Legal
A billing and coding specialist is allowed to make which of the following incidental disclosures within HIPAA guidelines?
A. Calling a patient by social security number
B. Calling a patient by insurance number
C. Calling a patient by identification number
D. Calling a patient by name
D. Calling a patient by name
A. Diagnosis
B. Outside laboratory
C. Amount paid
D. Patient's account number
A. Diagnosis
A. DO (Doctor of Osteopathy)
B. DK
C. DQ
D. DN
A. DO (Doctor of Osteopathy)
A patient's progress notes indicate that she is primigravida. Which of the following describes the patient's condition?
A. Stage one breast cancer
B. Painful bleeding
C. Anxiety related to stress
D. Pregnant for the first time
D. Pregnant for the first time
When does the physician-patient implied contract begin?
A. At the time the appointment is made
B. When the insurance company pays for the service
C. At the time the patient pays the copayment
D. When the patient completes the demographic information
A. At the time the appointment is made
Under HIPAA, which of the following scenarios requires the patient authorization for the release of health information?
A. Adhering to a subpoena
B. Reporting communicable disease data
C. Using patient information for marketing
D. Referring a patient to another provider
B. Reporting communicable disease data
Secondary to the CMS-1500 claim form, which of the following forms is the next most significant piece of paperwork for obtaining the patient's financial information?
A. Medical records
B. Preauthorization
C. Member contract
D. Explanation of benefits
D. Explanation of benefits
In which of the following locations should a billing and coding specialist find the contact information to appeal a claim?
A. Insurance company file
B. Accounts payable file
C. Physician's Desk Reference
D. Program management file
A. Insurance company file
Which of the following is a proper terminology when coding a directional area?
A. Superior
B. Closest to the middle
C. Below
D. Upward
A. Superior
If a patient qualifies for Medicare coverage and needs a prescription medication plan, which of the following should they obtain?
A. Medicare Part C
B. Medicare Part A
C. Medicare Part D
D. Medicare Part B
C. Medicare Part D
Which is an example of fraud?
A. Billing excessive fees for equipment, supplies, and services
B. Disputing provider's agreements with the insurance company
C. Violating participating provider agreements
D. Reporting an extensive procedure when a routine procedure was performed
D. Reporting an extensive procedure when a routine procedure was performed
A patient has a diagnosis of chest pains. The billing and coding specialist should link this diagnosis to the procedure in which of the following blocks on the CMS-1500? (Research)
A. 24D
B. 24E
C. 24A
D. 24J
B. 24E
Which of the following diagnosis establishes an admission?
A. History of
B. First listed
C. Principal
D. Previous conditions
C. Principal
Which of the following diagnosis can be found in the neoplasm table?
A. Diabetes
B. Cardiac murmur
C. Basal cell carcinoma
D. Streptococcal infection
C. Basal cell carcinoma
Which of the following is the meaning of dermatosis?
A. A skin specialist
B. The treatment of a skin condition
C. The abnormal condition of the skin
D. The study of the skin
C. The abnormal condition of the skin
Which of the following was passed in 1972, to protect patients from fraud and abuse by reducing the influence of money on health care? (Research)
A. OSHA
B. Federal Anti-Kickerback Law
C. Social Security Act
D. Stark II Physician Self-Referral Law
B. Federal Anti-Kickerback Law
A billing and coding specialist is filling out a CMS-1500 claim form. When the specialist enters a 99214 on the claim, which of the following is being used?
A. HCPCS
B. NPI number
C. CPT coding manual
D. ICD
C. CPT coding manual
A patient in a prepaid group plan is charged $80 for an office visit. After the patient pays the $10 copay, which of the following amount should the billing and coding specialist adjust off the account?
A. $16
B. $70
C. $8
D. $90
B. $70
Which of the following should a coder take before coding a medical record for billing?
A. Assign the discharge status on the medical record
B. Use an encoder software for designing codes
C. Analyze the medical record for upcoding and unbundling
D. Ensure that the provider has a complete medical record
D. Ensure that the provider has a complete medical record
A child lives in the same house as both parents and is insured by both parents. Which of the following is a common practice to determine which parent's insurance is identified as primary?
A. The parent whose insurance pays more
B. The parents whose employment year is earlier
C. The parent whose birth month occurs earlier
D. The parent whose birthday
C. The parent whose birth month occurs earlier
Which of the following entities works with the centers for Medicare and Medicaid services to prevent overpayment?
A. Quality improvement organization
B. Recovery audit contractors
C. Medicaid integrity contractors
D. Joint commission
C. Medicaid integrity contractors
Which of the following selections should be used on an outpatient claim?
A. Definitive diagnosis
B. First listed diagnosis
C. Differential diagnosis
D. Qualified diagnosis
D. Qualified diagnosis
A billing and coding specialist should verify code linkage in the charge capture process to ensure which of the following?
A. Claim scrubbing
B. Correct encounter documentation
C. Medical necessity
D. Allowed amount for procedure
C. Medical necessity
A billing and coding specialist should use HCPCS Level II to bill for which of the following?
A. Ambulance services
B. Surgical inpatient services
C. Category II service codes
D. Evaluation and management services
A. Ambulance services
What is the correct term for a primary disease of the heart muscle?
A. Cardiomyopathy
B. Mitral valve prolapse
C. Atherosclerosis
D. Aortic regurgitation
A. Cardiomyopathy