A child is brought into a facility by their mother. The child is covered under both parents' insurance policies. The child's father was born on 10/1/1980 and their mother was born on 10/2/1981. Which of the following statements is true regarding the primary policy holder for the child? - Answer ...
NHA CBCS (3.0 ) Revision Exam
Questions Fully Solved.
A child is brought into a facility by their mother. The child is covered under both parents' insurance
policies. The child's father was born on 10/1/1980 and their mother was born on 10/2/1981. Which of
the following statements is true regarding the primary policy holder for the child? - Answer The father
is the primary policy holder because his birthday falls first in the calendar year.
A billing and coding specialist is submitting a claim for a school-age child who was brought to the clinic
by their maternal grandmother. The child's parents are divorced and remarried, and the child's mother
has legal custody of the child. The specialist should recognize that the child's primary insurance coverage
is provided through which of the following insured individuals? - Answer Biologic mother
Which of the following is the purpose of running an insurance aging report each month? - Answer To
determine which claims are outstanding from third-party payers
A billing and coding specialist observes a colleague perform an unethical act. Which of the following
actions should the specialist take? - Answer Report the incident to a supervisor
Which of the following statements is true regarding the release of patients records? - Answer Patient
access to psychotherapy notes is restricted
A billing and coding specialist is preparing a claim for a patient who had a procedure performed on their
left index finger. Which of the following modifiers indicates the correct digit? - Answer -F1
-FA: used for left thumb
-F6: used for right index finger
-F4: used for the left pinky
A billing and coding specialist is processing a claim for a patient who broke their arm while repairing cars
at their workplace. There is no nerve damage, the arm is placed in a cast for 6 weeks, and the patient is
cleared to return to work in 6 weeks. Which of the following types of workers' compensation applies to
this patient? - Answer Temporary disability
,Based on the CPT integumentary coding guidelines, Mohs micrographic surgery involves the provider
filling which of the following roles? - Answer Both the surgeon and pathologist
A billing and coding specialist is preparing a claim for a provider. The operative note indicates the
surgeon performed a CABG. The specialist should identify that CABG stands for which of the following? -
Answer Coronary Artery Bypass Graft
A billing and coding specialist is arranging a payment plan with a patient who wants to leave postdated
checks with the office. The patient proposes leaving one check postdated for 3 months, one for 4
months, and another one for 5 months in the future. According to federal collection law, which of the
following actions should the specialist take? - Answer Notify the patient between 3 and 10 days prior to
depositing each check on the indicated date.
Which of the following qualifies a patient for eligibility under Medicare as the primary third-party payer?
- Answer Individuals who are under age 65 and have a disability
Which of the following is an example of a diagnostic category code? - Answer I10
(Diagnostic category codes contains three characters)
A billing and coding specialist is determining third-party payer responsibilities for a 70-year-old patient
who has Medicare coverage. The patient's spouse has insurance with Blue Cross Blue Shield through
their employer. Which of the following actions should the specialist take? - Answer Establish
coordination of benefits
When a patient has a condition that is both acute and chronic, how should it be coded? - Answer Code
both the acute and chronic conditions, sequencing the acute condition first.
When reviewing an established patient's insurance card, a billing and coding specialist notices a minor
change from the existing card on file. Which of the following actions should the specialist take? - Answer
Photocopy both sides of the new card
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? - Answer Provider
, 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 a billing and
coding specialist take? - Answer Send the medical information pertaining to the dates of service
requested.
A billing and coding specialist is working on a claim in which reimbursement was reduced due to services
being bundled. Which of the following types of modifiers should be assigned to indicate multiple
procedures were performed to prevent bundling? - Answer Category I modifier
(category I modifier provides the means to report or indicate that a service or procedure that has been
performed has been altered by some specific circumstance but not changed in its definition or code).
A billing and coding specialist is reviewing an encounter note that indicates a biopsy was performed. The
specialist requires which of the following additional details to fully code this procedure? - Answer
Benign vs. malignant status
A billing and coding specialist is determining the level of service for an office visit for a new patient.
Which of the following codes represents a detailed history and detailed exam with moderate medical
decision-making? - Answer 99204
Which of the following is true regarding Medicaid eligibility? - Answer Patient eligibility is determined
at each visit.
Which of the following pieces of guarantor information is required when establishing a patient's financial
record? - Answer Phone number
A billing and coding specialist is reviewing a delinquent claim. Which of the following actions should the
specialist take first? - Answer Verify the age of the account.
When a patient signs an Acknowledgement of Notice of Privacy Practice, it indicates which of the
following? - Answer The patient accepts the policies and procedures regarding how protected health
information (PHI) is handled.
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