Legal
The Civil Monetary Penalty Statue includes which of the following provisions regarding healthcare fraud and abuse? (Research)
A. Assessment of maximum penalty of three times the amount claimed by the provider
B. Penalties of no more than $10,000 per violation
C. Exclusion from non-government programs
D. Minimum of 1 year in prison for the first offenders
C. Exclusion from non-government programs
When identical procedures or services are performed on the same day, which of the following should the billing and coding specialist update on the CMS-1500 form? (Research)
A. Modifier-59
B. Modifier-99
C. Block 27
D. Block 24G
D. Block 24G
On an explanation of benefits form, which of the following should a billing and coding specialist use to determine why the insurance company denied the insurance claim?
A. Provider allowed charge
B. Service description
C. Remark Code
D. Provider payee
C. Remark Code
The HCPCS manual includes which of the following?
A. Diagnosis codes
B. Current Procedure Terminology
C. F codes
D. Tables of drugs
A. Diagnosis codes
Which of the following diagnosis meets the criteria for the use of a nebulizer?
A. Strep throat
B. Asthma
C. Pharyngitis
D. Tonsillitis
B. Asthma
Which of the following is the primary purpose of the Health Information Portability and Accountability Act (HIPAA) Title I?
A. To administer and enforce group health plan regulations
B. To provide tax benefits for specific health-related provisions under HIPAA
C. To allow for healthcare access, portability, and renewability
D. To assist providers with preventing healthcare fraud and abuse
D. To assist providers with preventing healthcare fraud and abuse
A billing and coding specialist submits a patient's claim for a surgical procedure. Further review by the insurance company is not necessary before submitting payment. This is an example of which of the following types of claims?
A. Clean
B. Rejected
C. Pending
D. Incomplete
A. Clean
Which of the following is included in an electronic remittance advice?
A. Patient's employer
B. Patient's deductible
C. Patient's phone number
D. Patient's provider
B. Patient's deductible
Which of the following references is needed to complete the procedure section of the CMS-1500 form?
A. Morphology listing
B. CPT
C. ICD
D. Physician's Desk Reference
B. CPT
What is the correct format when entering an address onto a CMS-1500 form?
A. 7803 S. Market Street Suite 203
B. 7803 S Market Street Suite 203
C. 7803 S, Market Street, Suite 203
D. 7803 S. Market Street, suite 203
A. 7803 S. Market Street Suite 203
A. Changing dates and services to bill them
B. Reporting duplicate charges on a claim
C. Entering another patient's insurance information to ensure reimbursement
D. Altering claims to increase reimbursement
B. Reporting duplicate charges on a claim
When submitting a workers compensation claim, the billing and coding specialist should populate which of the following on the CMS-1500 form? (Research on claim form)
A. Blocks 10 and 14
B. Blocks 8 and 22
C. Blocks 23 and 30
D. Blocks 19 and 29
A. Blocks 10 and 14
When posting a payment to an account, in which of the following columns should a billing and coding specialist record an insurance payment?
A. Charges column
B. Debit column
C. Balance column
D. Credit column
D. Credit column
A billing and coding specialist can find which of the following terms in the alphabetic index in the ICD-10-CM coding manual? (Research)
A. Colonoscopy
B. Circumcision
C. Bronchitis
D. Tonsillectomy
C. Bronchitis
Which of the following organizations is responsible for providing National Coverage Determination (NCDs)?
A. Health Insurance Portability and Accountability Act (HIPAA)
B. National Center for Health Statistics (NHCS)
C. American Hospital Association (AHA)
D. Centers for Medicare and Medicaid Services (CMS)
D. Centers for Medicare and Medicaid Services (CMS)
A patient's authorization for release of information is usually valid for a standard of period of which of the following amount of time?
A. 60 days
B. 45 days
C. 90 days
D. 120 days
C. 90 days
On the CMS-1500 form, populating block 6 with "Other" would indicate that the patient is the: (Research: Look on the CMS-1500 claim form)
A. Insured
B. Subscriber
C. Dependent
D. Guarantor
B. Subscriber
Which of the following covers the deductible of a patient's primary health insurance policy?
A. Department of outpatient services
B. The patient's liability plan
C. The patient's supplemental plan
D. The patient's primary insurance plan
D. The patient's primary insurance plan
Which of the following is the lowest level of an Evaluation and Management code for an established patient? (Research In the CPT, E and M section)
A. 99201
B. 99211
C. 99291
D. 99284
B. 99211
Which of the following is the appropriate way to key a form for Intelligent Character Recognition (ICR) scanning?
A. Strike over any errors when correcting letters or digits
B. Enter all information in uppercase letters
C. Use script, slant, or italicized fonts when entering the information
D. Use N/A or DNA when information is not applicable
B. Enter all information in uppercase letters
Which of the following organization conducts investigation and audits that are in question regarding the privacy law?
A. Centers for Medicare and Medicaid Services
B. Office of Inspector General
C. Department of Insurance
D. Office for civil rights
B. Office of Inspector General
A remittance advice states a denial of payment for an appendectomy due to the absence of preauthorization. Which of the following actions should the billing and coding specialist take if the appendectomy was an emergency procedure?
A. Resubmit the original claim
B. Submit the bill to the patient
C. Appeal the claim
D. Revise the original claim
C. Appeal the claim
A billing and coding specialist should take which of the following action to prevent fraud and abuse?
A. Discuss potential coding problems with the provider at least once per year
B. Avoid continuing education about coding
C. Notify the supervisor only when an individual admits to fraud and abuse
D. Use the most up-to-date coding manuals
D. Use the most up-to-date coding manuals
When a billing and coding specialist is filling a CMS-1500 claim form, the date must be in which of the following formats?
A. YYMMDD
B. MMDDYYYY
C. CCYYMMDD
D. MMDDCC
B. MMDDYYYY