Which of the following actions by a CBCS would be considered fraud?

Billing for services not provided

Which of the following indicates that a claim should ber submitted on paper

The claim requires an attachment

When a patient has a condition that is both acute and chronic, how should it be reported?

Code both acute and chronic, sequencing the acute first

Which of the following describes a delinquent claim?

The claim is overdue for payment

Which statement is correct regarding a deductible?

The deductible is the patients responsiblilty

PATIENT CALLS AND REQUEST COPY OF THE REMITTANCE ADVICE FOR A RECENTLY ADJUDICATED CLAIM. WHAT ACTION SHOULD YOU TAKE

REMOVE ALL INFORMATION OTHER THAN WHAT PERTAINS TO THE PATIENT

WHICH STATEMENT IS TRUE WHEN DETERMINING PT. FINANCIAL RESPONSIBILITY BY REVIEWING THE RA

COINSURNACE, COPAYMENT,OR DEDUCTIBLE SHOULD BE COLLECTED FROM PATIENT

Claims submitted without the NPI will delay payment to the provider because

The number identifies the physician

Which of the following describes the content of a medical practice aging report?

An overview of the practice's outstanding claims

Block 33a on the CMS-1500 form

National provider identification number

Which of the following is an violation of an adult patients confidentiality

Patient information was disclosed to the patients parent without consent

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Answers

1
Which of the following actions by a CBCS would be considered fraud?
Billing non-covered services as covered services
Billing for services not provided
Violating participating provider agreements with third party paye
Submitting a claim for services that are not medically necessary
2
Which of the following is the third stage of the life cycle of a claim?
Claims submission
Claims payment
Claim processing
Claims adjudication
3
Which of the following is a type of claim that will be denied by the third party payer?
Incomplete claim
Rejected claim
Pending claim
Secondary claim
4
Which of the following is the correct term for an amount that has been determined to be uncollectible?
Financial hardship
Bad debt
Discounted fee
Professional courtesy
5
Which of the following acts applies to the administrative simplification guideline
Deficit reduction act of 2005
Patient protection and affordible care act 2009
HIPAA
National correct coding initiative of 1995
6
On a remittance advice, who's responsible for writing off the difference (adjustment)
Patient
Insurance company
Provider
3rd party payer
7
Which best describes a government sponsored health benefit program
Worker's compensation
Tricare prime
Foundation for Medicare
Unemployment compensation disability
8
When a physician documents a patient's response to symptoms and various body systems. The results are documented as
Family history
Comprehensive examination
Past medical history
Review of systems
9
Which of the following indicates that a claim should ber submitted on paper
The claim needs authorization
The PMP software non functional
The claim requires an attachment
Software claims review process indicates the claim not completed
10
A patient met Medicare deductible of $150, allowed amount is $600 what is the patients out of pocket expense
$150
$450
$120
$300
11
The insurance allows $300 of a $600 billed amount, and $75 of the deductible has not been met. How much is written off
$75
$250
$150
$300
12
Which section of the medical record is used to determine the correct E/M code to use for billing and coding
Codes used during prior patient visits
Plan of care
Patient's insurance plan
History and physical
13
Ambulatory surgery centers, home health & hospice use the ___________ to bill
CMS - 1500 form
ABN form
UB-04 form
First report of injury form
14
Which of the following would be part of a physicians practice compliance program
HIPAA compliance audit
Internal monitoring & auditing
Notice of privacy practice
Physician recruitment
15
When a patient has a condition that is both acute and chronic, how should it be reported?
Code only the acute code
Code both acute and chronic, sequencing the acute first
Code both acute and chronic, sequencing the chronic first
Code only the chronic code
16
Which of the following is the initial step in perceiving a worker's compensation claim?
Notice of contest
Disability claim
Progress notes
First report of injury
17
Which block requires the patients authorization to release medical information
Block 12
Block 27
Block 31
Block 21
18
Which of the following describes a delinquent claim?
The claim is overdue for payment
The claim had more than one procedure submitted
The claim is an incoming claim
The claim was submitted beyond the timely filing limit
19
A FRAUD INVESTIGATING CONTRACTOR HIRED BY CMS TO AUDIT AND REVIEW ON THEIR BEHALF.
ZPICs
MIP
RAC
MAC
20
Which statement is correct regarding a deductible?
The insurance company pays the deductible
The deductible is the patients responsiblilty
The physician should write off the deductible
Coinsurance is a type of deductible
21
Which of the following is the function of the respiratory system?
Generating white blood cells
Oxygenating blood cells
Generating red blood cells
Deoxygenating blood cells
22
Which of the following describes an obstruction of the urethra?
Urethralgia
Urethratresia
Urethrism
Uretritis
23
Which of the following medical terms refers to the sac that encloses the heart?
Endocardium
Myocardium
pericardium
Epicardium
24
PATIENT CALLS AND REQUEST COPY OF THE REMITTANCE ADVICE FOR A RECENTLY ADJUDICATED CLAIM. WHAT ACTION SHOULD YOU TAKE
REMOVE ALL INFORMATION OTHER THAN WHAT PERTAINS TO THE PATIENT
REFER THE PATIENT TO THEDIR 3RD PARTY PAYER FOR A COPY
EXPLAIN TO THE PATIENT THAT THIS INFORMATION CANNOT BE RELEASED TO THEM
MAKE A CLEAR COPY OF THE PAGE WHERE THE PATIENTS INFORMATION IS INCLUDED
25
If the patient has osteomyelitis, he has problems with which of the following?
Bones and skin
Bones and muscles
Bones and bone marrow
Bones and tendons
26
A provider charged $500 Aetna allowable amount is $400. Which column should you apply the non allowed charge
Adjustment column
Reference column
Description column
Payment column
27
A billing practice such as excessive referrals to other providers for unnecessary services is considered
Health Insurance Portability and Accountability Act of 1996.
Medical billing abuse
HEALTHCARE PROVIDER
FRAUD
28
A patient who has an abnormal accumulation of fluids in her lower leg that has resulted in swelling
Edema
Emesis
-Ptosis
Dilation
29
WHAT TERM DESCRIBES THE AMOUNT THE PATIENT MUST PAY WHEN THE INSURANCE PLAN PAYS 70% OF ALLOWED AMOUNT AND PATIENT 30%
PREMIUM
DEDUCTIBLE
COINSURANCE
COPAYMENT
30
DONE TO PREVENT DUPLICATION OR OVERLAPPING OF PAYMENTS
MEDICALLY NECCESSARY
COORDINATION OF BENEFITS
MANDATED BENEFITS
PREEXISTING
31
WHICH STATEMENT IS TRUE WHEN DETERMINING PT. FINANCIAL RESPONSIBILITY BY REVIEWING THE RA
COINSURNACE, COPAYMENT,OR DEDUCTIBLE SHOULD BE COLLECTED FROM PATIENT
SERVICE DENIED FOR ERRONEOUS CLAIM DATA ARE THE RESPONSIBILITY OF THE PT.
DIFFERENCE BETWEEN THE BILLED AMOUNT & ALLOWED AMOUNT PATIENT RESPONSIBLE
CLAIMS NOT BILLED TO 3RD PARTY PAYER WITHIN TIME PATIENTS RESPONSIBLE
32
he provision of health insurance policies that specifies which coverage is considered primary or secondary is called?
Explanation of benefits
Assignment of benefits
Coordination of benefits
Eligibility verification
33
Claims submitted without the NPI will delay payment to the provider because
The number identifies the physician
It is used as a preauthorization number
Is used as a claim number
The NPI is the patients ID#
34
A biller will electronically submit a claim to the carrier via which of the following?
Direct data entry
Charge data entry
Electronic remittance advice
Electronic fund transfer
35
What is the maximum number of ICD codes that can be entered on a CMS-1500 claim form as of February 2012?
4
10
12
6
36
Which of the following describes the content of a medical practice aging report?
An overview of the practice's debts
An overview of the practice's outstanding claims
An overview of the practice's net worth
An overview of the practice deposits.
37
WHICH OF THE FOLLOWING MISSING PIECES OF PATIENT DEMOGRAPHIC INFORMATION WOULD CAUSE A REJECTION FROM THE CLEARINGHOUSE
DATE OF BIRTH
EMERGENCY CONTACT NAME
APARTMENT NUMBER
MIDDLE NAME
38
PURPOSE IS TO ELIMINATE WASTE, FRAUD AND ABUSE
OIG
ARRA
HIPAA
HITECH ACT
39
Patients charges that have not been paid will appear in
Accounts payable
Tracer
Rejected claim
Accounts receivable
40
Which of the following blocks on the CMS-1500 claim form is used to bill ICD codes?
22
17a
24D
21
41
Block 33a on the CMS-1500 form
Patient Id number
Provider social security number
Federal tax Id number
National provider identification number
42
Z codes are used to identify which of the following?
Infectious diseases
-Behavior disorders
Immunizations
Digestive diseases
43
The reason the patient came to see the physician
REFERRAL
CC
PHI
ROS
44
Which of the following is an violation of an adult patients confidentiality
A biller queries a physicuian about a Dx in a opatient chart
The physician uses his home phone to discuss patient care with a nurse
Patient information was disclosed to the patients parent without consent
45
Which of the following parts of the body system regulates immunity?
Endocrine system
Respiratory system
Lymphatic system
Urinary system
46
The CBCS should first divide the evaluation and management code by which of the following?
Combination code
Place of service
Severity
Point of service
47
What is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedure?
Operative report
Encounter form
Progress note
Approval on previous claim form
48
A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called which of the following
Encounter form
Remittance advice
Itemized bill
Chargemaster
49
Considered the final determination of the issues involving settlement of a claim
Translation
Transmission
Processing
Adjudication
50
WHICH OF THE FOLLOWING SECTIONS OF THE CPT BOOK WOULD YOU CODE FOR WBC WITH DIFFERENTIAL, AUTOMATED
ANESTHESIA
SURGERY
PATHOLOGY & LABORATORY
E/M
51
When completing CMS-1500 paper claim form, which of the following is an acceptable action for the CBCS to take?
Attach documents with staples in the left hand corner
Use Arial size 10 font
Fold the form in half for mailing
Use appropriate title for all patients
52
Which color formats allows optical scanning of the CMS-1500 form
Blue
Red
Black
Green
53
Which of the following is a verbal or written agreement that gives approval to release PHI?
Assignment of benefits
Right to privacy
Notice of privacy practices
Consent
54
A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with
A day sheet
accounts receivable report of the patient account
A billing worksheet from the patient account
-A superbill
55
Unlisted codes can be found in which of the following
End of each body system
Guidelines prior to each section
Table of contents
Appendix L
56
WHEN CODING FOR OUTPATIENT & PROFESSIONAL SERVICES, SEQUENCE THE Dx ACCORDING TO GUIDELINES. FIRST LISTED Dx WOULD BE
PRINCIPAL Dx
PRIMARY Dx
ETIOLOGY
MANIFESTATION
57
What the purpose of running an aging report each month?
Indicates which patients have upcoming or missed appointments
Indicates the balalnces patients owe
Indicates what the insurance company has paid for the month
Indicates which claims are outstandiing
58
A patients health plan is referred to as payer of last resort
Medicare
Tricare
Medicaid
CHAMPA
59
Which of the following terms describes the 70%/30% that the insurance pays
Premium
Deductible
Coinsurance
Copayment
60
The standard medical abbreviation "ECG" refers to a test used to assess which of the following body systems?
Cardiovascular system
Male reproductive system
Respiratory system
Endocrine system
61
DISCOVERING WHETHER TREATMENTS ARE COVERED UNDER A PATIENTS CONTRACT
PREDETERMUINATION
PRECERTIFICATION
PREAUTHORIZATION
ELIGIBILITY
62
Which of the following is the correct entry of a charge of $150 in block 24F
15000
150.00
150
150 00
63
WHICH SHOULD BE INCLUDED ON A CLAIM FORM THAT IS SENT FROM A SPECIALIST TO A MANAGED HEALTH CARE ORGANIZATION
REFERRING PROVIDER NPI
CLAIMS ADJUSTMENT REASON CODE
REFERRING PROVIDER SS#
PRIOR AUTHORIZATION NUMBER
64
A CBCS should enter the prior authorization number on the CMS-1500 claim form in which of the following blocks?
24E
24D
21A
23
65
Which of the following providers' is allowed to submit paper claim to Medicare
A Medicare advantage contractor (MAC)
A provider's office with fewer than 25 full time employees
A provider's office with fewer than 10 full time employees
A provider who submits a secondary insurance claim
66
Which blocks should be filled out for procedures on CMS 1500 form
Block 13
Block 24 D
Block 24J
Block 12
67
The destruction of lesions using cryosurgery would use which of the following treatments?
Cold treatment
Laser treatment
Chemical peel treatment
Electric current treatment
68
what action should be taken to prevent fraud & abuse in the medical office
Utilization review
Serviced procedure preauthorization
Internal monitoring and auditing
Correct coding Initiative
69
When billing a secondary insurance, which block should the CBCS fill out on the CMS-1500 form?
28
9a
24J
24F
70
Accepting assignment on the CMS-1500 claim form indicates which of the following?
patient agrees to pay the difference of billed amount and allowed amount
The physician agrees to bill according the third payer's fee schedule
patient agrees to accept payment and forward the payment to the physician
physician agrees to accept payment under the terms of the payer program.
71
A patient who has a primary malignant neoplasm of the lung should be referred to which of the following specialists?
Pulmonary oncologist
hematologist
Thoracic surgeon
Cardiologist
72
A provider receives a reimbursement from a third party payer accompanied by with document?
Monthly statement
Explanation of benefits
Age analysis
Benefit summary sheet
73
What's the status of a claim that does not include the required preauthoprization for a service
Denied
Adjudicated
Delinquent
Suspended
74
COMPANIES THAT CONTRACT WITH MEDICARE TO RECOUP MONEY FROM INAPPROPRIATELY PAID CLAIMS
SDP
MIP
RAC
ZPICs
75
Outpatient setting which of the following forms is used as a financial report of all services to patient
Accounts receivable journal
Patient account record
CMS-1500 claim form
Encounter form
76
A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with
A superbill
A billing worksheet from the patient account
Am accounts receivable report of the patient account
A day sheet
77
Which of the following blocks on the CMS-1500 claim form is required to indicate a worker's compensation claim?
22
21
10a
11a
78
When a patient has a condition that is both acute and chronic, how should it be reported?
Code only the chronic code
Code both acute and chronic, sequencing the chronic first
Code only the acute code
Code both acute and chronic, sequencing the acute first

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