107. Which of the following styles should a billing and coding specialist use to format a patient's date of birth on a CMS-1500 claim form? - ✔✔O MMDDYYYY 106. A Medicare provider submits a CMS-1500 claim form that is rejected for payment. Which of the following should be a reason for the form's rejection? - ✔✔O Medical coverage was cancelled In which of the following locations should a billing and coding specialist find the contract information to appeal a claim? - ✔✔O Insurance company file A patient takes his medication as prescribed and experiences swollen lips. The billing and coding specialist should refer to which of the following sections of ICD-10-CM to identify the appropriate code? - ✔✔O Adverse effect A billing and coding specialist is reviewing a signed release of information form that does not have a date. Which of the following is correct regarding this release? - ✔✔O This release is not valid A patient's progress notes indicate that she is primigravida. Which of the following describes the patient's condition? - ✔✔O Pregnant for the first time A remittance advice states a denial of payment due to lack of preauthorization. Which of the following of actions should the billing and coding specialist take if the appendectomy was an emergency procedure? - ✔✔File an Appeal A clearinghouse rejects a claim that is missing the patient's date of birth. Which of the following actions should the billing and coding specialist take next? - ✔✔O Add the missing information and resubmit 74. Under the Health Insurance Portability and Accountability Act (HIPAA), which of the following scenarios requires patients authorization for the release of health information? - ✔✔O Using patient information for marketing An omission clean claim from which of the following submission to a third party payer? blocks on the CMS-1500 claim form can prevent - ✔✔Diagnosis Which of the following procedures is an example of a code for removing cancer? - ✔✔O Excision of a fibrosarcoma O Aspiration of a breast cyst O Debridement of a pressure ulcer O Destruction of a benign lesion Which of the following medical terms is a procedure that is found on the fee schedule? - ✔✔Carpal tunnel syndrome O Laparoscopy O Endometriosis O Psoriasis On the CMS-1500 form, populating Block 6 with "Other" would indicate that the patient is the: - ✔✔O Insured O Guarantor O Dependent O Subscriber In the CPT-4 coding convention, the + is used to indicate which of the following? - ✔✔O An add-on code O A revised code O A resequenced code O A recycled CPT code The False Claims Act (FCA) was passed to penalize contractors who knowingly file false claims. Which of the following is considered a false claim? - ✔✔O Assigning diagnosis code to show medical necessity O Assigning procedure codes for reimbursement O Assigning an add-on procedure code for treatment rendered O Assigning diagnosis codes for increasing reimbursement of patient claims Which of the following reports should a billing and coding specialist use tor review and track balances from an insurance company by date of service? - ✔✔O Credit report O Claims report O Aging report O Audit report Which of the following forms is required to bill for a service that is not likely to be covered by Medicare? - ✔✔O Provider attestation form O Advance Beneficiary Notice O HIPAA privacy notice O Informed consent form Which of the following claims are submitted to the payer and await processing? - ✔✔O Unassigned claims O Claim appeals O Open claims O Closed claims A family member of a patient calls requesting information. Prior to discussing anything related to the patient, the billing and coding specialist must ensure that which of the following documents is on file in the patient's chart? - ✔✔O Notice of Privacy Practices O Records release authorization O Treatment consent O Advance Beneficiary Notice Which of the following mandates the retention of patient records and health insurance claims for a minimum of 6 years unless state law specifies a longer period? - ✔✔O Tax Relief and Health Care Act O Office of Inspector General O Health Insurance Portability and Accountability Act O American Medical Billing ASsociation When a billing and coding specialist is filing a CMS-1500 claim form, the date must be in which of the following formats? - ✔✔O MMDDCC O MMDDYYYY O CCYYMMDD O YYMMDD Medicaid, Medicare, and Tricare are examples of which of the following types of health insurance? O Individual O Federally funded O Group O Privately funded - ✔✔O Federally funded When submitting a worker's following on the CMS-1500 form? compensation claim, the billing and coding specialist should populate which of the O Block 23 and 30 O Blocks 8 and 22 O Blocks 10 and 14 OBlocks 19 and 29 - ✔✔O Blocks 10 and 14 If the contracted rate for the office visit is $200, A patient has a coinsurance of 10%, a $20 copayment, what is the total out-of-pocket fee for this and has met annual deductible. patient? O $38 O $40 O $20 O $36 - ✔✔O $40 Which of the following describes the amount to collect at the time of service from a patient who has a health maintenance organization (HMO) plan? O Deductible O Copay O Fee for service O Coinsurance - ✔✔O Copay following describes Which of the following is the purpose of a remíttance advice? O To establish an electronic date exchange O To indicate a release of infomation has been signed O To communicate claims processing decisions O To provide a listing of in-network providers - ✔✔O To communicate claims processing decisions