1.

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 the
agreement? Provider

2. Based on CPT integumentary coding guidelines, Mohs micrographic surgery

involves the provider filling which of the following roles? Both the surgeon and
pathologist

3. A patient has a resection of the intestines with anastomosis through the

abdominal walls. Which of the following is a type of anastomosis? Colostomy

4. Which of the following is the purpose of an internal review in a provider's office?

To verify that the medical records and the billing record match

5. Which of the following is a valid ICD-10-CM principle? Code signs and

symptoms in the absence of a definitive diagnosis

6. 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? National Correct
Coding Initiative (NCCI)

7. When should a billing and coding specialist initiate the collection of the
information needed to process a patient's insurance claim form? When the
patient contacts the providers office and schedules an appointment

8. A patient wants to see an endocrinologist for a consultation about their diabetes.

But they must see their primary care provider for a referral to an in network
specialist first which of the following types of insurance does the patient have?
Health maintenance organization (HMO)

9. A billing including 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? Excisional procedure

10. 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? Resubmit an updated claim.
11. A billing and coding specialist is reviewing a claim for a patient who presented to
the provider's office for an upper respiratory infection. During the encounter, the
patient also received the influenza vaccine. Which modifier should be attached to
the (E/M) code? -25

12. A patient is upset about a bill they received because their 3rd party payer denied
the claim. Which of the following actions should the billing and coding specialist
take? Inform the patient of the reason for the denial

13. A billing and coding specialist is assisting a patient who has 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? Payment for the encounter is based on a flat
rate?

14. When a patient has a condition that is both acute and chronic. How should it be
coded? Code both the acute and chronic conditions, sequencing the acute
condition first.

15. 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?
Medical record documentation

16. HIPAA transaction standards apply to which of the following entities?

Healthcare Clearinghouses

17. Which of the following symbols indicates an add on code in the CPT manual?
Plus sign

18. Which of the following information is correct code symbols in CPT manual? A
product pending FDA approval is indicated by a lightning bolt symbol.

19. Unlisted Codes can be found in which of the following locations in the CPT
manual? The guidelines prior to each section.
20. A billing and coding specialist is reviewing a remittance advice and encounters a
denial of payment for CPT code 44950 (appendectomy). The specialist
discovered the ICD-10-CM code assigned to the claim was J32.1 (chronic frontal
sinusitis). Which of the following is the reason for this claim denial? Incorrectly
linked codes were reported on the claim

21. A billing and coding specialist discovers a suspicious billing activity that may be
fraudulent in the workplace. Which of the following actions should the specialist
take? Call the U.S. Dept. of health and human services (DHHS) anonymous
hotline.

22. Which of the following should a billing and coding specialist complete to be
reimbursed for a provider's outpatient services? CMS-1500 claim form

23. A specialist is determining the level of service for an office visit for a new patient.
Which of the following codes represents detailed history and detailed exam with
moderate medical decision-making? 99204

24. A billing and coding specialist should identify that which of the following is used
to improve the efficiency and effectiveness of the healthcare system as
mandated by HIPAA for providers? CMS-1500 Claim form

25. A billing and coding specialist should add modifier -50 to a code when reporting
which of the following? A bilateral procedure

26. An explanation of benefits states the amount billed was $80. The allowed amount
is $60, and the patient is required to pay $20 copayment. Which of the following
describes the insurance check amount to be posted? $40

27. A new patient presents for an urgent care encounter. Which of the following code
sets should be used to report the encounter? Office or other outpatient
services

28. A star symbol in the CPT coding manual is used to indicate which of the
following? Telemedicine

29. Outstanding patient balances will appear on which of the following? Accounts
receivable
30. Which of the following statements is true regarding the release of patient
records? Patient access to psychotherapy notes is restricted.

31. A specialist is posting a medicare remittance advice and identifies an

overpayment of $15. Which of the following actions should the specialist take?
Notify medicare of overpayment within 60 days

32. Which of the following terms describes the removal of the eye, adnexa, and bony
structure? Exenteration

33. Used with wounds for exploring the injury site? Exploration

34. A billing and coding specialist is preparing an accounts receivable aging report.
The specialist should expect the report to include which of the following?
Outstanding balances organized by date.

35. In an outpatient setting, which of the following forms is used as a financial report
of all services provided to patient's? Patient account record

36. A 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?
Category 1 modifier

37. Which of the following entities are required to follow HIPAA rules and
regulations? Clearinghouses, health insurance companies, and billing
services.

38. A provider's office fee is $100 and the Medicare Part B allowed is $85. Assuming
the beneficiary has not met their deductible, the patient should be billed for which
of the following amounts? $85

39. A specialist is reviewing delinquent claims and discovers that a third-party pater
paid a claim but applied it to the incorrect provider. The third-party will reimburse
the payment once the improperly paid funds are recouped. Which of the following
terms is used to describe this claim? Suspended
40. A child is brought into a facility by the mother. The child is covered by both
parents' insurance. The child's father was born 10/1/1980. The mother was born
10/2/1981. Which of the following statements is true regarding the primary policy
holder for the child? The father is the primary policy holder because his
Birthday falls first in the calendar year.

41. A specialist is preparing a claim for a procedure with a prolonged operative time
that has modifier -22. Which of the following actions should the specialist take?
Send a copy of the operative report with the claim.

42. A specialist is reviewing an encounter note that indicates biopsy was performed.
The specialist requires which of the following additional details to fully code this
procedure? Benign vs. Malignant

43. Which of the following information is required on a patient account record?

Name and address of guarantor.

44. A billing and coding specialist is preparing to appeal a partially paid claim due to
an incorrect code. Which of the following steps of the appeal process includes
the review of the claim adjustment reason code? Identification

45. Which of the following actions by a billing and coding specialist ensures a
patient's health information is protected? Using data encryption software on
office workstations.

46. 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? Contact the patient
for assistance.

47. 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? The claim indicated an incorrect place of service.

48. A billing and coding specialist is collecting demographic information from a

patient. Which of the following pieces of information should the specialist expect
the Medicaid eligibility verification system (MEVS) to provide?
Dates of coverage
49. A billing and coding specialist observes a colleague perform an unethical act.
Which of the following actions should the specialist take? Report the incident to
a supervisor.

50. When a patient signs an Acknowledgement of Notice of Privacy Practice, it

indicates which of the following? The patient accepts the policies and
procedures regarding how protected health information (PHI) is handled.

51. A specialist is processing a claim for a patient who broke their arm while
repairing cars at a workplace. There is no nerve damage. 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? Temporary Disability

52. Medigap coverage is offered to Medicare beneficiaries by? Private 3rd party
payers

53. Which of the following qualifies a patient for eligibility under medicare as the
primary 3rd party payer? Under 65 with a disability.

54. An employer's workers' compensation payer requires blood work for an

employee who experienced a work-related injury. Which of the following modifiers
shoulda billing and coding specialist use? -32

55. 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? $120

56. A 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 this patient's wounds? Wounds should be grouped by anatomic site and
coded in order of complexity.

57. Which of the following CPT codes should a billing and coding specialist use to bill
for a 5-year-old child who had an initial repair of a 2.5 cm abdominal hernia?
49591
58. A billing and coding specialist is reviewing a claim for an established patient who
arrived at the office with an upper respiratory infection. Which of the following
codes should the specialist use for this encounter? 99213

59. A specialist discovers that one private payer has not reimbursed the provider for
any claims submitted in the past year. Clean claims have been submitted to the
payer and have been acknowledged. Which of the following entities should the
specialist contact to report the payer's failure to submit timely reimbursement?
State insurance commissioner's office

60. Which of the following is used by Medicare to determine if an item or service is

covered? National Coverage Determination NCD

61. A patient presents to the provider's office with difficulty speaking, facial drooping,
and an inability to close their left eye. They are diagnosed with Bell's palsy. A
billing coding specialist should report which of the following ICD-10-CM codes?
G51.0

62. A 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? Biological mother

63. A specialist is reviewing a delinquent claim. Which of the following actions should
the specialist take first? Verify the age of the account

64. Which of the following parts of Medicare is managed by private third party payers
that have been approved by Medicare? Medicare Part C

65. Which of the following is true regarding Medicaid eligibility? Patient eligibility is
determined each visit

66. For which of the following reasons should a b/c specialist follow the guidelines in
the CPT manual? The guidelines define items that are necessary to
accurately code

67. Which of the following provisions ensures that an insured patient's benefits from
third party payers do not exceed 100% of allowable medical expenses?
Coordination of benefits
68. A specialist is preparing a claim for a provider. The operative note indicates the
surgeon performed a CABG. the specialist should identify that CABG stands for
which of the following? Coronary artery bypass graft

69. A specialist is reviewing a claim that was denied for services provided during the
post op period. The patient was diagnosed with pneumonia during a post op
encounter for a knee joint replacement 2 weeks ago. Which of the following
modifiers should the specialist add to the claim prior to resubmitting? -24

70. Which of the following are qualifying circumstances in the anesthesia section of
the CPT manual? Add on codes

71. A billing and coding specialist is reviewing a patient's encounter progress note.
Which of the following modifiers indicates the patient received general
anesthesia from a surgeon? -47

72. 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? "It's when a provider requests
medical advice from a specialist."

73. Which of the following is an example of a diagnostic category code? I10

74. 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? -F1

75. Which of the following is an example of a violation of an adult patient's

confidentiality? Patient information was disclosed to the patient's parent
without consent

76. Which of the following links the ICD-10-CM and CPT codes for claims
processing? Diagnosis pointer

77. Which of the following is the provision of health insurance policies that specifies
which coverage is primary or secondary? Coordination of Benefits

78. Which of the following is the purpose of running an insurance aging report each
month? To determine which claims are outstanding from third party payers
79. A patient has a breast biopsy with the placement of a clip. After the biopsy is
determined to be malignant, the patient elects for a mastectomy during the global
period of the biopsy. Which of the following modifiers should a billing and coding
specialist use to report the mastectomy? -58

80. Which of the following is part of a provider's practice compliance program?

Internal monitoring and auditing

81. A billing and coding specialist is 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? 99213

82. A specialist is determining coordination of benefits for a patient who has health
insurance coverage from both parents. The patient's father's birthday is May 18,
1982 and their mother's birthday is May 18 1984. Which of the following
statements is correct for determining coverage? The parent whose insurance
policy has been active the longest will be the primary insurer.

83. When reviewing an established patient's 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? Photocopy both sides of the new
card.

84. Z codes are used to identify which of the following? Immunizations

85. Which of the following pieces of guarantor information is required when

establishing a patient's financial record? Phone #

86. A specialist is determining third party payer responsibilities for a 70 year old
patient who has Medicare coverage. The patient's spouse has insurance with
BCBS through their employer. Which of the following actions should the specialist
take? Establish coordination of benefits

87. Which of the following is the third stage of a claim's life cycle? Adjudication

88. Which of the following is an advantage of electronic claim submission?

Claims are expedited
89. A patient who recently received care from an endocrinologist is being referred to
an infectious disease specialist. Which of the following types of referral does that
patient need from the endocrinologist? Tertiary referral

90. A claim is submitted with a transposed insurance member ID number and

returned to the provider. Which of the following describes the status that will be
assigned to the claim by the third party payer? Invalid

91. For which of the following reasons should a claim be resubmitted? The claim
requires an attachment to support medical necessity

92. A provider's 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? Send the medical
information pertaining to the dates of service requested

93. A specialist is arranging a payment plan with a patient who wants to leave
postdated checks with the office. The patient proposes leaving one check post
dated 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? Notify the patient between 3 and 10 days prior to depositing
each check on the indicated date

94. 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? Retrospective review

95. A specialist is reviewing modifier use with a new employee. Which of the
following scenarios warrants the use of a modifier? Splinting of the fourth digit
on the left foot

96. A patient presents to a PCP for a closed right index finger fracture. the provider is
a non participating provider for a private payer and does not accept assignment
of benefits. The provider's charge for the service is $135. The third party payer's
usual customary reasonable UCR amount is $120 with a 20% coinsurance fee.
Which of the following is the patient's financial responsibility? $39

97. Which of the following actions should a billing and coding specialist take to
assign a diagnosis code to the highest level of specificity? Apply characters
four through seven to a claim
98. A specialist is filing a CMS 1500 claim form for a patient who has private
insurance. the specialist should recognize that a signature approving assignment
of benefits indicates which of the following? The payer should send
reimbursement directly to the provider with the exception of copays and
deductibles

99. Which of the following is a federal government health insurance program?

TRICARE

100. A specialist is preparing a claim for an appendectomy and reports it with two
units. The claim is then denied. Medically unlikely edits

101. In which of the following sections of a SOAP note does a provider indicate a
patient’s reported level of pain? Subjective