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- Which of the following is used to communicate why a claim line item was denied or paid differently than it was billed?
Ans>> Claim adjustment reason codes
- 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>> DOB
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- A billing and coding specialist is reviewing paperwork that indicates over- payment by Medicare for six patients over the past year. Which of the following describes this process?
Ans>> Audit
- 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
- Which of the following sections of the CPT manual lists the code for WBC with differential, automated?
Ans>> Pathology and laboratory
- A billing and coding specialist is reviewing provider notes to complete a claim. They need clarification on whether the procedure performed was on the left side, right side, or bilaterally. The specialist queries the provider and the
confirms it was a bilateral procedure. Which of the following modifiers should be
billed? Ans>> 50
- A provider orders a comprehensive metabolic panel for a 70-year-old patient who has Medicare as their primary insurance. Which of the following is re- quired to inform the patient they may be responsible for payment?
Ans>> Advanced beneficiary notice
- A billing and coding specialist is appealing a Medicare denial. Which of the following is the first step in the appeals process? Ans>> Redetermination
- Which of the following are used to code provider and outpatient services?-
Ans>> CPT codes
- A provider accepts assignment for a patient who has a $10 copayment and has already met 100 of their $150 deductible.The office charge is $100 and the allowed amount is 70. How much should the provider's office adjust off the patient's
account?
Ans>> $
- A patient has a new diagnosis of hypothyroidism. In which of the following body systems is the thyroid gland located? Ans>> Endocrine system
- 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 his portion of the bill
- Which of the following introduced documentation guidelines to Medicare carriers to ensure that services paid for have been provided and were med- ically necessary?
Ans>> CMS
- 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 tonsillitis was listed with the CPT code for an appendectomy
- Which of the following physical status modifiers should a billing and coding
individual to another of the same species but different genotype?
Ans>> Allograft
- 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
- Which of the following security features is required during transmission of protected health information and medical claims to third-party payers?
Ans>> En- cryption
- Which of the following modifiers indicates that a patient has signed Medicare Advance Beneficiary Notice (ABN)? Ans>> -GA
claimsWhich of the following should the specialist consult as a resource to check
- Time reporting is a guideline for which of the following sections of the CPT for
proper code assignment based on procedure-to-procedure (PTP) code pair edits and
- A patient undergoes hemodialysis.The code for this procedure is found in which
of the following areas of the CPT manual? Ans>> Medicine section
- Horizontaltriangles are the symbol usedinthe CPT coding manual to indicate which of the following?
Ans>> New or revised text
- Based on coding guidelines, which character in an ICD-10-CM diagnosis code provides information about the encounter for care? Ans>> Seventh character
- Which of the following requires an authorization to release protected health
information (PHI)? Ans>> Life insurance policy
- Which of the following do Category III codes describe? Ans>> Emerging technol- ogy
- When coding for outpatient and professional services and proceduresa billing and coding specialist must sequence the diagnosis codes according to ICD-10-CM guidelines. Which of the following describes the first listed diagnosis code on a claim?
Ans>> Primary diagnosis
- 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>> MDM
- A billing and coding specialist is submitting a batch of claims to the clearinghouse and receives a report stating that three were rejected. Which of the following actions should the specialist take? Ans>> Review the scrubber report
- A patient's employer has not submitted a premium payment for the com- pany's commercial insurance plan. Which of the following is the status the
