Divine Medical Billing Assessment Test

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| By Mylikia Franklin
M
Mylikia Franklin
Community Contributor
Quizzes Created: 1 | Total Attempts: 4,015
Questions: 11 | Attempts: 4,016

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Divine Medical Billing Assessment Test - Quiz

Divine Medical Billing assessment test.


Questions and Answers
  • 1. 

    Mary Smith is seen by Main Street Medical. The patient complains of chest pain and has hypertension. The provider performs a evaluation and management code (99214) and a EKG (93000). What modifier would be used on this claim?

    • A.

      59

    • B.

      76

    • C.

      26

    • D.

      25

    • E.

      TC

    Correct Answer
    D. 25
    Explanation
    Modifier 25 would be used on this claim. Modifier 25 is used to indicate that a significant, separately identifiable evaluation and management (E/M) service was performed on the same day as a procedure or other service. In this case, the provider performed an E/M code (99214) and an EKG (93000) on the patient with chest pain and hypertension. The modifier 25 would indicate that the E/M service was separate and distinct from the EKG service.

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  • 2. 

    Mary Smith is seen by a provider at Main Street Medical. The insurance responds that the patient may be covered by another insurance. As the medical biller, would you?

    • A.

      Write the claim off.

    • B.

      Leave the claim on the books until the next visit.

    • C.

      Contact the patient to see if they have another insurance.

    • D.

      Refill the claim to the same insurance.

    • E.

      File a complaint with the State Insurance Commissioner.

    Correct Answer
    C. Contact the patient to see if they have another insurance.
    Explanation
    The correct answer is to contact the patient to see if they have another insurance. This is because the insurance company has responded that the patient may be covered by another insurance, indicating that there might be additional coverage available. By contacting the patient, the medical biller can gather more information about the patient's insurance status and ensure that the claim is filed correctly, maximizing the chances of reimbursement.

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  • 3. 

    The acronym HIPAA stands for?

    • A.

      Health Insurance Portability and Accountability Act.

    • B.

      Health Institution of Patient Accessibility Act.

    • C.

      Health Information and Patient Accessibility Administration.

    • D.

      Health Information Provided to All Accountable.

    • E.

      None of these above.

    Correct Answer
    A. Health Insurance Portability and Accountability Act.
    Explanation
    The correct answer is "Health Insurance Portability and Accountability Act." HIPAA is a federal law in the United States that provides data privacy and security provisions for safeguarding medical information. It aims to ensure the portability of health insurance coverage for individuals when they change jobs and to establish standards for the electronic exchange of healthcare information.

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  • 4. 

    Mary Smith is seen by Main Street Medical. She has a $500 deductible. Mary Smith has met $450 of her deductible. Her insurance was billed a 99213 at $95. The insurance allowed $80 and paid $30. How much should the patient be billed?

    • A.

      $175

    • B.

      $110

    • C.

      $95

    • D.

      $15

    • E.

      $50

    Correct Answer
    E. $50
    Explanation
    Mary Smith should be billed $50. The deductible is the amount that the patient has to pay out of pocket before the insurance starts covering the expenses. In this case, Mary has already met $450 of her $500 deductible, so she only has $50 left to meet. The insurance allowed $80 for the visit, but they only paid $30, leaving a balance of $50 that the patient is responsible for. Therefore, Mary should be billed $50.

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  • 5. 

    Mary Smith is seen by Main Street Medical. She has a $500 deductible. Mary Smith has met $450 of her deductible. Her insurance was billed a 99213 at $95. The insurance allowed $80 and paid $30. What is the adjusted amount?

    • A.

      $175

    • B.

      $110

    • C.

      $95

    • D.

      $15

    • E.

      $50

    Correct Answer
    D. $15
    Explanation
    Mary Smith's insurance has already paid $30 towards the billed amount of $95. Therefore, the adjusted amount is the remaining balance after insurance payment, which is $95 - $30 = $65.

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  • 6. 

    Mary Smith is seen by Main Street Medical. She has a $500 deductible. Mary Smith has met $450 of her deductible. Her insurance was billed a 99213 at $95. The insurance allowed $80 and paid $30. What is the charge amount?

    • A.

      $175

    • B.

      $110

    • C.

      $95

    • D.

      $15

    • E.

      $50

    Correct Answer
    C. $95
    Explanation
    Mary Smith's insurance was billed a 99213 code at $95. This means that the charge amount for the medical service provided to her is $95.

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  • 7. 

    Medical professional services for a Medicare patient are billed under?

    • A.

      Medicare Part A

    • B.

      Medicare Part B

    • C.

      Medicare Part D

    • D.

      None of these above

    Correct Answer
    B. Medicare Part B
    Explanation
    Medical professional services for a Medicare patient are billed under Medicare Part B. Medicare Part A covers hospital services, while Medicare Part D covers prescription drugs. Therefore, the correct answer is Medicare Part B.

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  • 8. 

    The type of code to describe a procedure or service is?

    • A.

      ICD-9 code

    • B.

      HCPS code

    • C.

      CPT code

    • D.

      Revenue code

    Correct Answer
    C. CPT code
    Explanation
    CPT code stands for Current Procedural Terminology code, which is a standardized medical code set used to describe medical, surgical, and diagnostic services. It is widely used in the healthcare industry to ensure accurate communication and billing for procedures and services provided to patients. ICD-9 code, HCPS code, and Revenue code are also used in healthcare, but they serve different purposes and do not specifically describe a procedure or service like the CPT code does.

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  • 9. 

    The type of code to describe a diagnosis is?

    • A.

      ICD-9 code

    • B.

      HCPS code

    • C.

      CPT code

    • D.

      Revenue code

    Correct Answer
    A. ICD-9 code
    Explanation
    ICD-9 code is the correct answer because it is the standard code set used for describing diagnoses in healthcare. It stands for International Classification of Diseases, 9th Revision, and is used globally to classify and code diseases, injuries, and other health conditions. HCPS code, CPT code, and Revenue code are not specifically used for describing diagnoses, but rather for other purposes such as procedure coding and billing.

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  • 10. 

    If a patient is 65 years of age and retired, but has Medicare and Blue Cross, which insurance would you bill primary?

    • A.

      Medicare

    • B.

      Blue Cross

    • C.

      Option 3

    • D.

      Option 4

    Correct Answer
    A. Medicare
    Explanation
    Since the patient is 65 years of age and retired, Medicare would be the primary insurance to bill. Medicare is a federal health insurance program that primarily covers individuals who are 65 years or older, as well as some younger individuals with certain disabilities. Blue Cross, on the other hand, is a private health insurance company. In this scenario, Medicare takes precedence as the primary insurance.

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  • 11. 

    If a claim was denied for timely filing, what action would you take to try to get the claim paid? (Use the space below to write your answer)

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  • Current Version
  • Oct 11, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jul 15, 2009
    Quiz Created by
    Mylikia Franklin
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