✔✔O Copay following describes Which of the following is the purpose of a remíttance advice? O To establish an electronic date exchange O To indicate a release of infomation has been signed O To communicate claims processing decisions O To provide a listing of in-network providers - ✔✔O To communicate claims processing decisionsWhich of the following organizations conducts investigations and audits that are in question regarding the privacy law? O Office of Inspector General O Centers for Medicare and Medicaid Services O Office of Civil Rights O Department of Insurance - ✔✔O Office of Inspector General Which of the following is the appropriate way to key a form for intelligent character recognition (ICR) scanning? O Use script, slant, or italicized fonts when entering information. O Use N/A or DNA when information is not applicable OEnter all information in uppercase letters O Strike over any errors when correcting letters or digits - ✔✔Enter all information in uppercase letters letters A patient's claim is denied, stating that the diagnosis code does not meet requirements for procedure or service. Which of the following is the next step in obtaining reimbursement? O Change the code O File an appeal O Send the patient a bill O Write off the balance - ✔✔O File an appeal A patient's authorization for release of information is usually valid for a standard period of which of the following amounts of time? O 45 days O 90 days O 120 days O 60 days - ✔✔O 120 days What is the time limit for a billing and coding specialist to file a Medicare claim? O 15 months from date of service O 18 months from date of service O 12 months from date of service O 6 months from date of service - ✔✔O 12 months from date of service 22. In the ICD-10-CM coding manual, which of the following terms is used to indicate a late effect? O Combination code Chronic O Sequela O External cause - ✔✔O Sequela 23. A billing and coding specialist submits a patient's claim for a surgical procedure. Further review by the insurance company is not example of which of the following types of clams? necessary before submitting payment. This is an O Clean O Pending O Incomplete O Rejected - ✔✔O Rejected A billing and coding specialist receives an explanation of benefits from an insurance carrier for an office visit with a cost of $120. The provider participates in the patient's insurance plan, the patient has remaining deductible of $52, and the plan pays 80%. Which of the following insurance payments should the specialist expect for this visit? O $54.40 O $68.80 O $52 O $76 - ✔✔O $54.40 Which of the following is considered abuse? O Altering claims to increase reimbursement O Changing dates and services to bill the claim O Reporting duplicate charges on a claim O Entering another patient's insurance information to ensure reimbursement - ✔✔O Reporting duplicate charges on a claim26. Which of the following should the billing and coding specialist use to monitor the revenue cycle and improve cash flow for a provider's practice? O Accounts payable report O Unapplied credit report O Accounts receivable report O Claims transmission report - ✔✔O Accounts payable report 28. An ICD-10-PCS alphanumeric code contains how many characters?O 7 O 6 O 5 O 4 - ✔✔O 7 29. Which of the following is the primary purpose of the Health Information Portability and Accountability Act (HIPAA) Title I? O To assist providers with preventing health care fraud and abuse O To provide tax benefits for specific health-related provision under HIPAA O To allow for health care access, portability, and renewability O To administer and inforce Healthcare Plan regulations - ✔✔O To allow dor healthcare acess, portability and renewability Which of the following procedures requires a modifier-507 O Appendectomy O Umbilectomy O Cholecystectomy O Mastectomy - ✔✔O Mastectomy The Civil Monetary Penalty statute includes which of the following provisions regarding health care fraud and abuse? O Assessment of a maximum penalty of three times the amount claimed by the provider O Penalties of no more than $10,000 per violation O Exclusion from nongovernment programs O Minimum 1 year in prison for first offenders - ✔✔O Penalties of no more than $10,000 per violation Which of the following organizations is responsible for providing National Coverage Determination (NCDS)? O Centers for Medicare and Medicaid Services (CMS) O Health Insurance Portability and Accountability Act (HIPAA) Ó National Center for Health Statistics (NCHS) O American Hospital Association (AHA) - ✔✔O Centers for Medicare and Medicaid Services (CMS) Which of the following entities works with Centers of Medicare and Medicaid Services to prevent overpayment? O Medicaid integrity contractors O Joint Commission O Recovery audit contractors O Quality improvement organization - ✔✔O Recovery audit contractors A patient who has Medicare part B is seen in the office by an in-network provider. The provider charges $200, and the allowable amount for this visit is $100. The patient still owes $60 on her deductible and has a 20% coinsurance. Which of the following is the required adjustment for this visit? O $40 O $100 O $110 O $60 - ✔✔O $100A clearinghouse is an entity that performs which of the following services? O Processes patient claims O Ensures clean claims are submitted O Changes diagnosis and procedure codes O Updates insurance information - ✔✔O Ensures clean claims are submitted O Discuss potential coding problems with the provider at least once per year. O Avoid continuing education about coding O Notify the supervisor only when an individual admits to fraud or abuse O Use the most up-to-date coding manuals - ✔✔O Use the most up-to-date coding manuals When interpreting an explanation of benefits (EOB), it is necessary for a billing and ooding specialist to know which of the following? O The payment matches the billed amount, less the copayment. O There is only one patient per remittane advice O The payment amount equals the billed amount O The EOB can include multiple patients on one form - ✔✔O The EOB can include multiple patients on one form A billing and coding specialist should use which of the following to determine if claims are delinquent? O Explanation of benefits O Remittance advice O Aging report Practice analysis report - ✔✔O Aging report When identical procedures or services are performed on the same day, which of the following should the billing and coding specialist update on the CMS-1500 form? O Modifier 59 Block 27 O Block 24G O Modifier 99 - ✔✔O Modifier 59 What is the correct format when entering an address onto a CMS-1500 form? O 7803 S Market Street Suite 203 O 7803 S, Market Street, Suite 203 O 7803 S. Market Street Suite 203 O 7803 S. Market Street, Suite 203 - ✔✔O 7803 S Market Street Suite 203 [Show More]

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