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Pre-Hire Test 1

Total Time - 60 Min

Section I

Multiple Choice (Please choose the appropriate option there might ight be more than one correct Option)

Weightage for this section is 12 points

1. Who is a billable provider?
2. If a Pt has not met the deductible to the insurance and the insurance receives a claim for the PT
3. G0008 is ………………
4. SSG Jones, age 65, served in the military, did not retire, and has coverage with the Veterans Administration. He has coverage with Medicare Part A and B. SSG Jones was treated in your practice and now you need to send the bill. SSG Jones doesn’t specify to whom the claim is to be sent. Somehow the VA was never contacted for permission to treat SSG Jones. To whom will you send the bill?
5. Mary Jones, age 72, presents herself to your clinic. You see an insurance card with a copy of the medical record. On the card, there is a policy number: A212356779. To which insurance company will you send the claim, strictly on the policy number?
6. Mr. Smith comes to you with a sprained finger he sustained while working in a coal mine. Mr. Smith provides his Federal Black Lung Card and his Medicare card, which shows he has Medicare Part A and B. Referring to the above scenario, to which one of the following do you send the claim for the outpatient services rendered by the provider?
7. Which one of the following would you want to collect when working accounts receivables recovery?
8. You are preparing the CMS 1500 because your computer system is down and you need to send a claim immediately by facsimile to the insurance company. Where do you place the name and address of the insurance company to whom the claim is being sent?
9. Refer to the following simulated EOB from ABC Insurance Company. Reason Code:
  • A1: Amount approved per contract with Provider.
  • B2: Timely Filing
  • The provider has a contract to be paid at 80% of billed charges. Which claim was not paid per the terms of the contract?
    10. Mr Smith was seen in the hospital urgent care center for an open wound of the hand. The global period for the surgical procedure is 5 days. Three days after surgery, Mr. Smith returns and is asking to be seen for a backache from heavy lifting. Mr Smith has personal health insurance. You can charge for the back ache visit even though the visit falls within the global surgical period. (Indicate whether the sentence or statement is true or false)
    11. What do you understand by coinsurance?
    12. In What scenario would you need is a referring provider or a PCP office

    Section II

    Case Scenario (these cases are real time scenario, give detail answers or choose from given option)

    Weightage for this section is 50 points

    13. pt came for well visit 99386 & urine strip test 81002 & pt also discussed some ongoing issues (99213) pt got flu vaccine 90658 in the same visit with blood drawn 36415. DX, please use DX Z00.129, E78.1, Z23. Please fill the given CMS 1500 with the given info don’t worry about pt demographic & provider info?
    14. Please create a claim with given information, any critical info missing or hidden, mention them
    15. Chiro & 99213- for time-based- chiro session was for one hour please accordingly (Don’t worry about pt demographics)
    16. Pt X has a BCBS PPO plan as insurance came to the office for prenatal services & blood draw, please choose appropriate CPT codes to be billed for this scenario?
    CPT Description
    Prenatal care
    Prenatal care
    E&M 15 minutes
    Blood Draw
    Initial prenatal care
    Subsequent Prenatal care
    postpartum care
    Postpartum care
    17. Please review the rejection below & suggest what steps need to be taken to resolve all these rejections
    18. Payment entry scenario
    19. Claim billed with CPT 99397 (Gcode was required) denied by Medicare as CO181. Please share the steps on how to resolve this Denial
    20. Dear Provider: An audit of the above referenced claim indicates that there was an overpayment of $259.00 that resulted from services paid in error, Workers Compensation is liable. Please submit a refund to AvMed Health Plan, attention Claims Adjustment Unit at the above address. Florida Statute 641.355, Section 5, indicates you have 35 days to refund the overpayment, deny or contest this claim for overpayment. If you decide to contest the claim, please identify the contested portion and provide the specific reason for contesting If you do not deny or contest this request, or issue a refund within 35 days of the receipt of this letter, the above amount will be offset against your future payments The date is today’s date. The member name and number have been sanitized due to HIPAA. Using the above letter, how will you resolve this situation?
    21. You are reviewing a CMS 1500 form and in Block 17a, you see the following: 1D Per the NUCC, what does this mean?
    22. Jane Smith was seen today, by Dr. Jones at the hospital urgent care center located at 1500 Hospital Way, Anywhere, FL 12345. Mrs. Smith has an Aetna HMO through her employer, Bubba Burgers. The policy number is 578690452 and the group number is GND41123. The address is 6754 Aetna Way, Hartford, CT 78563. Bubba Burgers is located at 123 Main Street, Anywhere, FL 12345. Mrs. Smith resides at 893B Homestead Ave, Anyplace, FL 12346. Her birthday is January 12, 1953. Mrs. Smith sustained a 1.5 incision on her right index finger. Bubba Burgers carries workers compensation insurance through Gnopay Insurance. The policy number is 90011234. The address for Gnopay is 555 Gnopay Lane, Gnowhere, FL 12349. The adjustor is Gina N. Payer. The claim number is GNP062307. Mrs. Smith has signed an Assignment of Benefit form, which is in her medical record.

    Using the above information, fill out the required fields in the CMS 1500 form below

    Download CMS
    Accepted file types: pdf, Max. file size: 256 MB.