NHA Medical Coding and billing exam Latest Update Questions and Verified Correct Answers Guaranteed Success (RAC) Recovery audit Contractor - Correct Answer:Which of the following organizations identifies improper payments made on CMS claims
(S) Subjective - Correct Answer:Soap note to indicate patient level of pain to provider
0% - Correct Answer:Beneficiary of Medicaid/ Medicare crossover claim is responsible for the percentage
- Pieces of Information that need to be collected from patients - Correct
Answer:Patients name and date of birth
- reasons a claim may be denied - Correct Answer:Invalid subscriber name was given
or coding error was made
3rd Party Payer - Correct Answer:Insurance Carrier is a
18% - Correct Answer:Coding a front torso burn, what % should be used?
837 - Correct Answer:Format used to submit electronic claims and 3rd Party payer
A bilateral procedure - Correct Answer:A billing and coding specialists should add modifier -50 when reporting which procedure
A billing worksheet from the patient account - Correct Answer:A prospective billing account audit prevents fraud by reviewing & comparing a completed claim for with which of the following documents
A patients signature authorizing the release of any medical information necessary to
process the claim. - Correct Answer:Block 12
A Providers office with fewer than 10 fulltime employees - Correct Answer:Medicare enforces mandatory submission of electronic claims for most providers. Which of the providers is allowed to submit paper claims to Medicare?
Abuse - Correct Answer:Practices that directly or indirectly result in unnecessary cost to the Medicare program
Accounts recievable - Correct Answer:Patient charges that have not been paid will appear in which of the following
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Add on Codes - Correct Answer:Anesthesia section of CPT manual which are
considered qualifying circumstances
adjudication - Correct Answer:Which of the following is considered the final
determination of the issues involving settlement of an insurance claim
Advance Beneficiary Notice (ABN) - Correct Answer:Advanced beneficiary notice, or ABN is a form that is required for Medicare recipients.
An italicized code used as the 1st listed diagnosis - Correct Answer:Result of a claim being denied
APC Grouper - Correct Answer:Determine the appropriate ambulatory payment
classification for outpatient encounter
Assignment of Benefits - Correct Answer:Contract in which the provider directly bills the payer and accepts the allowable charge.
Auditing - Correct Answer:Review of claims for accuracy and completeness
Authorization - Correct Answer:Permission granted by the patient or the patients representative to release information for reasons other than treatment, payment, or health care operations
Billing provider NPI number is on what block on the CMS 1500 form? - Correct
Answer:Block 33a
Billing using 2- digit CPT Modifiers to indicate a procedure as preformed differs from its usual 5 digit code - Correct Answer:Which of the following is allowed when billing procedural codes
Birthday Rule - Correct Answer:Parent whose birthday comes 1st in the calendar year is considered primary
Block 23 - Correct Answer:A billing and coding specialists should enter the prior the authorization number on the following blocks.
Bone and bone marrow - Correct Answer:IF a patient has osteomyelitis he has
problems with which of the following areas?
Charge Description Master (CDM) - Correct Answer:Information about health care
services that patients have received and financial transactions that have taken place.
Charging excessive fees - Correct Answer:Example of Medicare abuse
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