Pre-Hire Test 1

Total Time - 60 Min

Section I

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

Weightage for this section is 12 points

Name(Required)

First Last

Email(Required)

1. Who is a billable provider?(Required)

Doctor

Nurse

PA, DMA, Counsellor

All of the above

None

2. If a patient has not met the deductible to the insurance and the insurance receives a claim for the patient.(Required)

Ins would deny the claim

Ins would pay the claim

Ins would allow the amt as PT resp

All three are correct

3. G0008 is ………………(Required)

A CPT code

An HCPCS code

An ICD code

not a correct code

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?(Required)

The Veterans Administration as primary and Medicare Part B as secondary.

The Veterans Administration accepting payment as payment in full

Medicare Part A as Primary and Medicare Part B as secondary

Medicare Part B as primary and the Veteran's Administration as Secondary

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?(Required)

Medicare

Florida Medicaid

Railroad Medicare

Florida Blue Cross and Blue Shield

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?(Required)

Federal Black Lung

The patient’s employer

Medicare Part A

Medicare Part B

7. Which one of the following would you want to collect when working accounts receivables recovery?(Required)

Patients with discharged bankruptcy

An HMO account over 300 days old.

A Medicaid account over 240 days old

All of the above

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?(Required)

Block 9a-d

Upper right corner of the claim form

Block 11a-d

Block 33

9. Refer to the following simulated EOB from ABC Insurance Company.(Required)

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?

Claim 1

Claim 2 Only

Claim 3

Claim 2 and 4

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)(Required)

True

False

11. What do you understand by coinsurance?(Required)

Amount to be Paid by Pt. every visit

Amount to be paid by Insurance.

Amount to be paid by Pt. based on the plan benefits %

12. In What scenario would you need is a referring provider or a PCP office(Required)

Medicare Pt. was seen in Office for Well visit

Medicare Pt. was seen in Office for Chest pain & EKG performed

Medicare Pt. was seen in Office for Stomach ache & lab test was performed

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. Patient came for well visit 99386 & urine strip test 81002 & patient also discussed some ongoing issues (99213) patient 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 patient demographic & provider info?

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

Download CMS

Max. file size: 128 MB.

14. Please create a claim with given information, any critical info missing or hidden, mention them

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

Download CMS

Max. file size: 128 MB.

15. Chiro & 99213- for time-based- chiro session was for one hour please accordingly (Don’t worry about patient demographics)

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

Download CMS

Max. file size: 128 MB.

16. Patient 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?

59425 Prenatal care

prena Prenatal care

99213 E&M 15 minutes

36415 Blood Draw

0500F Initial prenatal care

0502F Subsequent Prenatal care

0503F postpartum care

59430 Postpartum care

17. Please review the rejection below & suggest what steps need to be taken to resolve all these rejections

18. Payment entry scenario

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

Download table

Max. file size: 128 MB.

19. Claim billed with CPT 99397 (Gcode was required) denied by Medicare as CO181. Please share the steps on how to resolve this Denial

Step 1.(Required)

Step 2.(Required)

Step 3.(Required)

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?

Deny the refund due to timely filing limits

Return the overpayment

Send a claim to the workers comp carrier

Require AvMed to provide proof this is a workers compensation claim

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

Max. file size: 128 MB.

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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

Pre-Hire Test 1

Total Time - 60 Min

Section I

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

Weightage for this section is 12 points

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

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

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