Which of the following is considered the final determination of the issues involving settlement of an
insurance claim? - Ans-Adjudication
A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called
which of the following? - Ans-Encounter form
A patient come...
Which of the following is considered the final determination of the issues involving settlement of an
insurance claim? - Ans-Adjudication
A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called
which of the following? - Ans-Encounter form
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 insurance
information, and documenting the chief complaint? - Ans-Admitting clerk
Which of the following privacy measures ensures protected health information (phi)? - Ans-Using
data encryption software on office workstations
Which of the following planes divides the body into left and right? - Ans-Sagittal
Which of the following provisions ensures that an insured's benefits from all insurance companies
do not exceed 100% of allowable medical expenses? - Ans-Coordination of benefits
Which of the following actions should be taken first when reviewing a delinquent claim? - Ans-Verify
the age of the account
Which of the following is the advantage of electronic claim submission? - Ans-Claims are expedited
Which of the following components of an explanation of benefits expedites the process of a phone
appeal? - Ans-Claim control number
,The standard medical abbreviation ECG refers to a test used to assess which of the following body
systems? - Ans-Cardiovascular system
Which of the following actions by a billing and coding specialist would be considered fraud? - Ans-
Billing for services not provided
The >< symbol is used to indicate a new and revised test other than which of the following? - Ans-
Procedure descriptors
On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the
following? - Ans-The patient's condition and the provider's information
Which of the following includes procedures and best practices for correct coding? - Ans-Coding
Compliance Plan
When completing a CMS-1500 paper claim form, which of the following is an acceptable action for
the billing and coding specialist to take? - Ans-Use arial size 10 font
A participating blue cross/blue shield (BC/BS) provider receives an explanation of benefits for a
patient account. The charged amount was $100. BC/BS allowed $80 and applied $40 to the patient's
annual deductible. BC/BS paid the balance at 80%. How much should the patient expect to pay? -
Ans-$48
Which of the following indicates a claim should be submitted on paper instead of electronically? -
Ans-The claim requires an attachment
According to HIPAA standards, which of the following identifies the rendering provider on the CMS-
1500 claim form in block 24j? - Ans-NPI
Which of the following blocks should the billing and coding specialist complete on the CMS-1500
claim form form for procedures, services or supplies (CPT/HCPCS)? - Ans-Block 24D
, Which of the following terms describes when a plan pays 70% of the allowed amount and the
patient pays 30%? - Ans-Coinsurance
A provider charged $500 to claim that had an allowable amount of $400. In which of the following
columns should the billing and coding specialist apply the non-allowed charge? - Ans-Adjustment
column of the credits
Which of the following is a HIPAA compliance guideline affecting electronic health records? - Ans-
The electronic transmission and code set standards require every provider to use the healthcare
transactions ,code sets and identifiers
Patient: Jane Austin; Social Security # 555-22-1111; Medicare ID: 555-33-2222A; DOB: 05/22/1945.
Claim information entered: Austin, Jane; Social Security #.: 555-22-1111; Medicare ID No.: 555-33-
2222A; DOB: 052245. Which of the following is a reason this claim was rejected? - Ans-The DOB is
entered incorrectly
Why does correct claim processing rely on accurately completed encounter forms? - Ans-They
streamline patient billing by summarizing the services rendered for a given date of service
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? - Ans-Medicaid
Which of the following color formats is acceptable on the CMS-1500 claim form? - Ans-Red
Which of the following is an example of a violation of an adult patient's confidentiality? - Ans-Patient
information was disclosed to the patient's parents without consent.
In the anesthesia section of the CPT manual, which of the following are considered qualifying
circumstances? - Ans-Add-on codes
Ambulatory surgery centers, home health care, and hospice organizations use the - Ans-UB-04 claim
form
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