A patient's health plan is referred to as the payer of last resort. The patient is covered by which of the following health
... [Show More] plans?
Medicaid
CHAMPA
Medicare
TRICARE
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
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
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
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
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
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
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.
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
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
$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
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
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
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
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
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
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
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.
It indicates which claims are outstanding [Show Less]