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CBCS Exam Prep: Medical Billing and Coding Q&A, Exams of Medicine

Medical Training CollegeMedicine

A series of questions and answers related to medical billing and coding practices, focusing on the cms-1500 claim form, hipaa standards, and various insurance-related scenarios. It covers topics such as claim submission, reimbursement processes, coding guidelines (cpt and icd), and regulatory compliance. The document also includes definitions of key terms and concepts relevant to healthcare administration and billing. It is designed to test and reinforce understanding of medical billing and coding principles.

Typology: Exams

2024/2025

Available from 05/21/2025

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CBCS Exam Prep With Questions And
Answers100%
1. What actions should be taken when a claim is billed for a level four
office visit and paid at a level three?
ANS Submit an appeal with documentation
2. The standard medical abbreviation "ECG" refers to a test used to
assess which of the body systems?
ANS cardiovascular system- test checks electricity of heart
3. According to HIPAA standards, what identifies the rendering provider
on the CMS-1500 claim form in Block 24J?
ANS NPI
4. On the CMS-1500 claim form, blocks 14 through 33 contain
information about?
ANS The patient's condition and the provider's information
5. Which block should the BCS complete on the CMS-1500 form for
proce- dures, services, or supplies?
ANS 24D
6. Which term describes when a plan pays 70% of the allowed and the
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CBCS Exam Prep With Questions And

Answers100%

  1. What actions should be taken when a claim is billed for a level four office visit and paid at a level three? ANS Submit an appeal with documentation
  2. The standard medical abbreviation "ECG" refers to a test used to assess which of the body systems? ANS cardiovascular system- test checks electricity of heart
  3. According to HIPAA standards, what identifies the rendering provider on the CMS-1500 claim form in Block 24J? ANS NPI
  4. On the CMS-1500 claim form, blocks 14 through 33 contain information about? ANS The patient's condition and the provider's information
  5. Which block should the BCS complete on the CMS-1500 form for proce- dures, services, or supplies? ANS 24D
  6. Which term describes when a plan pays 70% of the allowed and the

2 / patient pays 30%? ANS Coinsurance is a percentage of the cost for covered services that is approved by the insurance company

  1. A provider charges $500 to a claim that had an allowable amount of $400. What should happen to the non-allowed charge? ANS Write Off or adjustment
  2. Patient ANS Justin Austin; Social Security NO. ANS 555-22-1111; Medicare ID NO. ANS 555-33-2222A; DOB ANS 05/22/1945. Claim information entered ANS Austin, Jane; So- cial Security No. ANS 555-22-111; Medicare ID No. ANS 555-33-2222A; DOB ANS 052245. What is a reason the claim was rejected? ANS The DOB is entered incorrectly - the format is two digits for the month and four digits for the year.
  3. A patient's health plan is referred to as the "payer of last resort." The patient is covered by which health plan? ANS Medicaid
  4. The physician bills $500 to a patient. After submitting the claim to

4 /

  1. What are considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? ANS Operative reports are required to sup- port surgical procedures
  2. When submitting a clean claim with a diagnosis of kidney stones, which of the following procedure names is correct? ANS Nephrolithiasis The destruction of kidney stones
  3. The BCS should first divide the e/m code by which of the following? ANS Place of service which narrows down the specific code as one of the three deciding factors
  4. Appeal the decision with a provider's report ANS Which of the following actions should be taken if an insurance company denies a service as not medically neces- sary?
  5. Which departments should a patient be seen for psoriasis? And what body system is involved? ANS Dermatology, related to the integumentary system which includes hair, skin, and nails
  6. Which block requires the patient's authorization to release medical infor- mation to process a claim? ANS Block 12
  7. What is the purpose of precertification?

5 / ANS Verification of Coverage

  1. A provider performs an examination of a patient's sore throat during an office visit. What describes the level of the examination? ANS Problem-focused examination is a specific examination of an affected organ.
  2. What is the verbal or written agreement that gives approval to some action, situation, or statement, and allows the release of patient information? ANS Consent agreement
  3. On the CMS-1500 claim form, blocks 1 through 13 include what informa- tion? ANS The patient's demographics are found in Blocks 2,3,5, and 7
  4. What is the main function of the respiratory system? ANS Oxygenating blood cells
  5. Which section of the medical record is used to determine the correct E/M code used for billings and coding? ANS History and physical
  6. Describe the birthday rule. ANS The parent whose birthday comes first in the calendar year is the Primary Insurance.
  7. What is used to code diseases, injuries, impairments, and other

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  1. 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 been met. How much should the physician write off the patient's account? ANS $40 - this is the difference between the amount billed and amount allowed.
  2. What is the difference between fraud and abuse? ANS fraud=intentional misrep- resenting services rendered for the purpose of receiving higher pay. abuse=practices that are done unknowingly as a result of poor business practices.
  3. What is the difference between consent and authorization? ANS consent=used for treatment authorization=used to release information and not treatment.
  4. What does disclosure refer to? ANS The way health information is given to an outside person or organization
  5. What does the Stark Law state? ANS Physicians can't refer patients to practitioners with whom they have a financial relationship.

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  1. What do you check for when auditing? ANS review claims for accuracy and completeness.
  2. What does the OIG do? ANS Office of Inspector General Fights against fraud.
  3. What is the health program for people over the age of 65 or people under 65 with disabilities and people of all ages in end-stage kidney failure? ANS Medicare.
  4. Name two causes of claim transmission errors ANS missing or invalid patient ID number and lack of authorization or referral number.
  5. What is the difference between co-pay and coinsurance? ANS co-pay=flat fee that a patient pays for visiting a provider or purchasing meds, varies. coinsurance=is a percentage of the covered benefits paid by both the insurance and the patient usually 80%/20%
  6. What are three major kinds of government insurance plans? ANS Medicare, Medicaid and children's health insurance program (SCHIP)
  7. What is the difference between RA and EOB? ANS RA=sent to the provider's office from the third-party payer. EOB=sent to the policyholder.
  8. What is an allowable charge?

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  1. Posterior, dorsal ANS back of the body surface
  2. Distal ANS far from the origin, away from
  3. Proximal ANS near the origin, closer
  4. nephr/o ANS kidney
  5. Cyst/o ANS Bladder
  6. erythr/o ANS Red
  7. -itis ANS Inflammation
  8. -emia ANS Blood Condition
  9. Abnormal Condition ANS - osis
  10. bursting forth of blood ANS - rrhagia

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  1. discharge, flow ANS - rrhea
  2. Hardening ANS - sclerosis
  3. Surgical Puncture ANS - centesis
  4. separation, breakdown, destruction ANS - lysis
  5. surgical fixation ANS - pexy
  6. Suture ANS - rrhaphy
  7. Opening ANS - stomy
  8. Before ANS ante-
  9. dys- ANS painful, difficult
  10. endo- ANS inside, within
  11. epi-

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  1. What is HMO? ANS Health Maintenance Organization. A form of health insurance combining a range of coverages in a group basis. A group of doctors and other medical professionals offer care through the HMO for a flat monthly rate with no deductibles.
  2. Health care program for Uniformed Service members, retirees and their families. ANS TRICARE
  3. What is PPO? ANS PPO is similar to an HMO, but care is paid for as received instead of in advance in form of a schedule. PPOs may offer more flexibility by allowing for

14 / visits to out-of-network professionals. Visits within network require only the payment of a small fee.

  1. Clean Claim ANS A completed insurance claim form submitted with the program time limit that contains all the necessary information without deficiencies so it can be processed and paid promptly.
  2. Dirty Claim ANS A claim submitted with errors or one that requires manual process- ing to resolve problems or is rejected for payment.
  3. Invalid Claim ANS Any Medicare claim that contains complete, necessary informa- tion but is illogical or incorrect (e.g., listing an incorrect provider member for a referring physician)
  4. CMS 1500 ANS what is an insurance claim submitted on paper, including those optically scanned and converted to an electronic form by the insurance carrier.
  5. Describe the life Cycle of a claim ANS Submission, Processing, Adjudication, Non-covered, Unauthorized, Medical Necessity Checks, Payment/RA/ERA.

16 / ANS Medigap

  1. What is the numeric and alphabetic coding system used for billing/pricing of procedures, medical supplies, medications, and durable medical equipment (DME)? ANS HCPCS
  2. A group that takes nonstandard medical billing software formats and translates them into the standard Electronic Data Interchange (EDI) formats is called a/an? ANS Clearinghouse
  3. What is the unique 10-digit number assigned to providers in the U.S. to identify themselves in all HIPAA transactions? ANS NPI
  4. What is Capitation? ANS A payment structure in which a health maintenance organization prepares an annual set fee per patient to a physician.

17 /

  1. A fixed percentage of covered charges applied to the patients bill after the deductible has been met. ANS "COINS"; Coinsurance
  2. "The difference between fraud and abuse is ." ANS Intent
  3. Numeric codes developed by the American Medical Association (AMA) to standardize medical services and procedures. ANS CPT codes
  4. The first listed diagnosis can also be referred to as. ANS Principal Diagnosis
  5. Physicians who enroll in managed care plans are called. They have contracts with Managed Care Organizations (MCO)s that stipulate their fees. ANS Participating Provider
  6. Insurer/Insured, Subscriber, Member, Recipient are all terms that apply to the? ANS Policyholder
  7. True or False, Preferred Provider Organizations (PPO)s never allow mem- bers to receive care from physicians outside the network. ANS False, however price may be higher for Out-of-Network

19 / information is called what? ANS Encounter Form

  1. What character of ICD-10-PCS for medical or surgical procedure would identify the body part?Character 4 ANS Character 4
  2. What are HCPCS Level II codes used for? ANS They were established to report services, supplies, and procedures not represented in CPT.

20 /

  1. What part of the medical record is used to determine the correct E/M code used for billing & coding? ANS History and physical
  2. Which block on the CMS-1500 claim form is used to bill ICD codes? ANS 21
  3. Which block should the billing and coding specialist fill out on the CMS-1500 claim form when billing a secondary insurance company? ANS 9a
  4. What modifier should be used to indicate a professional service has been discontinued prior to completion? ANS -
  5. What block on the CMS-1500 form should you enter the prior authoriza- tion number? ANS 23
  6. Block 17b on the CMS-1500 claim form should list what information? Re- ferring physician's national provider identifier number. ANS Referring physician's national provider identifier number.
  7. 10a ANS What block on the CMS-1500 claim form is required to indicate a