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- In which of the following sections of a SOAP note does a provider indicate a patient's reported level of pain? Ans>> subjective
- Which of the following is a valid ICD-10-CM principle? Ans>> Code signs and symptoms in the absence of a definitive diagnosis
- A billing and coding specialist discovers that one private payer has not reimbursed the provider for any claims submitted in the past year. Clean claims havebeen submitted to the payerand havebeen acknowledged.Which of the
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following entities
reimbursement? Ans>> State insurance Commissioner's office
- A billing and coding specialist is reviewing the procedure notes from a provider who selected a code indicating an incisional biopsy when the entirety of the patient's lesion was removed. The specialist should verify with the provider that which of the following types of procedures was performed? Ans>> - Excisional procedure
- A patient has an emergency appendectomy while on vacation.The claim is rejected due to the patient obtaining services out of network. Which of the following information should be included in the claim appeal? Ans>> The patient was out of town during the emergency
- Which of the following is the maximum number of diagnoses that can be re- ported
of an obesity diagnosis code for a child.The electronic health record (EHR) system
on allows for quick searches by offering a weight chart. the CMS-1500 claim form before an additional claim Which of the following is the is required?
- which of the following is the maximum number of diagnoses that can be reported on the cms 1500 claim form before an additional claim is required?-
Ans>> 12
- A billing and coding specialist is posting charges for a provider who performed an incision and drainage of an abscess of a Bartholin's gland. Which of the following anatomic sites includes the Bartholin's glands? Ans>> Vulva
- A billing and coding specialist is reviewing a denied claim for incorrect usage of an obesity diagnosis code for a child.The electronic health record (EHR) system allows for quick searches by offering a weight chart. Which of the following is the type of EHR
system being used?
patient's hand. a billing and coding specialist reports the code
for a 5cm simple repair. which of the following describes the specialist's action? Ans>> upcoding
- a billing and coding specialist is calculating a patient's financial responsi- bility for a service rendered by a non participating medicare provider. which of the following terms refers to the amount that the patient is responsible for paying? Ans>> Balance billing
- Which of the following governmental agencies is responsible for combat- ing fraud and abuseinhealth insuranceandhealth caredelivery? Ans>> Department of Health and Human Services (HHS)
- for which of the following is the provider responsible? Ans>> professional cour- tesy
- which of the following is an amount that has been determined to be uncollectible? Ans>> bad debt
- A billing and coding specialist notices that there have recently been sever- al appeals for denials due to failure to obtain procedure preauthorization. What action should the specialist take? Ans>> Contact the state's insurance commissioner to submit a complaint.???
injured on the job. the specialist should expect which of the following to be the reason
for denial? Ans>> the services provided are not covered by Medicare.
- A billing and coding specialist is determining a Medicare patient's financial responsibility.Which of the following should be on file for an elective service?-
Ans>> ABN - advanced beneficiary notice
- which of the following requires companies with 20 or more workers to offer employees who are laid off the ability to buy into the company's health insur- ance coveragefor18months? Ans>> Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
- a billing and coding specialist should identify thatwhich of the following statements is correct regarding the filing limit for medicaid? Ans>> The filing limit is 1 year from the date of service.
- A third-party payer requests a patients information related to a claim. A billing and coding specialist should ensure that which of the following is included in the patients file before providing the information? Ans>> Signed release of information form
for follow- ing? denial?
Ans>> Documentation of compliance plans
- which of the following symbols is used to indicate a new cpt code? Ans>> solid circle
- a billing/coding specialist is processing a claim. the specialist should iden- tify that which of the following conditions requires a qualifying circumstance code? Ans>> A moribund patient
