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NHA CBCS study guide Exam|271 Questions with 100% Accurate Answers
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NHA CBCS study guide Exam|271Questions with 100% Accurate Answers
When submitting claims, which of the following is the outcome if Block 13 is
left blank? - -The third-party payer reimburses the patient, and the patient is
responsible for reimbursing the provider
-Which of the following do physicians use to electronically submit claims? - -
clearinghouse
-When billing a secondary insurance company, which block should the billing
and coding specialist fill out on the CMS-1500 claim form? - -Block 9a
-A physician is contracted with an insurance company to accept the allowed
amount. The insurance company $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
-Which of the following is a requirement of some third-party payers before a
procedure is performed? - -Preauthorization
-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
-Which of the following documents is required to disclose an adult patient's
information? - -a signed release from the patient
-After reading a provider's notes about a new patient, a coding specialist
decides to code for a longer length of time than the actual office visit. Which
of the following describes the specialist's action? - -fraud
-Two providers from the same practice visit a patient in the emergency
department using the same CPT code. The claim may be denied due to which
of the following reasons? - -duplication of services
-Which of the following security features is required during transmission of
protected health information and medical claims to third-party payers? - -
encryption
-Which of the following billing patterns is a best-practice action? - -
documenting the patient's chief complaint, history, exam, assessment and
plan for care
, -A provider receives a reimbursement from a third-party payer accompanied
by which of the following documents? - -explanation of benefits
-Which of the following is a correct entry of a charge of $150 in Block 24F of
the CMS-1500 claim form? - -150 00
-A beneficiary of a Medicare/Medicaid crossover claim submitted by a
participating provider is responsible for which of the following percentages? -
-0%
-Which of the following coding manuals is used primarily to identify
products, supplies, and services? - -HCPCS level II manual
-A billing and coding specialist needs to know how much Medicare paid on a
claim before billing the secondary insurance. To which of the following
should the specialist refer? - -Remittance advice
-Which of the following is allowed when billing procedural codes? - -billing
using two-digit CPT modifiers to indicate a procedure as performed differs
from its usual five-digit code
-Which of the following types of health insurance plans best describes a
government-sponsored benefit program? - -TRICARE Prime
-Which of the following is the correct term for an amount that has been
determined to be uncollectable? - -bad debt
-Which of the following is a type of claim that will be denied by the third-
party payers? - -incomplete claim
-If a patient has osteomyelitis, he has problems with which of the following
areas? - -bones and bone marrow
-Block 17b on the CMS-1500 claim form should list which of the following
information? - -referring physician's national provider identifier (NPI) number
-Which of the following actions should the billing and coding specialist take
to effectively manage accounts receivable? - -collect copayment from the
patient at the time of service
-Which of the following acts applies to the Administrative Simplification
guidelines? - -Health Insurance Portability and Accountability Act (HIPAA)
-Which of the following is the primary information used to determine the
priority of collection letters to patients? - -the age of the account
, -Medicare enforces mandatory submission of electronic claims for most
providers. Which of the following providers is allowed to submit paper claims
to Medicare? - -A provider's office with fewer than 10 full-time employees
-In 1995 and 1997, which of the following introduced documentation
guidelines to Medicare carriers to ensure that services paid for have been
provided and we medically necessary? - -CMS
-Z codes are used to identify which of the following? - -immunizations
-Which of the following claims would appear on an aging report? - -a claim
that is delinquent for 60 days
-When a physician documents a patient's response to symptoms and various
body systems the results are documented as which of the following? - -
review of systems
-In an outpatient setting, which of the following forms is used as a financial
report of all services provided to patients? - -patient account record
-Which of the following is used by providers to remove errors from claims
before they are submitted to third-party payers? - -clearinghouse
-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? - -$120
-Which of the following modifiers should be used to indicate a professional
service has been discontinued prior to completion? - --53
-The explanation of payments received from the insurance company is often
referred to or called the: - -remittance advice
-A diseased condition or state is known as: - -morbidity
-A billing and coding specialist should add modifier -50 to codes when
reporting which of the following? - -a bilateral procedure
-When an electronic claim is rejected due to incomplete information, which
of the following actions should the medical billing specialist take? - -
complete the information and re-transmit according to the third-party
standards
-Accepting assignment on the CMS-1500 claim form indicates which of the
following? - -The physician agrees to accept payment under the terms of the
payer's program
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