What is the maximum number of ICD codes that can be entered on a CMS-1500 claim form as of February 2012? - ANSWER 12
Which of the following is considered the final determination of the issues involving settlement of an insurance claim? - ANSWER Adjudication
Which of the following qualifies a...
CBCS Exam Review with 234 answered
questions
What is the maximum number of ICD codes that can be entered on a CMS-1500 claim
form as of February 2012? - ANSWER 12
Which of the following is considered the final determination of the issues involving
settlement of an insurance claim? - ANSWER Adjudication
Which of the following qualifies as an exception to the HIPAA Privacy rule? - ANSWER
Psychotherapy notes
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? - ANSWER Photocopy both sides of the
new card
Which of the following is an example of a remark code from an explanation of benefits
document? - ANSWER Contractual allowance
Which of the following forms should the billing and coding specialist transmit to the
insurance carrier for reimbursement of inpatient hospital services? - ANSWER UB-04
When the remittance advice is sent from the third-party payer to the provider, which of
the following actions should the billing and coding specialist perform first? - ANSWER
Ensure proper payment has been made
Which of the following is true regarding Medicaid eligibility? - ANSWER Patient eligibility
is determined monthly
Which of the following describes a key component of an evaluation and management
service? - ANSWER History
Which of the following is considered fraud? - ANSWER The billing and coding specialist
unbundles a code to receive higher reimbursement
Which of the following is an example of Medicare abuse? - ANSWER Charging
excessive fees
Which of the following privacy measures ensures protected health information (PHI)? -
ANSWER Using data encryption software on office workstations
Which of the following organizations fights waste, fraud, and abuse in Medicare and
Medicaid? - ANSWER Office of Inspector General (OIG)
Which of the following forms does a third-party payer require for physician services? -
ANSWER CMS-1500
,CBCS Exam Review with 234 answered
questions
Which of the following reports is used to arrange the accounts receivable from the date
of service? - ANSWER Aging report
A patient has laboratory work done in the emergency department after an inhalation of
toxic fumes from a faulty exhaust fan at her place of employment. Which of the following
is responsible for the charges? - ANSWER Workers' compensation
If both parents have full coverage for a dependent child, which of the following is
considered to be the primary insurance? - ANSWER The parent whose birthdate comes
first in the calendar year is the primary insurance holder
Which of the following describes the organization of an aging report? - ANSWER By
date
Which of the following actions by the billing and coding specialist prevents fraud? -
ANSWER Performing periodic audits
Which of the following is a federal government health insurance program? - ANSWER
TRICARE
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 designated with power of
attorney. Which of the following is considered a HIPAA violation? - ANSWER The billing
and coding specialist sends the patient's records to the patient's partner
Which of the following is the primary function of the heart? - ANSWER Pumping blood in
the circulatory system
Which of the following is the deadline for Medicare claim submission? - ANSWER 12
months from the date of service
Which of the following terms refers to the difference between the billed and allowed
amounts? - ANSWER Adjustment
Which of the following would result in a claim being denied? - ANSWER An italicized
code used as the first listed diagnosis
The billing and coding specialist should follow the guidelines in the CPT manual for
which of the following reasons? - ANSWER The guidelines define items that are
necessary to accurately code
A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment
information is called which of the following? - ANSWER Encounter form
, CBCS Exam Review with 234 answered
questions
A patient comes to the hospital for an inpatient procedure. Which of the following
hospital staff members is responsible for the initial patient interview, obtaining
demographic and insurance information, and documenting the chief complaint? -
ANSWER Admitting clerk
Which of the following planes divides the body into left and right? - ANSWER Sagittal
Which of the following provisions ensures that an insured's benefits from all insurance
companies do not exceed 100% of allowable medical expenses? - ANSWER
Coordination of benefits
The standard medical abbreviation "ECG" refers to a test used to assess which of the
following body systems? - ANSWER Cardiovascular
Which of the following actions by a billing and coding specialist would be considered
fraud? - ANSWER Billing for services not provided
Which of the following includes procedures and best practices for correct coding? -
ANSWER Coding Compliance Plan
When completing a CMS-1500 paper claim form, which of the following is an acceptable
action for the billing and coding specialist to take? - ANSWER Use Arial size 10 font.
According to HIPAA standards, which of the following identifies the rendering provider
on the CMS-1500 claim form in block 24J? - ANSWER NPI
Which of the following blocks should the billing and coding specialist complete on the
CMS-1500 claim form for procedures, services, or supplies? - ANSWER Block 24D
Which of the following terms describes when a plan pays 70% of the allowed amount
and the patient pays 30%? - ANSWER Coinsurance
A provider charged $500 to a claim that had an allowable amount of $400. In which of
the following columns should the billing and coding specialist apply the non-allowed
charge? - ANSWER Adjustment column of the credits
Patient: Jane Austin; SSN: 555-22-1111; Medicare ID No.: 555-33-2222A; DOB:
05/22/1945. Claim information entered: Austin, Jane; SSN: 555-22-1111; Medicare ID
No.: 555-33-2222A; DOB:052245. Which of the following is a reason the claim was
rejected? - ANSWER The DOB is entered incorrectly.
In the anesthesia section of the CPT manual, which of the following are considered
qualifying circumstances? - ANSWER Add-on codes
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller millyphilip. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $12.99. You're not tied to anything after your purchase.
