Free CMIS Practice Questions

Question 1

After an 837P claim batch is transmitted, the payer returns an accepted 999 acknowledgment. A subsequent 277CA rejects one claim for an invalid subscriber ID and accepts the others. The rejected claim has not entered adjudication. How should the specialist resolve that claim without disrupting the accepted claims?

Accepted Answer

Verify the subscriber ID, correct it, and resubmit only the rejected claim as an original.

Answer

Appeal the rejection with proof that the payer accepted the original electronic batch.

Answer

Correct the subscriber ID and retransmit the entire batch to replace the earlier submission.

Answer

Keep the claim in the pending-payment queue because the accepted 999 establishes payer acceptance.

Question 2

An established patient presents for reassessment of worsening knee osteoarthritis. The physician revises the prescription and rehabilitation plan and also performs a joint injection with a 0-day Medicare global period. The signed note supports E/M work beyond the injection's routine assessment and aftercare. Both services use the same diagnosis. Which reporting approach is supported?

Accepted Answer

Report both services, appending modifier 25 to the E/M code.

Answer

Report only the injection because the diagnoses match.

Answer

Report both services, appending modifier 57 to the E/M code.

Answer

Report the injection with modifier 59 and an unmodified E/M service.

Question 3

A 54-year-old beneficiary has Medicare because of disability and also has group health coverage through a spouse's current employment. The single-employer plan's verified employee count for Medicare Secondary Payer purposes is 75. The group coverage began before Medicare. There is no ESRD or multiemployer-plan exception. Which payer order and reason correctly apply?

Accepted Answer

Medicare first, then the group plan; the disability rule uses a 100-employee threshold.

Answer

Group plan first, then Medicare, because the employer has at least 20 employees.

Answer

Medicare first, then the group plan, because the patient's own policy precedes dependent coverage.

Answer

Group plan first, then Medicare, because its coverage started earlier.

Question 4

For a medically necessary established-patient office visit, the physician logs 14 minutes evaluating and counseling the patient, 9 minutes reviewing records, and 4 minutes documenting, all on the encounter date. The physician also spends 6 minutes on a separately billed diagnostic interpretation; an assistant spends 10 minutes on intake. The physician selects the E/M level by time. Minimum times for 99212, 99213, 99214, and 99215 are 10, 20, 30, and 40 minutes, respectively. Which code and supporting time belong in the record?

Accepted Answer

99213, supported by 27 minutes of qualifying E/M time.

Answer

99212, supported by 14 minutes of qualifying E/M time.

Answer

99214, supported by 33 minutes of qualifying E/M time.

Answer

99215, supported by 43 minutes of qualifying E/M time.

Question 5

An emergency physician is treating an unconscious patient and urgently requests the patient's current medication list, allergies, and recent laboratory results from the medical office. The specialist verifies the requester through the hospital's published telephone number and has an approved secure transmission method. Office policy authorizes staff to handle treatment disclosures, and no special legal restriction applies to these records. What should happen first?

Accepted Answer

Transmit the requested information promptly for treatment without obtaining a separate authorization.

Answer

Obtain a signed authorization from the patient's legal representative before releasing the information.

Answer

Obtain the hospital's business associate agreement before transmitting the records.

Answer

Wait for the privacy officer's individual approval because the patient cannot consent to disclosure.

Question 6

A patient questions the balance for a covered in-network PPO service. The charge was $425 and the contracted allowance was $260. The plan applied the patient's remaining $80 deductible, then 25% patient coinsurance to the rest of the allowance. The patient already paid $60. There is no copayment, secondary coverage, or out-of-pocket-maximum adjustment. The charge above the allowance is contractual. What additional amount is collectible from the patient?

Accepted Answer

$65.00

Answer

$85.00

Answer

$125.00

Answer

$106.25

Question 7

A patient was prescribed warfarin 2 mg once daily. The pharmacy mistakenly dispensed 5-mg tablets in a bottle labeled to take one tablet daily. The patient followed the label and developed hematuria. At a July 2026 visit, the physician documents that the excessive dose caused the bleeding and confirms the dispensing error. Which classification and sequencing fit this event?

Accepted Answer

Accidental poisoning; list the poisoning code first, followed by the manifestation.

Answer

Adverse effect; list the manifestation first, followed by the drug adverse-effect code.

Answer

Accidental poisoning; list the manifestation first, followed by the poisoning code.

Answer

Adverse effect; list the drug adverse-effect code first, followed by the manifestation.

Question 8

On a Medicare CMS-1500 claim, form version 02/12, item 21 lists A for type 2 diabetes and B for right-knee osteoarthritis. The knee injection on the second service line treats the osteoarthritis; diabetes does not support that procedure. The specialist must complete item 24E for that line. Which entry correctly links the service to its supporting diagnosis?

Accepted Answer

B

Answer

A

Answer

AB

Answer

The full ICD-10-CM code for right-knee osteoarthritis

Question 9

Before a claim is submitted, a physician discovers that a signed electronic procedure note says 'right wrist' although the contemporaneous consent, procedure log, and examination document treatment of the left wrist. The physician confirms a dictation error. Which record correction preserves both accuracy and the audit trail?

Accepted Answer

The physician appends a currently dated, authenticated correction and retains the original entry.

Answer

The physician replaces the entry with today's correction, retaining no original wording.

Answer

The billing specialist changes the signed note's laterality and records the physician's verbal approval in the claim log.

Answer

The physician signs a corrected procedure note dated as though the correct wording had been entered on the service date.

Question 10

Medicaid denies a prescribed orthotic for a 19-year-old enrollee, citing only the state's exclusion of that service from its adult benefit package. A screening evaluation identified the functional problem, and the clinician documents why the orthotic is medically necessary to ameliorate it. The service falls within a federally coverable Medicaid benefit category. What is the strongest basis for requesting review?

Accepted Answer

EPSDT applies to enrollees under 21; the adult benefit exclusion alone does not resolve coverage.

Answer

The adult benefit exclusion controls because this enrollee is older than 18.

Answer

EPSDT covers screening and diagnosis, not treatment excluded from the adult benefit package.

Answer

Coverage can continue after age 18 only if the same orthotic was authorized before the enrollee became an adult.

Free CMIS Practice Questions

Domain 1: Basics of Insurance

Question 1

Question 2

Question 3

Domain 2: Medical Documentation

Question 4

Question 5

Domain 3: Diagnostic and Procedural Coding

Question 6

Question 7

Domain 4: Compliance

Question 8

Domain 5: Claims Processing

Question 9

Question 10

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