Legal
Which of the following mandates the retention of patient records and health insurance claims for a minimum of 6 years unless state law specifies a longer period?
A. Health Insurance Portability and Accountability Act
B. American Medical Billing Association
C. Office of Inspector General
D. Tax Relief and Health Care Act
A. Health Insurance Portability and Accountability Act
An electronic claim is submitting for several services and one service is denied. Which of the following actions should the billing and coding specialist do?
A. Add required information and retransmit the claim
B. Resubmit the original claim
C. Add the required information and call the insurance carrier for guidance
D. Resubmit the claim using the different code
A. Add required information and retransmit the claim
What is the purpose of obtaining a preauthorization?
A. To obtain prior approval for healthcare services
B. To verify a patients insurance coverage
C. To obtain permission to provide care in an emergency
D. To ensure that non-covered services are covered
A. To obtain prior approval for healthcare services
An ICD-10-PCS alphanumeric code containing how many characters?
A. 6
B. 4
C. 7
D. 5
C. 7
Which of the following claims are submitted to the payer and awaits processing?
A. Unassigned claims
B. Claim appeals
C. Open claims
D. Closed claims
C. Open claims
A family member of the patient calls requesting information. Prior to the discussion of anything related to the patient, the billing and coding specialist must ensure that which of the following documents is on file in the patient's chart?
A. Notice of Privacy Practice
B. Treatment consent
C. Records release authorization
D. Advance Beneficiary Notice
C. Records release authorization
A clearinghouse rejects a claim that is missing the patient's DOB. Which of the following actions should the billing and coding specialist take next?
A. Add the missing information and resubmit
B. Provide the clearinghouse with only the missing information
C. Create a new claim
D. File a claim appeal
A. Add the missing information and resubmit
Which of the following best describes the term "Allowed amount"?
A. The difference between what has been paid by the patient and the amount billed
B. The difference between the patient's co-payment and what is owed according to the EOB
C. The difference allowed by the provider for supplies
D. The amount of reimbursement an insurance payer and patient agree to pay a provider
D. The amount of reimbursement an insurance payer and patient agree to pay a provider
In the ICD-10-CM coding manual, which of the following terms is used to indicate a late effect?
A. Chronic
B. Combination code
C. External cause
D. Sequela
D. Sequela
Which of the following is required to bill for a service that is not likely to be covered by Medicare?
A. HIPAA privacy act
B. Provider attestation form
C. Advance Beneficiary Notice
D. Informed consent form
C. Advance Beneficiary Notice
Which of the following is nit a key component in selecting a level of Evaluation and Management (E&M) services?
A. History
B. Date
C. Examination
D. Medical decision-makings
B. Date
Which of the following information associated with an aging report informs the billing and coding specialist about more than just the immediate claim pending?
A. The number of patients who have high deductibles
B. Trends of non-payment by the insurance payer
C. The amount of co-payments that were paid at the time of the visit
D. The quality of claims that were processed last quarter
B. Trends of non-payment by the insurance payer
Which of the following data elements delay claim processing if missing?
A. Medical record number
B. Secondary insurance
C. Units of services
D. Telephone number
C. Units of services
In the CPT-4 coding convention, the + is used to indicate which of the following?
A. A revised code
B. A recycled CPT code
C. An add-on code
D. A re-sequenced code
C. An add-on code
Which of the following medical terms is a procedure that is found on the fee schedule?
A. Laparoscopy
B. Psoriasis
C. Carpal tunnel syndrome
D. Endometriosis
A. Laparoscopy
Which of the following entities is responsible for implementing the various provisions of HIPAA in healthcare?
A. Occupational Safety and Health Administration (OSHA)
B. Center of Disease Control and Prevention (CDC)
C. Food and Drug Administrative (FDA)
D. Centers for Medicare and Medicaid Services (CMS)
D. Centers for Medicare and Medicaid Services (CMS)
Which of the following terms describe the transmission of data for processing by payers or clearinghouses?
A. Claims adjudication
B. Claims submission
C. Coordinated care plans
D. Balance billing
A. Claims adjudication
Which of the following blocks on the CMS-1500 claim form must be signed in order to allow the provider to receive direct payment from a third-party payer?
A. Coordination of benefits block
B. Insurance block
C. Release of information block
D. Assignment of benefits block
D. Assignment of benefits block
A triangle placed in front of a code in the CPT manual means:
A. It is a code for a new procedure
B. The description for the code has changed
C. It is a minor procedure
D. It is a secondary procedure only
B. The description for the code has changed
Which of the following procedures is an example of a code for removing cancer?
A. Excisions of fibrosarcoma
B. Destruction of benign lesion
C. Aspiration of breast cyst
D. Debridement of a pressure ulcer
A. Excisions of fibrosarcoma
Which of the following should a billing and coding specialist collect from a patient during an initial visit?
A. Social security card
B. Credit card number
C. Insurance card
D. Medical record number
C. Insurance card
A billing and coding specialist receives a remittance advice indicating that a Medicare claim in the amount of $150 has incomplete information and will not be paid. How should the specialist handle this claim?
A. Adjust the charge minus the patient's 20%
B. Resubmit a corrected claim
C. File an appeal to the carrier
D. Adjust the entire charge of $150
C. File an appeal to the carrier
In which section of the CPT manual should the billing and coding specialist find the codes for an X-ray procedure?
A. Radiology
B. Pathology and laboratory
C. Medicine
D. Surgery
A. Radiology
The suffix meaning surgical repair is:
A. -plasty
B. -ectomy
C. -tomy
D. -itis
A. -plasty