Billing and Coding Final Study Guide

Question 1

A patient has paid in advance and the third-party payer paid more than the estimated amount. How should you apply the payment?

Answer 1

Credit

Question 2

Secondary to the CMS-1500 form which of the following forms is the next most significant piece of paperwork for obtaining patient financial information?

Answer 2

Explanation of Benefits(EOB)

Question 3

Which describes the billing provider NPI

Answer 3

The NPI of the provider who provided the service

Question 4

To ensure all claims are being submitted and received, you should document all claims processing on which of the following?

Answer 4

The CMS 1500 claim form

Question 5

which specialty providers should perform an orchiopexy?

Answer 5

Urologist

Question 6

if a billing and coding specialist is coding from the integumentary system and lesion needs to be completely removed with no pathology report, would the provider be performing

Answer 6

Excision

Question 7

Once fraud has been determined, which of the following entities investigates the case and prepares a referral for prosecution?

Answer 7

OIG ( Office of Inspector General )

Question 8

Which of the following should a billing and coding specialist establish to keep track of the status of each claim that is billed?

Answer 8

aging report

Question 9

Which of the following describes how billing and coding specialist should code a claim for a patient who falls in his yard at home and breaks his arm?

Answer 9

E code on accident due to natural and environmental factors

Question 10

A billing specialist should verify code linkage in the charge capture process to ensure which of the following?

Answer 10

Medical Necessity

Question 11

Which of the following best describes the term allowed amount?

Answer 11

The amount of reimbursement an insurance payer and patient agree to pay a provider

Question 12

To calculate a patient balance the biller calls the patients insurance company to find out the maximum dollar amount the insurance company will pay for a procedure. This process is called what?

Answer 12

Predetermination

Question 13

Which of the following patients under the age of 18 is considered qualified to sign a consent form

Answer 13

Emancipated Minor

Question 14

A patient who has a Nephrolithiasis should be treated for which of the following?

Answer 14

Kidney Stones

Question 15

The field “insured’s ID Number” located on the CMS-1500 claim form is used to report which of the following pieces of information ?

Answer 15

Policy Number

Question 16

A sinus procedure with a health maintenance organization (HMO) requires which of the following ?

Answer 16

Preauthorization

Question 17

A medicare provider submits a CMS-1500 Form that is rejected for payment which of the following should be a reason for the forms rejection

Answer 17

Services were not preauthorized

Question 18

A patient has changed policies and her coverage is now with per partner what information from the partner is required to bill the patients claims?

Answer 18

Policy number

Question 19

Which Organizations conducts investigations and audits that are in question regarding the privacy law

Answer 19

OIG

Question 20

In which of the following locations should a billing and coding specialist find the contact information to appeal a claim?

Answer 20

Insurance Company file