Medical Billing and Coding Practice Test Exam Verified Answers 2024

Medical Billing and Coding Certification Blocks 14 through 33 - The patient's condition and the provider's information are shown in what blocks in CMS 1500 form? Coding Compliance Plan - Which of the following includes procedures and best practices for correct coding? Use Arial size 10 font - When completing a CMS 1500 form which of the following is an acceptable action for the billing and coding specialist to take The claim requires an attachment - Which of the following indicates a claim should be submitted on paper instead of electronically? NPI (National Provider Identifier) - According to HIPAA Standards which of the following identifies the rendering provider on the CMS 1500 claim form in Block 24J? Block 32 - Service facility location information in CMS 1500 Block 31 - Signature of the Physician in CMS 1500 Block 27 - Accept Assignment in CMS 1500 Block 26 - Patient's Account Number in CMS 1500 Block 25 - Federal Tax I.D. Number / SSN / EIN in CMS 1500 Block 24J - Rendering Provider ID # in CMS 1500 Block 24G - Days or Units in CMS 1500 Block 24F - Charges in CMS 1500 Block 24E - Diagnosis Pointer in CMS 1500 Block 24 D - Procedures, Services or Supplies in CMS 1500 Block 24 B - Place of Service in CMS 1500 Block 24 A - Dates of Services in CMS 1500 Block 23 - Prior Authorization Number in CMS 1500 Block 21 - Diagnosis or nature of illness or injury in CMS 1500 Block 20 - Outside Lab in CMS 1500 Block 22 - Resubmission code in CMS 1500 Block 18 - Hospitalization Dates related to current services in CMS 1500 Block 17 - Name of referring provider or other source in CMS 1500 Block 17A - Referring provider NPI in CMS 1500 Block 14 - Date of Current Illness, Injury or Pregnancy (LMP) Block 16 - Dates patient unable to work in current occupation Block 13 - Insured's or authorized person's signature for payment of medical benefits to physician or supplier for services rendered. Block 9 - Secondary insurance Coinsurance - Term describes when a plan pays 70% of the allowed amount and the patient pays 30% Adjustment column of the credits - A provider charged $500 to a 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? The electronic transmission and code set standards require every provider to use the healthcare transactions, code sets and identifiers - Which of the following HIPAA compliance guidelines affecting electronic health record They streamline patient billing by summarizing the services rendered for a given date of service. - Why does correct claim processing rely on accurately completed encounter forms? Add-on codes - In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? UB-04 claim form - Ambulatory surgery centers, home health care, and hospice organizations use this form Aging report - Shows outstanding balance and it is a report used to arrange the accounts receivable from the date of service Guidelines to each section - The lists of unlisted codes in the CPT manual are listed in? Verifying that the medical records and the billing records match - Purpose of an internal auditing program in a physician's office Private third-party payers - Medigap coverage is offered to Medicare beneficiaries by which of the following? To ensure the patients understands his portion of the bill - A patient's portion of the bill should be discussed with a patient before a procedure is performed for which of the following reasons Follow up insurance claims by date - An insurance claim register (aged insurance report) facilitates which of the following? Patient's responsibility - When posting payment accurately, which of the following items should the billing and coding specialist include? CMS-1500 claim form - 1. Standard insurance form used by all government and most commercial insurance payers. 2. Which of the following should the Billing and Coding Specialist complete to be reimbursed for the patients services. Urethratresia - Which of the following describes an obstruction of the urethra? Operative report - Proper supportive documentation for reporting CPT and ICD codes for surgical procedures Delinquent claim - A claim that is overdue for payment and is 120 days old $40 - A physician is contracted with an insurance company to accept the allowed 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 patient's account? A claim that is delinquent for 60 days - Which of the following claims would appear on an aging report? The age of the account - The primary information used to determine the priority of collection letters to patients Phone number - Which of the following pieces of guarantor information is required when establishing a patient's financial record? Patient eligibility is determined monthly - Which of the following is true regarding Medicaid eligibility? Arthroscopy - A provider performs an examination of a patient's knee joint via small incision and an optical device. Which of the following terms describes this procedure? The billing and coding specialist unbundles a code to receive higher reimbursement - Which of the following is considered Fraud? Send the medical information pertaining to the dates of service requested in the subpoena - A provider's office receives a subpoena requesting medical documentation from a patient's medical record. After confirming the correct authorization, which of the following actions should the billing and coding specialist take? Contractual allowance - Which of the following is an example of a remark code from an explanation of benefits document? Appendix A and in the front of the book - The list of Modifiers are found where in the CPT book? - E&M codes 00100-01999, - Anesthesia is found Chief complaint - The reason the patient came to see the physician HIPAA - Health Insurance Portability and Accountability Act Brackets - Used to enclose synonyms, alternative wording, or explanatory phrase Bullets - Represents a new procedure or service code added since the previous edition of the manual Triangle - Revised code Circle/Dots - New code Plus sign - Add-on code Circle with a line through it - Represents Exemption from the use of modifier -51 Lightning bolt - Product Pending FDA Approval Star symbol - Telemedicine Modifier 22 - Increased procedural services Modifier 50 - Bilateral procedure Modifier 51 - Multiple procedures Modifier 52 - Reduced services Modifier 53 - Discontinued procedure Place of Service code #12 - Home Place of Service code #1 - Pharmacy Place of Service code #13 - Assisted Living Facility Place of Service code #20 - Urgent care facility Place of service code #21 - In patient hospital Place of service code #23 - Emergency Room - Hospital Place of service code #34 - Hospice Place of service code #31 - Skilled Nursing facility Place of service code #32 - Nursing facility Place of service code #99 - Other place of service algia - pain iasis - condition of oma - tumor, mass opathy - disease of orrhagia - hemorrhage lysis - destruction, breakdown, separation lytic - destroy orrhea - flow, discharge osis - abnormal condition paresis - weakness plasia - growth plegia - paralysis pnea - breathing itis - inflammation megalo - large mal - bad, poor iso - equal, same hypo - deficient, below, under, less than normal hyper - over homo - same hetero - different centesis - surgical puncture to remove fluid ectomy - surgical removal ostomy - create an opening otomy - cutting into orrhaphy - surgical repair opexy - surgical fixation -oplasty - plastic surgery on otripsy - crushing or destroying anterior - front of the body posterior - toward the back superior - above inferior - below lateral - side distal - farthest from center proximal - nearest to the center medial - middle, midline supine - face up or palm up prone - face down or palm down transverse - top and bottom sections coronal - front and back Pumping blood in the circulatory system - Which of the following is the primary function of the heart? Attach the remittance advice from the primary insurance along with the Medicaid claim - Which of the following the billing and coding specialist take when submitting a claim to Medicaid for a patient who has primary and secondary insurance coverage? Left Upper Quadrant (LUQ) - Left lobe of liver, stomach, pancreas, left kidney, spleen, portions of large intestine and small intestine An italicized code used as the first listed diagnosis - Will result in a claim being denied TRICARE - U.S. government health insurance plan for all military personnel Services require additional information - Which of the following causes a claim to be suspended? Medicare Part C - the part of Medicare policy that allows private health insurance companies to provide Medicare benefits Office of the Inspector General (OIG) - Which of the entities defines the essential elements of a comprehensive compliance program? Claims attachment - A billing and coding specialist used to submit a claim with supporting documents 18% - When coding a front torso burn, which of the following percentages should be coded? Follow up with the patient to determine current address, name and insurance carrier for resubmission - A claim is denied due to termination of coverage. Which of the following actions should the billing and coding specialist take next? The guidelines define items that are necessary to accurately code - The billing and coding specialist should follow the guidelines in the CPT manual for which of the following reasons? Provider - 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? Primary Care Provider - A patient has an HMO plan, needs to see a specialist for a specific problem from which of the following should the patient obtain a referral Third-party payer - Describes an insurance carrier that pays the provider who rendered services to a patient Incorrectly linked codes - A reason a claim would be denied 30 days of receiving claim - Federal regulations require clean claims to be paid within how many days Ureters - Used to transport urine to the bladder from the kidneys Precertification - A process by which a billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure Claim adjustment codes - A term used to communicate why a claim line item was denied or paid differently than it was billed. Professional component - Which of the following describes a two-digit CPT code used to indicate that the provider supervised and interpreted a radiology procedure? National Correct Coding Initiative (NCCI) - Developed by CMS to promote national correct coding methodologies and to eliminate improper coding practices Pleurocentesis - Surgical puncture of the pleura to remove fluid When an insurance company transfers data to allow coordination of benefits of a claim - Describes the term "crossover" as it relates to medicare Charging excessive fees - Example of Medicare abuse Adjustment - The difference between the billed and allowed amount HIPAA standard transactions - Standard transmission formats for electronically transmitted healthcare documents, as required by HIPAA law. Subjective - Which of the following sections of SOAP note indicate a patients level of pain to a provider UB-04 - A form the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services subpoena duces tecum - A documentation is valid authorization to release medical information to the judicial system Assignment of Benefits - A patient sign to allow payment of claims directly to the provider History - The key component of evaluation and management services Appeal the decision with a provider's report - Which of the following actions should be taken if an insurance company denies a service as not medically necessary Follow up insurance claim by date - An insurance claim register (aged insurance report) facilitates which of the following An authorization - Which of the following forms must the patient or representative sign to allow the release of protected health information? $120 - 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? A billing worksheet from the patient account - A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which of the following documents Patient account record or Patient Ledger - In an outpatient setting, which of the following forms is used as a financial report of all services provided to patients Denied - Which of the following describes the status of a claim that does not include required preauthorization for a service? Denied - A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer? 12 months from the date of service - Which of the following is the deadline for Medicare claim submission? 72-hour rule - This rule states that if a patient receives any treatment related to the inpatient admission, such as diagnostic, laboratory tests, x-ray examination, medical equipment or emergency services or any outpatient services within 72 hours of admission to the same hospital, then all these services are bundled with the inpatient service claims. The billing and coding specialist sends the patient's records to the patient's partner - A patient who is an active member of the military returned from overseas and is in need of specialty care. The patient does not have anyone designated with the power of attorney. Which of the following is considered a HIPAA violation? Durable Medical Equipment (DME) - Which of the following HMO managed care services requires a referral? Advance Beneficiary Notice (ABN) - Which of the following explains why Medicare will deny a particular service or procedure?