Which of the following Medicare policies determines if a particular item or service is covered by
Medicare? -Answer - National Coverage Determination (NCD)
A patient's employer has not submitted a premium payment. Which of the following claim
statuses should the provider receive from the third-p...
Which of the following Medicare policies determines if a particular item or service is covered by
Medicare? -Answer - National Coverage Determination (NCD)
A patient's employer has not submitted a premium payment. Which of the following claim
statuses should the provider receive from the third-party payer? -Answer - Denied
A billing and coding specialist should routinely analyze which of the following to determine the
number of outstanding claims? -Answer - Aging report
Which of the following should a billing and coding specialist use to submit a claim with
supporting documents? -Answer - Claims attachment
Which of the following terms is used to communicate why a claim line item was denied or paid
differently than it was billing? -Answer - Claim adjustment codes
On a CMS-1500 claim form, which of the following information should the billing and coding
specialist enter into Block 32? -Answer - Service facility location information
A provider's office receives a subpoena requesting medical documentation from a patient's
medical record. After confirming the correct authorization, which of the following actions should
the billing and coding specialist take? -Answer - Send the medical information pertaining to the
dates of service requested
Which of the following is the deadline for Medicare claim submission? -Answer - 12 months
from the date of service
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Which of the following forms does a third-party payer require for physician services? -Answer -
CMS-1500
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 designed 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 terms refers to the difference between the billing and allowed amounts? -
Answer - Adjustment
Which of the following HMO managed care services requires a referral? -Answer - Durable
medical equipment
Which of the following explains why Medicare will deny a particular service or procedure? -
Answer - Advance Beneficiary Notice (ABN)
Which of the following types of claims is 120 days old? -Answer - Delinquent
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
A husband and wife each have group insurance through their employers. The wife has an
appointment with her provider. Which insurance should be used as primary for the appointment?
-Answer - The wife's insurance
Which of the following would most likely result in a denial on a Medicare claim? -Answer - An
experimental chemotherapy medication for a patient who has stage III renal cancer
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Which of the following pieces of guarantor information is required when establishing a patient's
financial record? -Answer - Phone number
A provider surgically punctures through the space between the patient's ribs using an aspirating
needle to withdraw fluid from the chest cavity. Which of the following is the name of this
procedure? -Answer - Pleurocentesis
A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500
claim form should the information be entered? -Answer - Block 9
A Medicare non-participating (non-PAR) provider's approved payment amount is $200 for a
lobectomy and the deductible has been met. Which of the following amounts is the limiting
charge for this procedure? -Answer - $230
**A non-PAR who does not accept assignment, can collect a maximum of 15% (the limiting
charge) over the non-PAR Medicare fee schedule amount.
In the anesthesia section of the CPT manual, which of the following are considered qualifying
circumstances? -Answer - Add-on codes
Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries
describes which of the following procedures? -Answer - Angioplasty
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 statements is accurate regarding the diagnostic codes in Block 21? -
Answer - These codes must correspond to the diagnosis pointer in Block 24E
Which of the following parts of the Medicare insurance program is managed by private, third-
party insurance providers that have been approved by Medicare? -Answer - Medicare Part C
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