NCCT Practice Test
A medicare patient has an 80/20 plan. The charged amount was $300.00. The amount allowed was $100.00. Which of the following is the patient's coinsurance? a. $20 b. $80 c. $100 d. $60
a. $20
The patient's total charges are $300. The allowed amount is $150. Benefits pay 60%. Which of the following will the patient have to pay? a. $60 b. $90 c. $150 d. $180
a. $60
When filing an electronic insurance claim, the insurance and coding specialist processes which of the following forms? a. CMS-1500 b. HIPAA waiver c. encounter form d. assignment of benefits
a. CMS-1500
Which of the following are violations of the Stark Law? (Select the two (2) correct answers) a. accepting gifts in place of payment from patients b. referring patients to facilities where the provider has a financial interest c. upcoding d. negligent handling of protected health information (PHI) e. billing for services not rendered
a. accepting gifts in place of payment from patients b. referring patients to facilities where the provider has a financial interest
When there is a professional courtesy awarded to a patient's account the insurance and coding specialist should post the amount under the a. adjustment column b. charges column c. balance column d. payment column
a. adjustment column
A patient has called to schedule an appointment for an office visit to see the doctor tomorrow for an earache. It is discovered during the scheduling process that the insurance policy on file has been cancelled. Which of the following should the insurance and coding specialist do next? a. Advise the patient to bring current insurance information to the appointment b. Ask the patient if he is currently employed and if the cancellation is an error c. Advise the patient that he will not be able to schedule an appointment with the doctor d. Ask the patient to pay the insurance premium to the office at the time of the visit.
a. advise the patient to bring current insurance information to the appointment
Which of the following financial reports produces a quarterly review of any dollar amount a patient still owes after all insurance carriers claim payments have been received? a. aging b. claims settlement c. patient listing d. rejected claims
a. aging
When the patient calls to inquire about an account, which of the following does the insurance and coding specialist need to ask for before discussing the account? (Select the three (3) correct answers.) a. patient's claim number b. patient's name c. patient's insurance ID number d. patient's date of birth e. patient's social security number
b. patient's name c. patient's insurance ID number d. patient's date of birth
Which of the following is the most likely cause of the deposits not agreeing with the credits on the day sheet or the patient ledgers? a. there are duplicate cards b. payment is misplaced c. cash is missing d. the bank made an error
b. payment is misplaced
Which of the following are necessary to complete a CMS 1500 form? (Select the three (3) correct answers.) a. patient SSN b. physician information c. demographic information d. effective date of insurance e. diagnosis and CPT codes
b. physician information c. demographic information e. diagnosis and CPT codes
The Stark Law was enacted to govern the practice of a. medical office coding practices b. physician referrals to facilities that she has a financial interest in c. use of controlled substances in medical facilities d. physician referrals to other providers such as physical and occupational therapists
b. physician referrals to facilities that she has a financial interest in
When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim? a. insurance plan's allowable fee b. physician's office fee c. insurance plan's UCR fee d. physician's contractual fee
b. physician's office fee
How often should the encounter form CPT codes be updated? a. annually b. quarterly c. semi-annually d. monthly
b. quarterly
A third party payer made an error while adjudicating a claim. Which of the following should the insurance and coding specialist do? a. Resubmit the claim with a correction b. Resubmit the claim with an attachment explaining the error c. Contact the patient to make payment arrangements d. contact the insurance commissioner
b. resubmit the claim with an attachment explaining the error
Which of the following forms should be transmitted to obtain reimbursement following a physician's office visit for a patient with active Medicaid coverage? a. Private Pay Agreement b. UB-04 c. CMS-1450 d. CMS-1500
d. CMS-1500
Which of the following forms provides information from the Managed Care Organization that paid on the claim? a. CMS-1500 b. UB-92 c. UB-04 d. EOB
d. EOB
Collections agencies are regulated by the a. Outpatient Prospective Payment System b. Health Care Finance Administration c. Uniform Bill of 2004 d. Fair Debt Collections Practices Act
d. Fair Debt Collections Practices Act
Which of the following is an appropriate way to open the discussion when explaining practice fees to a patient? a. "Do you have any questions about the cost of today's visit?" b. We can accept your insurance as payment in full." c. "Do you know what your out of pocket cost is today?" d. "We will bill you for the visit in full."
A. "Do you have any questions about the cost of today's visit?"
A Medicare patient presents to an outpatient hospital facility for a scheduled hysterectomy. To which Medicare plan should the facility submit the claim? a. Part D b. Part B c. Part C d. Part A
B. Part B
The insurance and coding specialist calls a carrier to verify a patient's insurance and the representative states that the patient insurance was canceled three months ago. Which of the following should the insurance and coding specialist do first? a. ask the patient for another form of insurance coverage b. discuss self-pay options with the insurance policy holder. c. ask the patient to reschedule the appointment d. record the information and refer the patient to another provider
a. ask the patient for another form of insurance coverage
When following up on a denied claim, an insurance and coding specialist should have which of the following information available when speaking with the insurance company? (Select the three (3) correct answers). a. date of service b. date the claim was denied c. physician's NPI d. patient's mailing address e. patient's insurance ID number
a. date of service c. physician's NPI e. patient's insurance ID number
The patient is sent a statement for an office visit. The total amount of the bill is $100.00 and this amount must be paid before the insurance company will pay on the claim. Which of the following is this called? a. deductible b. premium c. copayment d. coinsurance
a. deductible
Encounter forms should be audited to ensure the a. diagnosis is in proper ICD-10-CM format b. payer's address and phone are current c. practice information is included on each encounter d. patient's vitals are present
a. diagnosis is in proper ICD-10-CM format
When a capitation account is applied to the ledger it is also known as a a. monthly prepayment amount b. monthly premium c. fee for service d. copayment amount
a. monthly prepayment amount
The patient opted to have a tubal ligation performed. Which of the following is needed in order for the third party payer to cover the procedure? a. pre-certification b. coordination of benefits c. letter of necessity d. insurance verification
a. pre-certification
If a married couple is covered under both spouses' health insurance and the husband wishes to schedule an appointment for an annual exam, he should call his primary care provider and a. schedule an appointment using both his insurance benefits and his wife's insurance benefits b. his wife's primary care provider to see which has the earliest appointment available c. his wife's primary care provider and schedule an appointment to visit with both d. schedule an appointment using just his insurance benefits
a. schedule an appointment using both his insurance benefits and his wife's insurance benefits
Which of the following is the correct procedure for keeping a Workers' Compensation patient's financial and health records when the same physician is also seeing the patient as a private patient? a. Separate financial and health records must be used. b. the same health record may be used, but a separate financial record must be maintained c. the same financial and health records may be used d. the same financial record may be used, but a separate health record must be maintained
a. separate financial and health records must be used
The insurance and coding specialist is billing the insurance company of a 66-year-old woman who has Medicare and is covered under her husband's private insurance. Which of the following should be billed first? a. the husband's insurance b. Medigap c. Medicare d. Medicaid
a. the husband's insurance
When using an EHR system to enter CPT codes on a CMS 1500 claim form for electronic submission, which of the following should be entered on the claim form first? a. the most resource-intensive procedure or service b. the first code selected on the electronic superbill c. any HCPCS code d. the least expensive procedure or service
a. the most resource-intensive procedure or service
Developing an insurance claim begins a. when the patient calls to schedule an appointment b. once the charges have been entered into the computer c. when the patient arrives for the appointment d. after the medical encounter is completed
a. when the patient calls to schedule an appointment
If a provider refuses to accept assignment, when must the patient pay for services? a. on next visit b. after receipt of statement c. time of service d. upon denial of insurance payment
b. after receipt of statement
The provider is paid the same rate per patient whether or not they provide services and no matter which services were provided. This payment is known as a. coinsurnace b. capitation c. fee for service d. a deductible
b. capitation
A claim submitted with all the necessary and accurate information so that it can be processed and paid is called a a. timely filing b. clean claim c. allowable claim d. closed claim
b. clean claim
Which of the following must be verified to process a credit card transaction? (Select the three(3) correct answers). a. insurance b. credit card number c. security code d. patient date of birth e. account number
b. credit card number c. security code d. patient date of birth
Which of the following should an insurance and coding specialist do when checking for completion of a new patient's registration form? (Select the three (3) correct answers.) a. verify the patient's insurance with his employer b. Make sure that the patient's name matches the insurance card. c. make sure that the registration form is signed and dated d. Check the patient's emergency contacts e. check that demographics are completed.
b. make sure that the patient's name matches the insurance card c. make sure that the registration form is signed and dated e. check that demographics are completed
Collecting statistics on the frequency of copay collection at time of service is a step in the process of a. a recovery audit b. managing A/R c. claims management d. performance reviews
b. managing A/R
A new HIM director was recently hired at a hospital. She was advised her health insurance benefits become available in 90 days. Which of the following is correct regarding her health insurance? a. she will need to pay cash for the medical services and be reimbursed by her new insurance company after 90 days b. she will be able to keep her current medical insurance from her previous job through COBRA c. she will be able to get medical insurance benefits immediately because she is the HIM director d. she will not have the option of keeping her medical insurance from her previous job.
b. she will be able to keep her current medical insurance from her previous job through COBRA
When is a referral from a provider required? a. If a patient goes to a network hospital for services b. when containing in the individual policy c. within 24 hours of a medical procedure d. for Workers' Compensation patients
b. when containing in the individual policy
When should a provider have a patient sign an ABN? a. when a service is excluded from coverage under Medicare b. when the items may be denied and prior to performing the service c. when the service is covered under Part B fee schedule d. prior to treating a patient who requires emergency services that might not be covered
b. when the items may be denied and prior to performing the service
Which of the following federal regulations requires disclosure of finance changes, late fees, amount, and due dates for all payment plans? a. Fair and Accurate Credit Transaction Act b. Truth in Lending Act c. Fair Debt Collection Practices Act d. Equal Credit Opportunity Act
c. Fair Debt Collection Practices Act
Which of the following regulations prohibits the submission of a fraudulent claim or making a false statement or representation in connection with a claim? a. Stark Law b. Federal Claims Collection Act c. Federal False Claims Act d. Anti-kickback Law
c. Federal False Claims Act
Which of the following protects federal healthcare programs from fraud and abuse by healthcare providers who solicit referrals? a. Federal Claims Collection Act b. Utilization Review Act C. Fraud and Abuse Act d. Anti-Kickback Statute
c. Fraud and Abuse Act
Which of the following MCOs always requires an authorization before seeing a specialist? a. POS b. EPO c. HMO d. PPO
c. HMO
If the insurance and coding specialist suspects Medicare fraud she should contact the a. AMA b. DOJ c. OIG d. FDA
c. OIG
Based on the CMS manual system, when updating or maintaining the billing code database. Which of the following does the "R" donate? a. Revisited b. Replaced c. Revised d. Repaired
c. Revised
Which of the following must a patient sign prior to an insurance claim being processed? a. the HIPAA waiver form b. a referral form c. an Authorization to Release Information d. the actual insurance claim form
c. an Authorizaiton to Release Information
The most effective method to manage patient statements and other financial invoices as well as avoid payment delays is to a. use a bimonthly billing system b. issue periodic reminders c. collect fees at the time of service d. write off overdue balances
c. collect fees at the time of service
If the insurance carrier's rate of benefits is 80%, the remaining 20% is known as a. deductible b. capitation c. copayment d. coinsurance
c. copayment
A patient has two health insurance policies- a group insurance plan through her full-time employer and another group insurance plan through her husband's employer. Which of the following policies should be billed as primary? a. husband's policy b. both policies c. her policy d. the policy with the highest coverage
c. her policy
Which of the following patient information is needed to determine a Medicaid sliding fee scale. Select the three (3) correct answers. a. amount of the bill b. occupation c. number of dependents d. poverty level e. salary
c. number of dependents d. poverty level e. salary
When the patient has signed the assignment of benefits form, the payment for services should be sent to the provider unless the provider is a. in network b. the primary care provider c. out of network d. a referred specialist
c. out of network
When using the EHR to schedule a patient visit, which of the following screens should be used to complete the scheduling process? a. accounts receivable b. correspondence c. patient search d. clinical care
c. patient search
Claims are often rejected because a provider needs to obtain a. a utilization review b. medical records c. pre-authorizations d. the patient's social security number
c. pre-authorizations
When reviewing the charges for a patient procedure using computer assisted coding software (CAC), the insurance and coding specialist should first a. discuss with the nurse b. speak to the physician c. review the chart for needed information d. use the same diagnosis as the last office visit
c. review the chart for needed information
Which of the following items are mandatory in patient financial policies? (Select the three (3) correct answers.) a. participating insurance companies b. provider fee schedule c. statement that responsibility for payment lies with patient d. collection process e. expectation of payment due at time of service
c. statement that responsibility for payment lies with patient d. collection process e. expectation of payment due at time of service
Which of the following defines the maximum time that a debt can be collected from the time it was incurred or became due? a. Stark Law b. practice management payment policy c. statute of limitations d. benchmark
c. statute of limitations
HIPAA allows a health care provider to communicate with a patient's family, friends, or other persons who are involved in the patient's care regarding their mental health status providing a. the patient is not incapacitated b. a second physician signs off on the disclosure c. the patient does not object d. psychotherapy notes are used for further treatment
c. the patient does not object
Applying the birthday rule, a minor child comes in. Both parents have remarried and the child is listed on the mother's, father's and both step-parents' policies. The mother's birthday is April 16, stepfather's birthday March 19, father's birthday is February 19th, and the stepmother's birthday is January 20th. Which of the following is correct? a. Mother's plan is primary, father's plan is secondary b. Father's plan is primary, stepfather's plan is secondary c. Mother's plan is primary, stepmother's plan is secondary d. Father's plan is primary, mother's plan is secondary
d. Father's plan is primary,mother's plan is secondary
Which of the following Medicare parts covers inpatient hospital stays? a. Part B b. Part C c. Part D d. Part A
d. Part A
Which of the following reports is used to follow up on outstanding claims to third party payers? a. accounts payable b. financial c. audit d. aging
d. aging
Which of the following fees posted to the patient's account is an example of "usual, customary, and reasonable?" a. adjusted amount b. submitted amount c. billed amount d. allowed amount
d. allowed amount
Which of the following process makes a final determination for payment in an appeal board? a. deposition b. peer to peer c. special handing d. arbitration
d. arbitration
The Fair Debt Collection Practices Act restricts debt collectors from engaging in conduct that includes a. contacting the person who owes the debt at their place of employment b. garnishing wages after receiving a judgment c. collecting fees or interest charges as stated in the contract d. calling before 8:00 am or after 9:00 pm, unless permission is given.
d. calling before 8:00 am or after 9:00 pm unless permission is given
When patients sign Block 13 of the CMS-1500 claim to instruct the payer to directly reimburse the provider, it is known as a. assignment of benefits b. notice of privacy practice c. code linkage d. coordination of benefits
d. coordination of benefits
An established patient is being seen by the physician today. The patient owes $25.00 for the visit. The amount collected for the office visit is called the a. balance b. deductible c. coinsurance d. copayment
d. copayment
When a document is changed in an EHR, the original documentation is a. locked b. deleted c. printed d. hidden
d. hidden
When posting an insurance payment via an EOB, the amount that is considered contractual is the: a. co-insurance b. NON-PAR payment allowable c. patient responsibility d. insurance allowed amount
d. insurance allowed amount
A patient was seen in the office. Charges were recorded and submitted to the patient's insurance, and an EOB was received by the office with payment of $70.89. These transactions should be recorded in the a. day sheet b. encounter form c. patient statement d. patient ledger
d. patient ledger
In order to have claims paid as quickly as possible, the insurance specialist must be familiar with which of the following? a. Automated claims status requests b. clearinghouse processing procedures c. prompt pay laws d. payer's claim processing procedures
d. payer's claim processing procedures
An insurance and coding specialist is reviewing a patient's encounter form that is documented in the medical record prior to completing a CMS-1500 form. She notices that the physician upcoded the encounterform. The specialist has the ethical obligation to first a. report the physician to the state board b. correct the code c. down code d. query the physician
d. query the physician
Which of the following information should be used to capture charges from an encounter form? a. provider participation status b. patient's insurance benefits c. past procedures and scheduled future visits d. services rendered and reason for visit
d. services rendered and reason for visit