Docsity
Log inSign up
Docsity
Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity

Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan

Guidelines and tips
Guidelines and tips
Sell on Docsity
Sell on Docsity
Log inSign up

Prepare for your exams

Study with the several resources on Docsity

Find documents

Prepare for your exams with the study notes shared by other students like you on Docsity

Search Store documents

The best documents sold by students who completed their studies

Search through all study resources
Docsity AINEW

Summarize your documents, ask them questions, convert them into quizzes and concept maps

Explore questions

Clear up your doubts by reading the answers to questions asked by your fellow students

Earn points to download

Earn points by helping other students or get them with a premium plan

Share documents
download point icon20 Points

For each uploaded document

Answer questions
download point icon5 Points

For each given answer (max 1 per day)

All the ways to get free points
Get points immediately

Choose a premium plan with all the points you need

Study Opportunities

Choose your next study program

Get in touch with the best universities in the world. Search through thousands of universities and official partners

Community

Ask the community

Ask the community for help and clear up your study doubts

University Rankings

Discover the best universities in your country according to Docsity users

Free resources

Our save-the-student-ebooks!

Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors

From our blog

Exams and Study
Go to the blog

Medical Billing and Coding: Questions and Answers for Healthcare Professionals, Exams of Medicine

Medical Training CollegeMedicine

A series of questions and answers related to medical billing and coding practices. It covers topics such as claim adjustments, hipaa compliance, cpt codes, icd-10-cm coding guidelines, payer responsibilities, claim submission processes, and revenue cycle management. The questions are designed to test knowledge of billing and coding procedures, regulations, and best practices. It also addresses specific scenarios related to medicare, medicaid, tricare, and commercial insurance plans, providing insights into the complexities of healthcare reimbursement. The document serves as a study aid for billing and coding specialists, offering practical knowledge and guidance for navigating the intricacies of the healthcare billing process. It is useful for understanding the roles of clearinghouses, third-party payers, and providers in ensuring accurate and timely claim processing. The content is structured to enhance comprehension and retention of key concepts in medical billing and coding.

Typology: Exams

2024/2025

Available from 05/19/2025

berine-odessy
berine-odessy 🇺🇸

41 documents

1 / 25

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
1 /
25
CBCS 3 rd
WITH ACCURATE QUESTIONS AND
ANSWERS
1. A provider accepts assignment for a patient who has a $10 copayment
and has already met $100 of their deductible. The office charge is $100,
and the allowed amount is $70. How much should the providers office
adjust off the patients account?
ANS $30
2. Claims that are submitted without an NPI number will delay payment
to the provider due to which of the following?
ANS The number is needed to identify the provider
3. Which of the following describes a CPT modifier that is used to
indicate a provider supervised and interpreted a radiology procedure?
ANS Professional component
4. A billing and coding specialist is preparing a list of delinquent
accounts over 300 days old that have received telephone calls, letters,
and have been referred to a collection agency with no results. Which of
the following is the term that describes accounts receivable that are
deemed to be "uncollec- table"?
pf3
pf4
pf5
pf8
pf9
pfa
pfd
pfe
pff
pf12
pf13
pf14
pf15
pf16
pf17
pf18
pf19

Partial preview of the text

Download Medical Billing and Coding: Questions and Answers for Healthcare Professionals and more Exams Medicine in PDF only on Docsity!

1 /

CBCS 3

rd

WITH ACCURATE QUESTIONS AND

ANSWERS

  1. A provider accepts assignment for a patient who has a $10 copayment and has already met $100 of their deductible. The office charge is $100, and the allowed amount is $70. How much should the providers office adjust off the patients account? ANS $
  2. Claims that are submitted without an NPI number will delay payment to the provider due to which of the following? ANS The number is needed to identify the provider
  3. Which of the following describes a CPT modifier that is used to indicate a provider supervised and interpreted a radiology procedure? ANS Professional component
  4. A billing and coding specialist is preparing a list of delinquent accounts over 300 days old that have received telephone calls, letters, and have been referred to a collection agency with no results. Which of the following is the term that describes accounts receivable that are deemed to be "uncollec- table"?

2 / ANS Bad debts

  1. 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 health care transactions, code sets, and identifiers
  2. Which of the following are used to code provider and outpatient services?- ANS CPT codes
  3. Which of the following terms describes the amount the patient must pay for a service when they have an insurance plan benefit that pays 70% of the allowed amount and the patient is responsible for 30% of the allowed amount? ANS Coinsurance
  4. A billing and coding specialist is preparing to create patient statements and has been asked to collect finance charges on any late payments. According to the Truth in Lending Act (TILA), which of the following is the way the finance charges must be disclosed on the statement? ANS As an annual percentage rate
  5. How many behavior classifications are included in the Table of

4 /

  1. A billing and coding specialist is submitting a batch of claims to the clearinghouse and receives a report stating that three claims were rejected. Which of the following actions should the specialist take? ANS Review the scrubber report
  2. A billing and coding specialist is reviewing an operative report for a patient who had a graft. The specialist should consult the CPT coding guidelines to determine that which of the following is a tissue transplanted from one individual to another of the same species but different genotype? ANS Allograft
  3. Which of the following is the filing limit for claim submission for an outpa- tient service with TRICARE? ANS Within 1 year from the date of service
  4. A billing and coding specialist in an internal medicine practice is assisting a patient who is already collecting social security but will be turning 65 in the next year and has questions about what Medicare will cover. The specialist should know that which of the following is the Medicare benefit the patient will be enrolled in automatically? ANS Medicare Part A
  5. A billing and coding specialist is submitting claims through a

5 / clearing- house. The specialist should identify that which of the following actions is per- formed by the clearinghouse? ANS Scrubbing claims, translating them to a standard format, then sending them to various third-party payers

  1. A patient's employer has not submitted a premium payment for the com- pany's commercial insurance plan. Which of the following is the claim status the provider will receive for any claims sent to the third- party payer? ANS Denied
  2. Which of the following is used to communicate why a claim line item was denied or paid differently than it was billed? ANS Claims adjustment reason codes
  3. Which of the following security features is required during transmission of protected health information and medical claims to third-party payer? ANS En- cryption
  4. Which of the following sections of CPT manual lists the code for WBC with differential, automated? ANS Pathology and Laboratory
  5. Timing report is a guideline for which of the following sections of the CPT manual?

7 /

  1. Which of the following prohibits a provider from referring Medicare pa- tients to a clinical laboratory service in which the provider has a financial interest? ANS Stark Law
  2. A billing and coding specialist is performing a coordination of benefits check. The patient has primary and secondary benefits. Which of the following applies to the guarantor? ANS They are responsible for any charges that are incurred
  3. Which of the following describes an insurance company that offers plans that pay health care providers who render services to patients? ANS Third-party payer
  4. A patient has a history of breast cancer that has metastasized to the liver and is undergoing chemotherapy today for the liver cancer. Which of the following ICD-10-CM codes should be sequenced first? ANS Z51.11 Chemotherapy
  5. A billing and coding specialist is reviewing paperwork that indicated over- payment by Medicare for six patients over the past year. Which of the following describes this process? ANS Audit
  6. A billing and coding specialist is reviewing a denied claim for a 19-year-

8 / old patient's hysterectomy (58150-26). Which of the following is the reason for the denial? ANS The modifier is not valid with the procedure

  1. A billing and coding specialist is processing a claim for a patient who has Medicare and Medicaid coverage. Which of the following is the type of claim that is automatically adjudicated by Medicare and forwarded to Medicaid? ANS - Crossover
  2. A billing and coding specialist is collecting demographic information for a patient who lives in Hawaii and is an active-duty service member. The specialist should identify that the insured has which of the following types of insurance? ANS TRICARE
  3. A patient's portion of the bill should be discussed with the patient before a procedure is performed for which of the following reasons? ANS To ensure the patient understands how much they are responsible to pay
  4. Which of the following is issued to active-duty uniformed service person- nel for access to TRICARE benefits? ANS Common access card
  5. A billing and coding specialist is posting payments for an

10 /

  1. Which of the following documents should a billing and coding specialist use to ensure that all payers are sending reimbursement within 45 days of claim submission? ANS Aging report
  2. A married couple each have group insurance through their employers. The patient has an appointment with the provider. Which insurance should be used as primary for the appointment? ANS The patients
  3. Which of the following do providers use to electronically submit claims?- ANS Clearinghouse
  4. A billing and coding specialist is reviewing a remittance advice for a claim that was denied for medical necessity. Which of the following is an example of this type of error? ANS The ICD-10-CM code for tonsilitis was listed with the CPT code for an appendectomy
  5. A billing and coding specialist is verifying coverage for a Medicare bene- ficiary. Which of the following determines Medicare coverage of services on a national level? ANS NCD

11 /

  1. ]A billing and coding specialist is submitting an electronic claim for a pro- cedure with modifier -22. Which of the following actions should the specialist take? ANS Include an attachment to the claim
  2. A billing and coding specialist is reviewing a claim edit report and iden- tifies a rejection for missing patient demographic information. Which of the following missing pieces of patient demographic information would cause a rejection from the clearinghouse? ANS Date of birth
  3. A provider documents a patient's response to questions about various parts of the body. A billing and coding specialist should identify that this information is included in which of the following sections of the note? ANS Review of systems
  4. Based on coding guidelines, which character in an ICD-10-CM diagnosis code provides information about the encounter for care? ANS Seventh character
  5. Which of the following physical status modifiers should a billing and coding specialist use for anesthesia services performed on a health 4- year-old patient? ANS -P

13 /

  1. A billing and coding specialist is posting payments to accounts based on remittance advice and discovers a denial of payment. Which of the following codes indicated why reimbursement was denied? ANS Claims adjustment reason code
  2. Which of the following is a covered entity affected by HIPAA security rules? ANS Health care clearinghouses
  3. A billing and coding specialist is preparing a claim for a patient encounter. The patient was last seen in the office 2 years ago. Which of the following evaluation and management (E/M) codes should the specialist use? ANS 99213
  4. Which of the following does a patient sign to allow payment of claims directly to the provider? ANS Assignment of benefits statement
  5. A patient undergoes hemodialysis. The code for this procedure is found in which of the following areas of the CPT manual? ANS Medicine section
  6. A billing and coding specialist is contacted by a patient who requests a copy of the remittance advice for a recently adjudicated claim. Which

14 / of the following action should the specialist take? ANS Remove all information other than what pertains to the patient

  1. Which of the following information is required to include on an Advance Beneficiary Notice (ABN) form? ANS The reason Medicare may not pay
  2. A billing and coding specialist is reviewing an electronic remittance advice (ERA). Which of the following gives additional information about the denial of reimbursement? ANS Remark code
  3. A billing and coding specialist is completing a claim to be submitted for Blue Cross Blue Shield by a provider who used to be in private practice but was recently hired by a group practice. Which of the following is true regarding the providers national provider identifier (NPI)? ANS The provider's individual NPI for the group practice is the same as the one from the private practice
  4. A billing and coding specialist is reviewing a Medicare remittance advice (RA) and discovers a denial due to medical necessity. Which of the following actions should the specialist take? ANS Check the local and national coverage deter- mination policies for diagnosis requirements

16 /

  1. A billing and coding specialist is processing a claim for a new patient who came to the office for a sore throat The provider diagnosed the patient with tonsilitis and wrote a prescription for antibiotics. Which of the following codes should the specialist use? ANS 99203
  2. Which of the following is an electronic form that is used to post reimburse- ments? ANS Electronic remittance advice (ERA)
  3. A billing and coding specialist is processing a claim for a patient who went to the emergency department for services. Which of the following is a component of determining the evaluation and management (E/M) level of care? ANS Medical decision-making
  4. A billing and coding specialist is coding a consultation in the providers office. The provider documented that a detailed examination was performed. Which of the following evaluation and management (E/M) codes should the specialist report? ANS 99243
  5. A billing and coding specialist is coding a claim for an autopsy. Which of the following CPT codes should be included on the claim?

17 /

ANS 88000

  1. A claim was denied due to termination of coverage. The patient had recent- ly obtained new insurance. Which of the following actions should the billing and coding specialist take? ANS Obtain the patients updated insurance and submit the claim to the new third-party payer
  2. Which of the following actions should a billing and coding specialist take when submitting a claim to Medicaid for a patient who has primary and secondary insurance coverage? ANS Attach the remittance advice from the primary insurance along with the Medicaid claim
  3. Which of the following describes the term "crossover" as it relates to Medicare? ANS When a third-party payer transfers data to allow coordination of benefits for a claim
  4. Which of the following identifies improper payments made for CMS claims? ANS Recovery Audit Contractors (RACs)
  5. A billing and coding specialist is reviewing the encounter form for a patient who has type 1 diabetes mellitus and stage III chronic kidney disease (CKD). Which of the following diagnosis codes should be assigned?

19 / to ICD-10-CM guidelines. Which of the following describes the first listed diagnosis code on a claim? ANS Primary diagnosis

  1. A billing and coding specialist is coding a laceration repair and needs to determine the type of closure. The specialist queries the provider, who confirms retention sutures were used. The specialist should code which of the following types of closure? ANS Complex
  2. A patient was seen in an outpatient clinic for a cough, chest congestion, and a low-grade fever and was given the diagnosis of possible pneumo- nia. How should a billing and coding specialist code this encounter using ICD-10-CM? ANS Cough, chest congestion, and low-grade fever
  3. Which of the following is proper supportive documentation for reporting CPT and ICD-10-CM codes for the removal of a skin lesion? ANS Operative report
  4. Which of the following is the purpose of coordination of benefits? ANS To prevent multiple third-party payers from paying benefits covered by other policies
  5. A billing and coding specialist is evaluating code assignments for a

20 / batch of claims. Which of the following should the specialist consult as a resource to check for proper code assignment based on procedure-to- procedure (PTP) code pair edits and medically unlikely edits (MUEs)? ANS National Correct Coding Initiative (NCCI)

  1. Which of the following requires an authorization to release protected health information (PHI)? ANS Life insurance policy
  2. A patient presents to a provider with chest pain and shortness of breath. After an unexpected EKG result, the provider calls a cardiologist and summa- rizes the patient's symptoms. Which of the following is a portion of HIPAA that allows the provider to speak to the cardiologist prior to obtaining the patient's consent? ANS Title II ANS Administrative Simplification
  3. A billing and coding specialist is training a new specialist about submitting claims to a clearinghouse. Which of the following describes the process completed by the clearinghouse before submitting claims to a third-party payer? ANS Checking claims against payer edits for missing, incomplete, or invalid information
  4. A patient is preauthorized to receive vitamin B12 injections from