Which of the following Medicare policies determines if a particular item or service is covered by Medicare? - National Coverage Determination (NCD)
A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party pay...
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Which of the following Medicare policies determines if a particular item or service is
covered by Medicare? - National Coverage Determination (NCD)
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? - Denied
A billing and coding specialist should routinely analyze which of the following to
determine the number of outstanding claims? - Aging report
Which of the following should a billing and coding specialist use to submit a claim with
supporting documents? - Claims attachment
Which of the following terms is used to communicate why a claim line item was denied
or paid differently than it was billing? - Claim adjustment codes
On a CMS-1500 claim form, which of the following information should the billing and
coding specialist enter into Block 32? - Service facility location information
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? - Send the medical
information pertaining to the dates of service requested
Which of the following is the deadline for Medicare claim submission? - 12 months from
the date of service
Which of the following forms does a third-party payer require for physician services? -
CMS-1500
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 designed 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 terms refers to the difference between the billing and allowed
amounts? - Adjustment
Which of the following HMO managed care services requires a referral? - Durable
medical equipment
,Which of the following explains why Medicare will deny a particular service or
procedure? - Advance Beneficiary Notice (ABN)
Which of the following types of claims is 120 days old? - Delinquent
When reviewing an established patient's insurance card, the billing and coding specialist
notices a minor change from the existing card on file. Which of the following actions
should the billing and coding specialist take? - Photocopy both sides of the new card
A husband and wife each have group insurance through their employers. The wife has
an appointment with her provider. Which insurance should be used as primary for the
appointment? - The wife's insurance
Which of the following would most likely result in a denial on a Medicare claim? - An
experimental chemotherapy medication for a patient who has stage III renal cancer
Which of the following pieces of guarantor information is required when establishing a
patient's financial record? - Phone number
A provider surgically punctures through the space between the patient's ribs using an
aspirating needle to withdraw fluid from the chest cavity. Which of the following is the
name of this procedure? - Pleurocentesis
A patient has AARP as secondary insurance. In which of the following blocks on the
CMS-1500 claim form should the information be entered? - Block 9
A Medicare non-participating (non-PAR) provider's approved payment amount is $200
for a lobectomy and the deductible has been met. Which of the following amounts is the
limiting charge for this procedure? - $230
**A non-PAR who does not accept assignment, can collect a maximum of 15% (the
limiting charge) over the non-PAR Medicare fee schedule amount.
In the anesthesia section of the CPT manual, which of the following are considered
qualifying circumstances? - Add-on codes
Threading a catheter with a balloon into a coronary artery and expanding it to repair
arteries describes which of the following procedures? - Angioplasty
Which of the following actions by a billing and coding specialist would be considered
fraud? - Billing for services not provided
Which of the following statements is accurate regarding the diagnostic codes in Block
21? - These codes must correspond to the diagnosis pointer in Block 24E
, Which of the following parts of the Medicare insurance program is managed by private,
third-party insurance providers that have been approved by Medicare? - Medicare Part
C
A billing and coding specialist can ensure appropriate insurance coverage for an
outpatient procedure by first using which of the following processes? - Precertification
**Precertification is the first step. Preauthorization is a decision from the payer to
approve the service. It is not the first step to determine insurance reimbursement.
Which of the following is considered fraud? - The billing and coding specialist unbundles
a code to receive higher reimbursement
The authorization number for a service that was approved before the service was
rendered is indicated in which of the following blocks on the CMS-1500 claim form? -
Block 23
A patient is preauthorized to receive vitamin B12 injections from Jan 1 to May 31. On
June 2, the provider orders an additional 6 months of injections. In order for the patient
to continue with coverage of care, which of the following should occur? - The provider
should contact the patient's insurance carrier to obtain a new authorization
Which of the following symbols indicates a revised code? - Triangle
If both parents have full coverage for a dependent child, which of the following is
considered to be the primary insurance holder? - The parent whose birthdate comes
first in the calendar year is the primary insurance holder
Which of the following entities defines the essential elements of a comprehensive
compliance program? - Office of Inspector General (OIG)
The >< symbol is used to indicate new and revised text other than which of the
following? - Procedure descriptors
Which of the following describes the organization of an aging report? - By date
Which of the following is the purpose of coordination of benefits? - Prevent multiple
insurers from paying benefits covered by other policies
A billing and coding specialist submitted a claim to Medicare electronically. No errors
were found by the billing software or clearinghouse. Which of the following describes
this claim? - Clean claim
Which of the following qualifies as an exception to the HIPAA Privacy Rule? -
Psychotherapy notes
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