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CBCS Practice Test 1 Exam Papers With
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Splinting of the fourth digit on the left foot
A billing and coding specialist is reviewing modifier use with a new employee. Which of the following scenarios warrants the use of a modifier?
Patient access to psychotherapy notes is restricted
Which of the following statements is true regarding the release of patient records?
Coordination of benefits
Which of the following provisions ensures that an insured patient's benefits form third party payers do not exceed 100% of allowable medical expenses?
G51.
A patient presents to a provider's office with difficulty speaking, facial dropping, and an inability to close their left eye. They are diagnosed with Bell's palsy. A billing and coding specialist should report which of the following ICD- 10 - CM codes?
Phone number
Which of the following pieces of guarantor information is required when establishing a patient's financial record?
Report the incident to a supervisor
A billing and coding specialist observes a colleague perform an unethical act. Which of the following actions should the specialist take?
Provider
On a remittance advice form, which of the following is responsible for writing off the difference between the amount billed and the amount allowed by agreement?
Excisional procedure
A billing and coding specialist is reviewing the procedure notes from a provider who selected a code indicating an incisional biopsy when the entirety of the patient's lesion was removed. The specialist should verify with the provider that which of the following types of procedures was performed?
Resubmit an updated claim
A billing and coding specialist is reviewing a report from the clearinghouse after submitting electronic claims and notices that one claim was rejected due to missing demographic information. Which of the following actions should the specialist take?
- F
A billing and coding specialist is preparing a claim for a patient who had a procedure performed on their left index finger. Which of the following modifiers indicates the correct digit?
A billing and coding specialist is posting a Medicare remittance advice and identifies an overpayment of $15. Which of the following actions should the specialist take?
Medicare part C
Which of the following parts of Medicare is managed by private third-party payers that have been approved by Medicare?
Send a copy of the operative report with the claim
A billing and coding specialist is preparing a claim for a procedure with a prolonged operative time that has modifier - 22 attached. Which of the following actions should the specialist take?
Adjudication
Which of the following is the third stage of a claim's life cycle?
Outstanding balances organized by date
A billing and coding specialist is preparing an accounts receivable aging report. The specialist should expect the report to include which of the following?
CMS-1500 claim form
Which of the following should a billing and coding specialist complete to be reimbursed for a providers outpatient service?
Payment for the encounter is based on a flat rate
A billing and coding specialist is assisting a patient who has a capitated health maintenance organization (HMO) and presents to the office with a sinus infection. The specialist should identify that which of the following statements is true regarding a capitated HMO?
Medically unlikely edits
A billing and coding specialist is preparing a claim for an appendectomy and reports it with two units. The claim is then denied. Which of the following coding edits should the specialist have reviewed prior to submitting the claim?
A product pending FDA approval is indicated by a lightening bolt symbol
Which of the following information is correct regarding code symbols in the CPT manual?
Health care clearinghouses
HIPAA transaction standards apply to which of the following entities?
Employers who provide workers compensation plans
Name and address of guarantor
Which of the following information is required on a patient account record?
Medigap coverage is offered to Medicare beneficiaries by which of the following?
Verify the age of the account
A billing and coding specialist is reviewing a delinquent claim. Which of the following actions should the specialist take first?
A providers office fee is $100, and the Medicare part B allowed amount is $85. Assuming the beneficiary has not met their annual deductible, the patient should be billed for which of the following amounts?
Colostomy
A patient has a resection of the intestines with anastomosis through the abdominal walls. Which of the following is a type of anastomosis?
Retrospective review
A billing and coding specialist identifies a CPT code that is routinely being denied by a third-party payer. Which of the following types of review should the specialist perform?
To determine which claims are outstanding from third party payers
Which of the following is the purpose of running an insurance aging report each month?
A billing and coding specialist is determining the level of service for an office visit for a new patient. Which of the following codes represents a detailed history and detailed exam with moderate medical decision-making?
I
Which of the following is an example of a diagnostic category code?
Claims are expedited
Which of the following is an advantage of electronic claim submission?
Coordination of benefits
Which of the following is the provision of health insurance policies that specifies which coverage Is primary and secondary?
Using data encryption software on office workstations
Which of the following actions by a billing and coding specialist ensured a patient's health information is protected?
The claim indicated an incorrect place of service
A billing and coding specialist Is reviewing a remittance advice from Medicare and notices that the amount paid for a procedure is less than the contracted amount. Which of the following Is a potential reason for the reduced amount of payment?
Apply characters four through seven to a claim
Which of the following actions should a billing and coding specialist take to assign a diagnosis code to the highest level of specificity?
"It's when a provider requests medical advice from a specialist."
A billing and coding specialist is training a new employee on a claim for a consultation. The new employee asks, "What is a consultation?" Which of the following responses should the specialist make?
Call the U.S. Department of Health and Human Services (DHHS) anonymous hotline
A billing and coding specialist discovers suspicious billing activity that may be fraudulent in the workplace. Which of the following actions should the specialist take?
Identification
A billing and coding specialist is preparing to appeal a partially paid claim due to an incorrect procedure code. Which of the following steps of the appeal process includes the review of the claim adjustment reason code?
Immunizations
Z codes are used to identify which of the following?
National Correct Coding Initiative (NCCI)
Which of the following editing systems should a billing and coding specialist reference to determine if a supplies and materials code should be assigned to report a surgical tray used during an ambulatory procedure?
Subjective
In which of the following sections of a SOAP note does a provider indicate a patient's reported level of pain?
The guidelines define items that are necessary to accurately code
For which of the following reasons should a billing and coding specialist follow the guidelines in the CPT manual?
TRICARE
Which of the following is a federal government health insurance program?
Category I modifier
A billing and coding specialist is working on a claim in which reimbursement was reduced due to services being bundled. Which of the following types of modifiers should be assigned to indicate multiple procedures were performed to prevent bundling?
Individuals who are under age 65 and have a disability
Which of the following qualifies a patient for eligibility under Medicare as the primary third-party payer?
Unlisted codes can be found in which of the following locations in the CPT manual?
Patient account record
In an outpatient setting, which of the following forms is used as a financial report of all services provided to patients?
An explanation of benefits states the amount billed was $80. The allowed amount is $60, and the patient is required to pay a $20 copayment. Which of the following describes the insurance check amount to be posted?
A billing and coding specialist is reviewing a patients encounter progress note. Which of the following modifiers indicated the patient received general anesthesia from a surgeon?
Wounds should be grouped by anatomic site and coded in order of complexity
A billing and coding specialist is reviewing a provider's documentation for a patient who underwent repair of multiple wounds to the face and trunk. The provider coded repair of all wounds individually. The specialist should recognize that the provider should have applied which of the following concepts to the documentation of the repair for the patients' wounds?
Inform the patient of the reason for the denial
A patient is upset about a bill they received because their third-party payer denied the claim. Which of the following actions should a billing and coding specialist take?
Internal monitor and auditing
Which of the following is part of a provider's practice compliance program?
Send the medical information pertaining to the dates of service required
A providers office receives a subpoena requesting medical documentation from a patient's medical record. After confirming the correct authorization, which of the following actions should a billing and coding specialist take?
Office or other outpatient services
A new patient presents for an urgent care encounter. Which of the following code sets should be used to report this encounter?
The patient accepts the policies and procedures regarding how protected health information (PHI) is handled
When a patient signs an Acknowledgement of Notice of Privacy Practice. It indicated which of the following?
To verify that the medical records and the billing record match
Which of the following is the purpose of an internal review in a provider's office?
A billing and coding specialist is reviewing a claim that was denied for services provided during the postoperative period. The patient was diagnosed with pneumonia during a postoperative encounter for a knee joint replacement 2 weeks ago. Which of the following modifiers should the specialist add to the claim prior to resubmitting?
A patient has met a Medicare deductible of $150. The patient's coinsurance is 20%, and the allowed amount is $600. Which of the following is the patients out of pocket expense?
Clearinghouses, health insurance companies, and billing services
Which of the following entities are required to follow HIPAA rules and regulations?
Diagnosis pointer
Which of the following links the ICD- 10 - CM and CPT codes for claims processing?
Code signs and symptoms in the absence of a definitive diagnosis
Which of the following is a valid ICD- 10 - CM principle?
Telemedicine
The star symbol in the CPT coding manual is used to indicate which of the following?
Notify the patient between 3 and 10 days prior to depositing each check on the indicated date
A billing and coding specialist is arranging a payment plan with a patient who wants to leave postdated checks with the office. The patient proposes leaving one check postdated for 3 months, one for 4 months, and another one for 5 months in the future. According to federal collection law, which of the following actions should the specialist take?
The claim requires an attachment to support medical necessity
For which of the following reasons should a claim be resubmitted?
Photocopy both sides of the new card
When reviewing and established patients' insurance card, a billing and coding specialist notices a minor change from the existing card on file. Which of the following actions should the specialist take?
Health maintenance organization (HMO)
A patient wants to see an endocrinologist for a consultation about their diabetes mellitus, but they must see their primary care provider (PCP) for a referral to an in-network specialist first. Which of the following types of insurance does the patient have?
A billing and coding specialists preparing a claim for an established patient who arrived for an annual exam. During the examination, the provider treated the patient's sinus infection and prescribed medication for it. Which of the following evaluation and management (E/M) codes requires modifier - 25?
A billing and coding specialist is reviewing delinquent claims and discovers that a third-party payer paid a claim but applied it to the incorrect provider. The third-party payer will reimburse the payment once the improperly paid funds are recouped. Which of the following terms is used to describe this claim?
Biological mother
A billing and coding specialist is submitting a claim for a school-age child who was brought to the clinic by their maternal grandmother. The child's parents are divorced and remarried, and the child's mother has legal custody of the child. The specialist should recognize that the child's primary insurance coverage is provided through which of the following insured individuals?
Contact the patient for assistance
A billing and coding specialist receives a denial for payment from TRICARE for services provided in the emergency department while a provider was on call. The provider is not a participating TRICARE provider. Which of the following actions must the specialist take to process an appeal for payment?
