NHA Billing and Coding Specialist

These questions are part of the practice quiz. Start practicing

• What does the term "deductible" refer to?
• When both parents have the same birthday, which insurance should be primarily used to cover their child?
• What is the ICD-10-CM code to report for a patient diagnosed with Bell's Palsy?
• What does "pre-authorization" signify in healthcare billing?
• How are CPT codes generally structured?
• What type of insurance does a patient have if they must see their primary care provider for a referral to an in-network specialist?
• A billing and coding specialist should add modifier -50 to a code when reporting which of the following?
• What type of health insurance plan permits patients to select any healthcare provider?
• Who primarily benefits from bundled payments?
• When reviewing an encounter note that indicates a biopsy was performed, what additional detail is needed to fully code this procedure?
• A patient has requested a copy of the remittance advice for a claim. What action should the specialist take?
• Which CPT code category is used for surgical procedures?
• Which document is typically used to request pre-authorization for a service?
• What is meant by coding compliance?
• If a patient's office visit is billed at a higher rate than the allowed amount from insurance, what should the patient be charged?
• In a SOAP note, what category would a provider's objective findings fall under?
• According to federal collection law, what should a billing and coding specialist do when arranging postdated checks with a patient?
• HIPAA transaction standards apply primarily to which of the following entities?
• Which level of care would typically require a Level II HCPCS code?
• When submitting an electronic claim for a procedure with modifier -22, what action should the billing and coding specialist take?
• Which coding system is used primarily for durable medical equipment?
• What does the principal diagnosis code on a claim represent when coding for inpatient?
• What term refers to the amount a patient must pay when their insurance covers 70% of the allowed amount?
• Define "payer mix."
• Which process involves reviewing a patient's medical necessity for a proposed service?
• How can a billing and coding specialist reduce claim denials?
• Which of the following actions by a billing and coding specialist ensures a patient's health information is protected?
• A billing and coding specialist is reviewing a report from the clearinghouse and notices one claim was rejected due to missing demographic information. What should be the next step?
• Which modifier should be used when an employer's workers' compensation payer requires bloodwork for a work-related injury?
• Which information is required on a patient account record?
• What is the purpose of a National Coverage Determination (NCD) in Medicare?
• What is true regarding patient access to psychotherapy notes?
• When coding for a patient with both acute and chronic conditions, how should these be sequenced?
• What is the correct action for a specialist upon receiving a subpoena for a patient's medical documentation?
• What does the abbreviation CPT stand for within the context of medical coding?
• What does the plus sign in the CPT manual signify?
• Outstanding patient balances will appear on which of the following?
• Which of the following is a common reason for insurance claim denials?
• Which review process evaluates coding information after services have been delivered?
• How often is the ICD-10-CM coding system updated?
• What is the primary function of a billing and coding specialist?
• What is the significance of the term "outpatient" in healthcare?
• What does PPO stand for in health insurance?
• Which modifier correctly indicates that the procedure was performed on the left index finger?
• Which aspect of coding is most important for ensuring compliance?
• What is considered a service provided by durable medical equipment?
• Which entity typically utilizes the principal diagnosis code when processing inpatient claims?
• What coding guidelines must be followed when coding a patient's visit?
• Which of the following is NOT a requirement for submitting insurance claims?
• What is the primary purpose of a patient encounter form?
• What code set should be used to report an urgent care encounter for a new patient?
• What term describes the process of checking for new or revised text in documentation or guidelines?
• What does the term "unbundling" refer to in medical billing?
• A patient is covered by Medicare through managed care. Which part of Medicare provides this coverage?
• A specialist is collecting demographic information for a patient who lives in Hawaii and is an active duty service member. What type of insurance does this patient have?
• What action should a billing and coding specialist take after observing an unethical act performed by a colleague?
• Which coding system is primarily used for medical diagnoses in the United States?
• What type of insurance code is specifically designed for new technologies and procedures?
• Which entities are required to comply with HIPAA rules and regulations?
• If a billing specialist identifies an overpayment of $15 after posting a Medicare remittance advice, what should they do?
• What is the primary purpose of coding in medical billing?
• Which missing piece of patient demographic information would most likely cause a claim rejection?
• Which coding system is primarily used for outpatient and inpatient procedures?
• What does "RBRVS" stand for, and what is its purpose?
• Where can Unlisted Codes be found in the CPT manual?
• A child is brought into a facility by the mother. The child is covered by both parents’ insurances. Which statement is true regarding the primary policy holder for the child?
• What does the term "co-insurance" refer to in health insurance?
• Name one essential skill a billing and coding specialist should possess.
• A billing and coding specialist is preparing an accounts receivable aging report. The specialist should expect the report to include which of the following?
• After coding a claim, what should a specialist do if they notice an error in demographic information?
• If a provider's office fee is $100 and Medicare Part B allowed is $85, what amount should the patient be billed assuming the deductible has not been met?
• What should a billing and coding specialist do when a patient is upset about a claim denial from a 3rd party payer?
• What is the primary purpose of the ICD-10 coding system?
• Which role is required in a provider's office to comply with HIPAA regulations?
• Why should a billing and coding specialist follow CPT manual guidelines?
• Which statement is true about the billing process for surgical procedures?
• If a claim is submitted with a transposed insurance member ID number, what status will the third party payer likely assign to the claim?
• A billing and coding specialist is assisting a patient with a capitated health maintenance organization (HMO) who presents with a sinus infection. Which statement is true regarding a capitated HMO?
• What is a common requirement for Medicaid eligibility?
• In coding, what does the term "modifier" mean?
• According to CPT integumentary coding guidelines, who are the providers involved in Mohs micrographic surgery?
• Which modifier indicates the patient required general anesthesia from a surgeon?
• When collecting demographic information from a patient, what should the Medicaid eligibility verification system (MEVS) provide?
• Which of the following professionals is responsible for ensuring accurate revenue cycle management?
• A billing and coding specialist is preparing an appeal letter in response to a denial by a third-party payer for lack of medical necessity. Which of the following should the specialist include with the letter to indicate medical necessity?
• In the CPT manual, what does a lightning bolt symbol indicate?
• Which of the following healthcare providers is likely to be classified as a non-participating provider?
• What is the function of billing software in healthcare management?
• Which modifier should be used for services rendered by both a surgeon and an assistant?
• What does NHA stand for in the context of billing and coding certification?
• What is the third stage of the claims cycle?
• What form is essential for improving the efficiency of the healthcare system as mandated by HIPAA?
• Which part of Medicare is managed by private 3rd party payers?
• For an office visit for a new patient, which code represents detailed history and detailed exam with moderate medical decision-making?
• A billing and coding specialist is preparing a claim for a provider. What does CARG stand for?
• What is considered the "primary diagnosis" in insurance claims?
• A patient undergoes a resection of intestines with anastomosis. What type of anastomosis is involved?
• What type of insurance policy is typically designed to cover catastrophic medical events?
• Which of the following is a federal government health insurance program?
• In the context of medical billing, what does the term "deductible" refer to?
• In coding guidelines, what does "upcoding" refer to?
• What kind of information should a billing and coding specialist verify during the internal review process?
• What action should a specialist take to determine 3rd party payer responsibilities for a patient with Medicare coverage?
• What is the purpose of coding compliance audits?
• When billing for services provided by an assistant surgeon, which modifier should be used?
• Which document outlines the professional agreement between a provider and a patient regarding payment?
• When reviewing paperwork showing overpayment of Medicare for multiple patients, what is this process called?
• Which modifier should be added to the claim for a patient diagnosed with pneumonia during a postoperative encounter for knee joint replacement?
• In a married couple where each spouse has group insurance through their employer, which insurance is typically used as primary for a patient's appointment?
• What is the purpose of diagnostic coding in healthcare?
• What is the time frame typically required for submitting claims to Medicare?
• What does a "clean claim" signify in medical billing?
• What does the term "allowable charge" mean in insurance billing?
• What type of referral does a patient need from an endocrinologist to see an infectious disease specialist?
• Which section of the CPT manual lists the code for WBC with differential, automated?
• Why is a patient's portion of the bill discussed with them before a procedure?
• What is the primary responsibility of a medical billing specialist in the revenue cycle?
• What is the purpose of running an insurance aging report each month?
• Which government program provides healthcare coverage for individuals aged 65 and older?
• What action should a specialist take to assign a diagnosis code to the highest level of specificity?
• What does a "payer" refer to in the context of healthcare billing?
• What is a common outcome of improper billing practices?
• A billing and coding specialist is reviewing a remittance advice and encounters a denial of payment for CPT code 44950 (appendectomy). The specialist discovers that the ICD-10-CM code assigned was J32.1 (chronic frontal sinusitis). What is the reason for this claim denial?
• What type of coding includes both procedural and diagnostic codes?
• Who offers Medigap coverage to Medicare beneficiaries?
• What does the term "deductible" refer to in insurance billing?
• What does a patient's signing of an Acknowledgement of Notice of Privacy Practice indicate?
• What links the ICD-10-CM and CPT codes for claims processing?
• Which provision ensures that an insured patient's benefits from 3rd-party payers do not exceed 100% of allowed medical expenses?
• When should a patient typically be informed of their coinsurance responsibilities?
• What should a billing and coding specialist verify if the procedure notes indicate an incisional biopsy but the lesion was completely removed?
• When reviewing a delinquent claim, what should a billing and coding specialist do first?
• What should a billing specialist do if they notice a minor change on an established patient's insurance card?
• Which Evaluation and Management (E/M) code requires modifier -25?
• What does PHI stand for under HIPAA regulations?
• What is the purpose of modifiers in CPT coding?
• In medical coding, what does "RVS" stand for?
• What is the purpose of the HCPCS level II code set?
• What qualifies a patient for Medicare eligibility as the primary 3rd party payer?
• A patient has met a Medicare deductible of $150. The patient's coinsurance is 20% and the allowed amount is $600. What is the patient's out-of-pocket expense?
• What is typically required in order for insurance to cover services?
• In coding, what does "E/M" stand for?
• What is the primary purpose of a remittance advice?
• What does a modifier signify in medical billing?
• In the context of HIPAA, what is the primary objective of safeguarding patient information?
• Which of the following are qualifying circumstances in the anesthesia section of the CPT manual?
• What is typically included in a bundled payment?
• On a remittance advice form, who is responsible for writing off the difference between the amount billed and the amount allowed by the agreement?
• Which category of CPT codes includes codes for emerging technology and procedures?
• While reviewing remittance advice from Medicare, a billing and coding specialist finds that the payment for a procedure is less than expected. What could be a reason for this?
• What document is used to report medical information to insurance companies and to bill patients?
• Which code is used for an established patient visit in outpatient settings?
• What should a billing and coding specialist verify before submitting a claim?
• Which of the following is a valid principle of ICD-10-CM coding?
• What is the main role of the coding auditor?
• What is consultation in the medical billing context?
• Which coding system is primarily used for diagnoses in the United States?
• What type of modifier should be used to indicate that multiple procedures were performed to prevent bundling?
• A specialist is processing a claim for a patient who broke their arm while repairing cars at a workplace. The arm is placed in a cast for 6 weeks and the patient is cleared to return to work in 6 weeks. Which type of workers' compensation applies to this patient?
• What does a medical coding audit assess?
• When a patient visits for an upper respiratory infection and also receives an influenza vaccine, which modifier is appropriate to attach to the evaluation and management (E/M) code?
• Which term is used to describe the process of reviewing claims for accuracy prior to submission?
• For which of the following reasons should a claim be resubmitted?
• What action should be taken if a billing and coding specialist detects an issue with a payment reduction after reviewing Medicare remittance advice?
• What should be collected from a patient when reviewing the remittance advice for financial responsibility?
• What is an expected outcome of accurately coding visits with modifiers?
• What does a signature approving assignment of benefits on a CMS-1500 claim form indicate?
• Which of the following pieces of guarantor information is required when establishing a patient's financial record?
• What does the term "Global period" refer to in surgical coding?
• If TRICARE denies payment for services provided in the emergency department, what must the specialist do to process an appeal?
• When should a billing and coding specialist perform a charge entry?
• A billing and coding specialist discovers a suspicious billing activity that may be fraudulent in the workplace. What action should the specialist take?
• 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?
• Which coding system is used for durable medical equipment (DME)?
• Z codes are primarily used to identify which of the following?
• What is the purpose of conducting an internal review in a provider's office?
• What refers to the provision in health insurance policies that specifies which coverage is primary or secondary?
• What modifier should be used to report a mastectomy after a biopsy during the global period?
• If a claim for an appendectomy was denied after reporting two units, which coding edits should the specialist review before resubmitting?
• What is an electronic form used to post reimbursements?
• Why is it important for healthcare providers to submit claims accurately?
• What equation determines how patient responsibility is calculated when posting payments from an explanation of benefits (EOB)?
• What does Medicare Part D cover?
• What is a key distinction between "non-participating" and "participating" providers?
• What does "NPI" stand for in healthcare billing?
• What is the primary goal of the Resource-Based Relative Value Scale (RBRVS)?
• What does the modifier -25 signify in coding?
• Which of the following is an example of a violation of an adult patient's confidentiality?
• Which of the following may indicate that a claim submitted to a third-party payer has an error?
• Which information should be included on a claim form sent from a specialist to a managed care organization?
• What does the term "bundled payment" mean?
• If a CPT code is routinely denied by a third-party payer, what type of review should the specialist perform?
• Which platform do providers use to electronically submit claims?
• Which of the following is the correct way to handle billing discrepancies?
• What is an "explanation of benefits" (EOB)?
• Which of the following is NOT a typical component of a healthcare claim?
• What does CPT stand for?
• A billing and coding specialist is preparing to appeal a partially paid claim due to an incorrect code. Which step of the appeal process includes reviewing the claim adjustment reason code?
• Which section of the CPT codebook contains codes for anesthesia services?
• Which of the following do Category III codes describe?
• For reimbursement, what must be included in the submission for linking ICD-10-CM and CPT codes?
• When a patient has health coverage through multiple third-party payers, which is identified as the payer of last resort?
• What is defined as intentionally providing false information to obtain improper payment or benefits in healthcare?
• In an aging report, which category should ideally contain the lowest percentage of accounts receivable?
• Which of the following is an acceptable way to handle a denied claim?
• Which of the following is true regarding Medicaid eligibility?
• Healthcare providers must ensure that which type of information is collected for effective billing?
• What differentiates in-network providers from out-of-network providers?
• Which symbol indicates an add-on code in the CPT manual?
• What is defined as a fixed amount a patient pays for a covered healthcare service at the time of service?
• What best describes the purpose of the remittance advice?
• What is a "superbill" in medical billing?
• What is the primary goal of medical coding?
• Which editing system should a billing and coding specialist reference to determine if a supplies and materials code should be assigned for a surgical tray used during an ambulatory procedure?
• What is a component of a provider's practice compliance program?
• What does the abbreviation "CMS" stand for in healthcare?
• When coding outpatient services, what describes the first listed diagnosis code on a claim?
• The purpose of modifiers in coding is to provide:
• In an outpatient setting, which form is used as a financial report of all services provided to patients?
• Who provides the primary insurance coverage for a school-age child brought to a clinic by their maternal grandmother?
• What is the term for the amount a patient pays before their insurance covers the rest?
• In a SOAP note, where does a provider indicate a patient's reported level of pain?
• What is a "patient ledger" in the context of medical billing?
• A specialist is preparing a claim for a procedure with a prolonged operative time that has modifier -22. What action should the specialist take?