Which of the following is considered the final determination of the issues involving
settlement of an insurance claim?
Correct Answer: Adjudication
A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment
information is called which of the following?
Correct Answer: Encoun...
Which of the following is considered the final determination of the issues involving
settlement of an insurance claim?
Correct Answer: Adjudication
A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment
information is called which of the following?
Correct Answer: Encounter form
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?
Correct Answer: Admitting clerk
Which of the following privacy measures ensures protected health information (phi)?
Correct Answer: Using data encryption software on office workstations
Which of the following planes divides the body into left and right?
1
,Correct 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?
Correct Answer: Coordination of benefits
Which of the following actions should be taken first when reviewing a delinquent claim?
Correct Answer: Verify the age of the account
Which of the following is the advantage of electronic claim submission?
Correct Answer: Claims are expedited
Which of the following components of an explanation of benefits expedites the process
of a phone appeal?
Correct Answer: Claim control number
The standard medical abbreviation ECG refers to a test used to assess which of the
following body systems?
Correct Answer: Cardiovascular system
Which of the following actions by a billing and coding specialist would be considered
fraud?
Correct Answer: Billing for services not provided
2
,The >< symbol is used to indicate a new and revised test other than which of the
following?
Correct Answer: Procedure descriptors
On the CMS-1500 claim form, blocks 14 through 33 contain information about which of
the following?
Correct Answer: The patient's condition and the provider's information
Which of the following includes procedures and best practices for correct coding?
Correct 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?
Correct Answer: Use arial size 10 font
A participating blue cross/blue shield (BC/BS) provider receives an explanation of
benefits for a patient account. The charged amount was $100. BC/BS allowed $80 and
applied $40 to the patient's annual deductible. BC/BS paid the balance at 80%. How
much should the patient expect to pay?
Correct Answer: $48
3
, Which of the following indicates a claim should be submitted on paper instead of
electronically?
Correct Answer: The claim requires an attachment
According to HIPAA standards, which of the following identifies the rendering provider
on the CMS-1500 claim form in block 24j?
Correct Answer: NPI
Which of the following blocks should the billing and coding specialist complete on the
CMS-1500 claim form form for procedures, services or supplies (CPT/HCPCS)?
Correct Answer: Block 24D
Which of the following terms describes when a plan pays 70% of the allowed amount
and the patient pays 30%?
Correct Answer: Coinsurance
A provider charged $500 to 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?
Correct Answer: Adjustment column of the credits
Which of the following is a HIPAA compliance guideline affecting electronic health
records?
4
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