Which of the following describes the reason for a claim rejection because of Medicare ncci edits? - Improper code combinations
A claim is submitted
... [Show More] with a transposed insurance member ID number and returned to the provider. Which of the following describes the status that should be assigned to the claim by the carrier? - invalid
Medigap coverage is offered to Medicare beneficiaries by which of the following? - Private third-party payers
Which of the following provisions ensures that an insureds benefits from all insurance companies do not exceed 100% of allowable medical expenses? - coordination of benefits
A coroner's autopsy is comprised of what examinations? - Gross examination
Which of the following statements is true regarding the release of patients records? - Patient access to psychotherapy notes may be restricted
Which of the following actions by a billing and coding specialist would be considered fraud? - billing for services not provided
Which of the following components of an explanation of benefits expedites the process of a phone appeal? - claim control number
On the cms-1500 claim form, blocks 14 through 33 contain information about which of the following? - The patient's condition and the provider's information
A billing and coding specialist should understand that the financial records source that is generated by a providers office is called a - Patient ledger account
Which of the following medical terms refers to the sac that causes the heart - Pericardium
Hipaa transaction standards apply to which of the following entities? - Health care clearinghouses
All dependents 10 years of age or older are required to have which of the following for tricare? - Military identification
The standard medical abbreviation ECG refers to a test used to assess which of the following body systems? - cardiovascular system
Which of the following is an example of a violation of an adult patient confidentiality? - Patient information was disclosed to the patient's parent without consent
Claims that are submitted without an NPI number will delay payment to the provider because - the number is needed to identify the provider
Which of the following sections of the medical record is used to determine the correct evaluation and management code used for billing and coding? - history and physical
Which of the following actions should be taken if an insurance company denies a service as not medically necessary? - Appeal the decision with a provider's report
Which of the following is the portion of the account balance the patient must pay after services are rendered in the annual deductible is met? - coinsurance
Which of the following is the function of the respiratory system? - Oxygenating blood cells
Which of the following describes a delinquent claim? - The claim is overdue for payment
Which of the following actions should be billing and coding specialist take if he observes a colleague and on ethical situation? - Report the incident to a supervisor
A participating Blue Cross Blue Shield provider receives an explanation of benefits for a patient account. The charge amount was $100. Blue Cross Blue Shield allowed $80 and applied $40 to the patient's annual deductible. Blue Cross Blue Shield paid the balance at 80%. How much should the patient expect to pay? - $48
Which of the following statements is correct regarding a deductible? - The deductible is the patient's responsibility
A physician ordered a comprehensive metabolic panel for 70-year-old patient who has Medicare as her primary insurance. Which of the following forms is required so no she may be responsible for payment? - Advance beneficiary notice
Which of the following is the purpose of pre-certification? - Verification of coverage
Which of the following claims is submitted and then optically skin by the insurance carrier and converted to an electronic form? - Paper claim
Which of the following information is required on a patient account record? - Name and address of guarantor
Which of the following includes procedures in best practices for correct coding? - Coding compliance plan
A patient who has a primary malignant neoplasm of the lung should be referred to which of the following specialist? - Pulmonary oncologist
A provider performs an examination of a patient's sore throat during an office visit. Which of the following describes a level of the examination? - Problem focused examination
To be compliant with Hipaa which of the following positions should be assigned in each office? - privacy officer
Which of the following indicates a claim should be submitted on paper instead of electronically? - The claim requires an attachment
Which of the following should the billing and coding specialist include in an authorization to release information? - the entity to whom the information is to be released
In the anesthesia section of the CPT manual which of the following are considered qualifying circumstances? - add-on codes
When submitting a clean claim with a diagnosis of kidney stones which of the following procedure names is correct? - nephrolithiasis
Ambulatory surgery centers home health care and hospice organizations use the - UB-04 claim form
Which of the following describes an obstruction of the urethra? - Urethratresia
The >< symbol is used to indicate new and revised text other than which of the following? - procedure descriptors
A patient's health plan is referred to as the pair of last resort. The patient is covered by which of the following health plans - Medicaid
Which part of Medicare covers prescriptions - Part D
Which of the following actions by the billing and coding specialist prevent fraud? - Performing periodic audits
A patient who is an active member of the military recently returned from overseas and is in need of specialty care. The patient does not have anyone designated with power of attorney. Which of the following is considered a HIPAA violation? - The billing and coding specialist sends the patient's records to the patient's partner
Which of the following is used to code diseases, injuries, impairments, and other health related problems? - International Classification of Diseases (ICD)
An insurance claims register (aged insurance report) facilitates which of the following? - follow up of insurance claims by date
Which of the following is the verbal or written agreement and that gives approval to some action, situation, or a statement, and allows the release of patient information? - consent, agreement
A dependent child whose parents both have insurance. The billing and coding specialist uses the birthday rule to determine which insurance policy is primary. Which of the following describes the birthday rule? - The parent whose birthday comes first in the calendar year
The star symbol in the CPT code book is used to indicate which of the following - Telemedicine
A patient's portion of the bill should be discussed with the patient before procedure is performed for which of the following reasons? - To ensure the patient understands his portion of the bill
A deductible of $100 is applied to a patient's remittance advice. The provider request the account personnel write it off. Which of the following terms describes this scenario? - Fraud
When posting Payment accurately, which of the following items should the billing and coding specialist include? - Patient's responsibility
On the CMS 1500, blocks one through 13 include which of the following? - The patient's demographics
Which of the following blocks should be billing and coding specialist to complete on the CMS 1500 claim form for procedures, services, or supplies? - 24D
Which of the following is the primary function of the heart? - Pumping blood in the circulatory system
A patient's employer has not submitted a premium payment. Which of the following claim status it should be provider received from the third-party payer? - Denied
Which of the following types of claims is 120 days old? - Delinquent
A nurse is reviewing a patient's lab results prior to discharge and discovers an elevated glucose level. Which of the following healthcare providers should be alerted before the nurse can proceed with discharge planning? - The attending physician
Which of the following is considered the final determination of the issues involving settlement of an insurance claim? - adjudication
Urine moves from the kidneys to the bladder through which of the following parts of the body? - ureters
A provider charge $500 to a claim that had an allowable amount of 400. In which of the following columns show the billing and coding specialist apply the non-allowed charge? - Adjustments
Which of the following blocks requires the patient's authorization to release medical information to process a claim? - Block 12
Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - Operative report
Which of the following privacy measures ensure is protected health information (phi)? - Using data encryption software on office workstations
As of April 1, 2014 which is the maximum number of diagnosis that can be reported on the CMS 1500 claim form before a further claim is required - 12
Why does correct claim processing rely on accurately completed encounter forms? - They streamline patient billing by summarizing the services rendered for a given date of service
Which of the following is the advantage of electronic claim submissions? - Claims are expedited
Which of the following as a private insurance carrier - Blue Cross Blue Shield
The billing and coding specialist should first divide the evaluation and management code by which of the following? - place of service
A claim can be denied or rejected for which of the following reasons? - Block 24D contains the diagnosis code
Which of the following color formats allows optical scanning of the CMS 1500 claim form - Red
Which of the following actions should be taken first when reviewing a delinquent claim? - Verify the age of the account
Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes which of the following procedures - angioplasty
A patient presents to the provider with chest pain and shortness of breath. After an unexpected ECG result, the provider calls a cardiologist and summarizes the patient's symptoms. Which portion of Hipaa allows the provider to speak to the cardiologist prior to obtaining the patient's consent? - Title II
Which of the following shows outstanding balances? - Aging report
A patient with a past due balance request that his records be sent to another provider. Which of the following actions should be taken? - Accommodate the request and send the records
Which of the following plane divides the body into left and right - Sagittal
According to hipaa standards, which of the following identifies the rendering provider on the CMS 1500 claim form in black 24J? - NPI
Which of the following terms describes on a plan pays 70% of the allowed amount and the patient pays 30% - Coinsurance
Which of the following should the billing and coding specialist complete to be reimbursed for the provider services? - CMS 1500 claim form
Which of the following information should the billing and coding specialist input into black 33a on the CMS 1500 claim form? - National provider identification number (npi)
A patient comes to the hospital for an inpatient procedure. Which of the following hospital staff members is responsible for the initial patient interview, obtaining demographic and j surname information, and documenting the chief complaint? - Admitting clerk
All email correspondence to a third-party payer containing a patient's protected health information (phi) should be - Encrypted
A patient is upset about a bill she received. Her insurance company denied the claim. Which of the following actions is an appropriate way to handle the situation - Inform the patient of the reason for the denial
When coding on the UB 04 form the billing and coding specialist must sequence the diagnoses codes according to the ICD guidelines. Which of the following is the first listed a diagnosis code - Principal diagnosis
Which of the following is a hipaa compliance guideline affecting electronic health records? - The electronic transmission and code set standards require every provider to use the healthcare transactions, code sets, and identifiers.
Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? - UB-04
A form that contains dos, cpt codes, icd codes, fees, and copayment information is called which of the following? - Encounter form
A patient has aarp as secondary insurance. And which of the following blocks on the CMS 1500 claim form so this information be entered - Block 9
Which of the following is the purpose of running an aging report each month? - It indicates which claims are outstanding
When completing a CMS 1500 paper claim form, which of the following is an acceptable action for the billing and coding specialist to take - Use Ariel size 10 font
A physician is contracted with an insurance company to accept the allowed amount. The insurance company allows $80 over $120 bill amount, and $50 of the deductible has not been met. How much should the physician right off the patient's account? - $40
The position bills $500 to a patient. After submitting the claim to the insurance company, the claim is sent back with no payment. The patient so I was $500 for the year. This amount is called which of the following? - Deductible
Which of the following actions should be taken on a claim is billed for a level 4 office visit and paid at a level 3? - Submit an appeal to the carrier with the supporting documentation
Which of the following does a patient sign to allow payment of claims directly to the provider? - assignment of benefits
The unlisted codes can be found in which of the following locations in the CPT manual? - Guidelines prior to each section
On a remittance advice form, which of the following is responsible for writing off the difference between the amount billed in the amount allowed by the agreement? - provider
In which of the following departments should I patient be seen for psoriasis? - Dermatology
Which of the following is one of the purposes of an internal auditing program at physicians office? - Verifying that the medical records and the billing record match
Which of the following do physicians use to electronically submit claims? - Clearinghouse [Show Less]