A patient's health plan is referred to as the payer of last resort. The patient is covered by which of the following health plans? Medicaid CHAMPA Medicare TRICARE - ANSWER Medicaid A provider ... charged $500 to a claim that had an allowable amount of $400. In which of the following columns should the CBCS apply the non allowed charge? -Reference column (For notations) -Description column -Payment column -Adjustment column of the credits - ANSWER Adjustment column of the credits Which of the following statements is correct regarding a deductible? -Coinsurance is a type of deductible -The physician should write off the deductible -The insurance company pays for the deductible -The deductible is the patient's responsibility - ANSWER The deductible is the patient's responsibility Which of the following color formats allows optical scanning of the CMS-1500 claim form? -Red -Blue -Green -black - ANSWER red Ambulatory surgery centers, home health and hospice organizations use the ______. -CMS-1500 claim form -UB-04 claim form -Advance Beneficiary notice -First report of injury form - ANSWER UB-04 Claims that are submitted without an NPI number will delay payment to the provider because ______. -The number is the patient' id number -The number is needed to identify the provider -Is is used as a claim number -It is used as a pre authorization number - ANSWER The number is needed to identify the provider Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays 30%? -Coinsurance -Deductible -Premium -copayment - ANSWER coinsurance Which of the following indicates a claim should be submitted on paper instead of electronically? -The software claims review process indicates the claim is not complete -The claim needs authorization -The claim requires an attachment -The practice management software is non functional. - ANSWER the claim requires an attachment On a remittance advice form, which of the following is responsible for writing off the difference between the amount billed and the amount allowed by the agreement? -Provider -Insurance company -Patient -Third party payer - ANSWER provider A physician is contracted with an insurance company to accept the amount. The insurance company allows $80 of a $120 billed amount, and $50 of the deductible has not been met. How much should the physician write off the patient's account? -$40 -$15 -$0 -$50 - ANSWER $40 The unlisted codes can be found in which of the following locations in the CPT manual? -Appendix L -Guidelines prior to each section -End of each body system -Table of contents - ANSWER Guidelines prior to each section Which of the following blocks should the billing and coding specialist complete the CMS 1500 claims form for procedure, services or supplies? -Block 12 -Block 2 -Block 24D -Block 24J - ANSWER Block 24D -Block 12 (patient's authorization block -Block 2 ( patient's name) -Block 24J ( for the rendering provider) Which of the following blocks requires the patient's authorization to release medical information to process a claim? Block 12 Block 13 Block 27 Block 31 - ANSWER Block 12 - Block 13 patient authorization for benefits required for third party payer - Block 27 accepting assignment of benefits - Block 31 (treating physician) Which of the following steps would be part of a physician's practice compliance program? -HIPAA compliance audit -Physician recruitment -Internal monitoring and auditing -Notice of privacy practice - ANSWER Internal monitoring and auditing Behavior plays an important part of being a team player in a medical practice. Which of the following is an appropriate action for the CBCS to take? -Reprimanding another staff member during a team meeting for displaying a bad attitude toward a patient -Looking in the medical record of a friend who receives services at the office -Communicating with the front desk staff during a team meeting about missing information in patient files -Questioning the nurse about the provider documentation in the medical record - ANSWER Communicating with the front desk staff during a team meeting about missing information in patient files Which of the following acts applies to the administrative simplification guideline? -HIPAA -Deficit reduction act of 2005 -The patient protection and affordable care act 2009 -National correct coding initiative of 1995 - ANSWER HIPAA Which of the following is an example of a violation of an adult patient's confidentiality? -While reviewing a claim, the CBCS reads the diagnosis before realizing that the patient is a neighbor -A CBCS queries the physician about a diagnosis in a patient's medical record -The physician uses his home phone to discuss patient care with the nursing staff -Patient information was disclosed to the patient's parents without consent - ANSWER Patient information was disclosed to the patient's parents without consent Which of the following is the purpose of running an aging report each month? -If indicates the balances the patients owe the provider -It indicates which patients have upcoming or missed appointment -It indicates which claims are outstanding -It indicates what the insurance company has paid for the provider's services to a patient. - ANSWER It indicates which claims are outstanding Which of the following describes the status of a claim that does not include the required preauthorization for a service? -Delinquent (overdue) -Denied -Suspended -Adjudicated (claim still being processed) - ANSWER Denied -Delinquent (overdue) -Adjudicated (claim still being processed) Which of the following actions should the CBCS take to prevent fraud and abuse in the medical office? -Serviced procedure preauthorization -Internal monitoring and auditing -Utilization review -Correct coding initiative - ANSWER Internal monitoring and auditing In an outpatient setting, which of the following forms is used as a financial report of all services provided to patients? -Encounter form -Patient account record -CMS-1500 claim form -Accounts receivable journal - ANSWER Patient account record (patient ledger, all transactions between patient and the practice) -Accounts receivable journal (Day sheet = chronological summary of all transaction on a specific day) Patient charges that have not been paid will appear in which of the following? -Accounts receivable -Accounts payable -Tracer -Rejected claim - ANSWER Accounts receivable Which of the following is considered the final determination of the issues involving settlement of an insurance claim? -Processing -Translation -Adjudication -Transmission - ANSWER Adjudication (process of putting a claim through a series of edits for final determination) -Processing ( handling a claim from the first encounter to claim submission) -Translation (claim is send from the host system to the clearing house) -Transmission (how the claim was sent) Which of the following information should the CBCS input into block 33a on the CMS-1500 claim form -Provider social security number (no Social security number on CMS1500) -Federal tax id number (entered in block 25) -Patient id number (on block 1a) -National provider identification number - ANSWER National provider identification number A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which of the following documents? -A billing worksheet from the patient account -A superbill -A day sheet -Am accounts receivable report of the patient account - ANSWER A billing worksheet from the patient account When a patient has a condition that is both acute and chronic, how should it be reported? -Code only the acute code -Code both acute and chronic, sequencing the acute first -Code only the chronic code -Code both acute and chronic, sequencing the chronic first - ANSWER Code both acute and chronic, sequencing the acute first Which of the following types of health insurance plan best describes a government sponsored benefit program? -Unemployment compensation disability -TRICARE prime -Foundation for Medicare -Worker's compensation - ANSWER TRICARE prime -Unemployment compensation disability (state insurance covering non work related illness and injury) Accepting assignment on the CMS-1500 claim form indicates which of the following? -The patient agrees to accept payment and forward the payment to the physician -The physician agrees to accept payment under the terms of the payer's program. -The physician agrees to bill according the third payer's fee schedule -The patient agrees to pay the difference between the billed amount and the allowed amount - ANSWER The physician agrees to accept payment under the terms of the payer's program. Which of the following parts of the body system regulates immunity? -Endocrine system (regulates growth, metabolic) -Respiratory system (removes carbon dioxide) -Urinary system (filters blood to remove waste of cellular metabolism) -Lymphatic system - ANSWER Lymphatic system -Endocrine system (regulates growth, metabolic) -Respiratory system (removes carbon dioxide) -Urinary system (filters blood to remove waste of cellular metabolism) Which of the following sections of the medical record is used to determine the correct evaluation and management code to use for billing and coding? -Codes used during prior patient visits -Patient's insurance plan -Plan of care -History and physical - ANSWER History and physical A patient has met a Medicare deductible of $150. The patient's coinsurance is 20%, and the allowed amount is $600. Which of the following is the patient's out of pocket expense? -$450 -$300 -$120 -$150 - ANSWER $120 Which of the following is allowed when billing procedure codes? -Unbundling codes to ensure that all medical services were received and billed for -Billing using two digit CPT modifiers to indicate a procedure as performed differs from its usual five digit code -Billing for a surgical package with itemized codes -Referring to the ICD book for the accurate description of the procedural code. - ANSWER Billing using two digit CPT modifiers to indicate a procedure as performed differs from its usual five digit code Which of the following describes the content of a medical practice aging report? -An overview of the practice's net worth -An overview of the practice deposits. -An overview of the practice's debts -An overview of the practice's outstanding claims - ANSWER An overview of the practice's outstanding claims Which of the following is the correct term for an amount that has been determined to be uncollectible? -Discounted fee -Bad debt -Financial hardship -Professional courtesy - ANSWER bad debt Which of the following is the function of the respiratory system? -Deoxygenating blood cells -Oxygenating blood cells -Generating red blood cells -Generating white blood cells - ANSWER Oxygenating blood cells [Show More]
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