Certified Billing and Coding Specialist CBCS-B Practice Test

These questions are part of the practice quiz. Start practicing

• Which CMS-1500 field indicates the availability of a secondary payer?
• The UB-04 form is used to submit claims for which setting?
• What is the primary function of denial management in revenue cycle management?
• The provision of health insurance policies that specifies which coverage is primary or secondary is called which of the following?
• Which modifier is used to indicate the professional component of a service billed separately?
• In CMS payment integrity programs, RAC stands for what?
• Which organization issued the Medicare documentation guidelines referenced in the material?
• Which of the following was developed to reduce Medicare program expenditures by detecting inappropriate codes and eliminating improper coding practices?
• What is an advantage of electronic claim submission?
• Which term describes the process of auditing CMS claims to recover improper payments?
• Which of the following is a private insurance carrier?
• Which statement describes in-network status for a healthcare provider?
• Which statement best defines a claim status in medical billing?
• What does CPT modifier -25 indicate?
• Which statement about the CPT/HCPCS modifiers is true?
• What is the role of quality measures in CBCS?
• Which Act applies to the Administrative Simplification guidelines?
• What is the difference between professional and institutional claims?
• A billing and coding specialist should enter the prior authorization number on the CMS-1500 claim for in which of the following blocks?
• What is the appropriate diagnosis for a patient with abnormal accumulation of fluid in the lower leg causing swelling?
• Which modifier is used to indicate that a procedure was performed on both sides?
• A claim submitted without all required fields is described as which type?
• Behavior plays an important part of being a team player in a medical practice. Which of the following is an appropriate action for a billing and coding specialist to take?
• Which block on the CMS-1500 claim form is used to bill ICD codes?
• Which form is used for institutional claims?
• Why is accurate claim processing important?
• What term describes a verbal or written agreement that gives approval to release protected health information?
• Store-and-forward telemedicine is coded as what?
• The standard medical abbreviation ECG refers to a test used to assess which of the following body systems?
• What is the difference between 'problem-focused' and 'expanded problem-focused' E/M documentation?
• Which of the following describes the final determination of a settled insurance claim?
• In determining an Evaluation and Management code, which part of the chart provides the detailed history and examination?
• What is the CMS-1500 form used for?
• Which document is required to disclose an adult patient’s information to an authorized party?
• What is the primary use of the CMS-1500 claim form?
• Which document is required to disclose an adult patient's information?
• Which type of claim is most likely to be denied by a third-party payer?
• The physician bills $500; after submission, the claim is denied; the patient still owes $500 for the year. This amount is called which?
• What is the primary purpose of the patient account record?
• What is a copayment?
• What is coinsurance and how is it calculated?
• Which coding system is used for diagnoses in CBCS outpatient billing?
• HCPCS Level II codes are used to identify which categories?
• What are external cause codes and when should they be used?
• What is a deductible and how does it affect patient payment?
• Which statement best defines a medical consultation for billing purposes?
• Which HIPAA 5010 transaction is used to verify a patient's coverage before service?
• Which step would be part of a physician's practice compliance program?
• What is the maximum number of ICD codes that can be entered on a CMS-1500 claim form as of February 2012?
• Which of the following is not typically a function of revenue cycle management?
• Which 837 transaction set is used for institutional claims?
• Which term describes an obstruction of the urethra?
• For an emergency service billed as out-of-network, what documentation helps support an appeal?
• In an outpatient setting, which form is used as a financial report of all services provided to patients?
• Which organization mandates electronic claims for most providers?
• For which of the following time periods should the billing and coding specialist track unpaid claims before taking follow-up action?
• Patient charges that have not been paid will appear in which accounting category?
• Which modifier is used to denote the technical component of a service?
• Which practice should be used to detect and prevent improper billing practices in a clinic?
• If two providers from the same practice bill the same CPT code for the same patient encounter in the emergency department, the claim may be denied for which reason?
• Which action best preserves patient confidentiality in practice?
• A biller will electronically submit a claim to the carrier by which method?
• In a plan with deductible and coinsurance, when is coinsurance paid?
• Which document is commonly required by some payers to authorize a procedure in advance?
• Which coding manual is used primarily to identify products, supplies, and services?
• What is the initial step in processing a workers' compensation claim?
• In Medicare documentation guidelines introduced in the 1990s, what was the primary purpose?
• How can you minimize claim denials from a payer perspective?
• What is a Z-code and when is it used?
• What defines the global surgical package and the global period?
• What information must be included on an Advance Beneficiary Notice (ABN) form?
• What elements are required to bill chronic condition management (CCM) services?
• Which statement best describes the payer of last resort in the billing process?
• Which of the following billing patterns is a best-practice action?
• If a physician is contracted with an insurer to accept the allowed amount, and the insurer allows $80 of a $120 billed amount with $50 deductible not yet met, how much should be written off?
• Which CPT codes are used for vaccine administration?
• In an emergency service claim billed as out-of-network, which statement should be included in the appeal?
• What is eligibility verification and why is it essential?
• Which section of the medical record is used to determine the correct Evaluation and Management code used for billing and coding?
• When billing a vaccine with both administration and product codes, what should be submitted?
• After reviewing notes about a new patient, a coder codes for a longer visit than occurred. Which term describes this action?
• A Medicare/Medicaid crossover claim submitted by a participating provider requires what patient responsibility percentage?
• Which indicates a claim should be submitted on paper rather than electronically?
• Under HIPAA, which entity is specifically involved in processing electronic health information exchanges between parties?
• Which practice helps prevent fraud and abuse in a medical office?
• A prospective billing account audit compares a completed claim form with which document?
• A claim is denied because the service was not covered by the insurance company. Upon confirmation of no errors on the claim, which describes the process that will follow the denial?
• What does a medical practice aging report describe?
• Which item is sometimes required by some payers before a procedure is performed?
• What is the likely outcome if a claim is submitted without all required fields?
• Which describes the status when a claim does not include required pre-authorization for a service?
• What is the role of revenue cycle management (RCM) in a medical practice?
• Which term refers to the portion of the account balance the patient must pay after services are rendered and the annual deductible is met?
• Which option best reflects the HIPAA portion that enables communication with other providers for treatment?
• Which term describes a fixed fee paid at the time of service, before insurance applies?
• What is the importance of the provider taxonomy code?
• To effectively manage accounts receivable, which action is appropriate?
• In an authorization to release information, what must be specified about the recipient?
• A prospective billing audit is performed to prevent fraud by comparing a complete claim form with which document?
• In an authorization to release information, which item must be included?
• What is the purpose of running an aging report each month?
• CPT codes report which of the following?
• What is a provider NPI and why is it required on claims?
• Which statement correctly identifies the use of external cause codes V00–Y99?
• What term describes a debt that is unlikely to be collected and is written off?
• Which modifier should be used to indicate a professional service has been discontinued prior to completion?
• Which of the following entries correctly shows a charge of $150 in Block 24F on the CMS-1500 form?
• How is anesthesia coding typically billed?
• Which type of services does the CMS-1500 form primarily bill?
• What stage follows adjudication in the life cycle of a claim?
• Auditing in medical billing serves which primary purpose?
• What does National Correct Coding Initiative refer to?
• When a physician documents a patient's response to symptoms and various body systems, these results are recorded as which of the following?
• Which document explains the payer's approved benefits and patient responsibility after processing a claim?
• What is the difference between 'inadequate documentation' and 'incorrect codes' in claim denials?
• On a CMS-1500 claim, which identifier uniquely identifies the treating provider?
• A Medicare/Medicaid crossover claim is a claim that involves coordination between which programs?
• What is the role of a clearinghouse in medical claims processing?
• What is the third stage of the life cycle of a claim?
• Which telehealth modifier denotes store-and-forward?
• Z codes identify which of the following?
• Which statement is true when determining patient financial responsibility by reviewing the remittance advice?
• What is unbundling in medical billing and why is it risky?
• What is the role of the NPI and TIN in claims?
• Cryosurgery destroys lesions using which type of treatment?
• Regarding the release of patient records, which statement about psychotherapy notes is true?
• Which statement best describes the content of CMS-1500 blocks 1-13?
• Osteomyelitis affects which parts of the body?
• What are the main E/M coding guidelines used to determine levels?
• Which medical term refers to the sac that encloses the heart?
• Who bears the responsibility for paying the deductible?
• Medicare requires electronic submission of claims for most providers. Which claim submission method is mandated?
• On UB-04 form, the main condition that occasioned the admission is known as what?
• Which modifier is commonly used to indicate store-and-forward telemedicine?
• 837 transaction sets are used for electronic submission of claims for which services?
• What does CPT modifier -59 indicate?
• Which code describes the purpose of Z-codes?
• What are the coding differences between outpatient and inpatient settings for diagnosis and procedures?
• When posting a payment, which item should be included?
• What is the difference between in-network and out-of-network reimbursement?
• Which term describes permission to release PHI?
• The CMS-1500 claim form has the 'assignment of benefits' box checked 'yes.' What does this indicate?
• When is modifier -26 used?
• Which portion of HIPAA allows the provider to speak to the cardiologist prior to obtaining the patient's consent?
• On the CMS-1500 claim form, which item should contain the referring physician's National Provider Identifier?
• Which scenario is a violation of adult patient confidentiality?
• Which claim would appear on an aging report?
• Which insurance carrier is commonly considered the payer of last resort?
• What is UB-04 form used for?
• Under the birthday rule for determining primary insurance, which statement is correct?
• What does ERA provide besides payments?
• When submitting claims, what happens if Block 13 is left blank?
• Which coding system codes inpatient procedures?
• When an electronic claim is rejected due to incomplete information, which action should the medical billing and coding specialist take?
• Assuming the deductible has already been met, if the allowed amount is $800 and the coinsurance is 20%, what is the patient's coinsurance amount?
• In inpatient coding, which code set is used for procedures?
• When billing a secondary insurance company, which CMS-1500 block should the billing specialist complete?
• ERA stands for Electronic Remittance Advice. What information does it contain?
• Which document explains payer payment decisions and the patient's remaining financial responsibility after processing a claim?
• Which method do physicians use to electronically submit claims?
• When is modifier -TC used?
• Which organization identifies improper payments made on CMS claims?
• HIPAA transaction standards apply to which entities?
• What is the purpose of the appeals process in medical billing?
• What is the HIPAA 5010 standard primarily used for in electronic health care transactions?
• How do you ensure immunization coding and billing are accurate?
• What term describes an amount determined to be uncollectible?
• Under privacy rules, patient access to psychotherapy notes may be restricted. Which statement is true?
• Which factor most determines the order in which collection letters are sent to patients?
• What is bundling in CPT coding, and how does it affect payment?
• Which form documents the services provided, charges, and amounts billed to a patient or payer in outpatient setting?
• When a patient balance remains after insurance payment, which component represents the out-of-pocket amount?
• When a denial states the service is not covered, which approach is most appropriate?
• Which code sets are used for diagnoses and procedures in outpatient coding?
• What factor determines whether a claim is considered in-network or out-of-network for a patient?
• Which reimbursement method is typically associated with inpatient hospital stays?
• In medical billing, what term describes the money a practice expects to collect from patients and payers for services performed but not yet paid?
• A billing and coding specialist needs to know how much Medicare paid on a claim before billing the secondary insurance. To which of the following should the specialist refer?
• Which body system regulates immunity?
• Which form is required so the patient knows she may be responsible for payment for a Medicare service?
• Which CMS-1500 block is required to indicate a worker's compensation claim?
• What is the primary audience of the CMS-1500 form?
• Accepting assignment on the CMS-1500 claim form indicated which of the following?
• What is preauthorization and what services typically require it?
• On UB-04 form, which diagnosis code is listed first?
• Which action helps ensure accuracy when entering payer information on a CMS-1500 claim?
• Which health insurance plan best describes a government-sponsored benefit program?
• The CPT symbol O indicates which status of a code?
• Who is responsible for payment of the deductible?
• 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 patient's out of pocket expense?
• Why should immunization billing verify payer requirements before submitting codes?
• Which cost-sharing element represents the portion of costs that the patient pays after deductible is met?
• What is the purpose of CPT/HCPCS modifiers in billing?
• What does CPT modifier -51 indicate?
• Under the birthday rule, who is primary for a dependent child?
• Remittance advice typically includes which of the following?
• One of the purposes of an internal auditing program in a physician's office?
• What is the function of the respiratory system?
• What is the purpose of revenue codes on UB-04?
• Which statement about the allowed amount in insurance reimbursement is correct?
• What is the difference between modifier -GT, -GQ, and -95 in telehealth?
• What does CPT code 99490 represent in CCM billing?
• HCPCS Level II codes cover what?
• During an office visit, the examination of a patient with a sore throat is described as which level of examination?
• NCCI edits are used to prevent improper payments by identifying codes that should not be billed together or require modifiers.
• In ICD-10-CM, what do the 7th character extensions A, D, and S signify?
• Which statement best defines coinsurance?
• When a patient has a condition that is both acute and chronic, how should it be coded?
• Which security feature is required during transmission of protected health information and medical claims to third-party payers?
• Test results indicated that no abnormalities were found in the brain's electrical activity and patterns are normal. Which test was used?
• Which term describes the payer that pays first for a given claim in coordination of benefits?
• Which of the following is an example of electronic claim submission?
• Which form must the patient or their representative sign to allow the release of protected health information?
• In CPT coding, what does the symbol 'O' indicate?
• Medical necessity means a service must be reasonable and necessary to diagnose or treat a condition. How is it documented?
• Which part of Medicare covers prescriptions?
• Which item would typically appear under accounts receivable in a practice's financial records?
• When billing a procedure, which practice is allowed to indicate differences from the standard code?
• Given a scenario with a $100 charge, $80 allowed, $40 applied to deductible, and payment of 80% of the remaining balance, what is the patient’s responsibility?
• After a third-party payer validates a claim, which of the following takes place next?
• On the CMS-1500 claim form, blocks 1 through 13 include which of the following?