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Billing & Coding

Prep Exam items

what form used to post payments? remittance advice
the authorization number for a service approved before service was rendered is indicated in which block on cms-1500 claim form? block 23
which block of cms-1500 form if the federal tax ID entered? block 25
which block of cms-1500 form indicates an ICD diagnosis code? block 21
which block of cms-1500 form is additional claim information entered? block 18
what standardized format is used in the electronic filing of claims? HIPPA standard transactions
which block of cms-1500 form is used to accept assignment of benefit? block 27
on cms-1500 claim form, blocks 14 - 33 contain what information? patients condition and provider's information
the EOB states the amount billed was $80. the amount allowed is $60, and the patient is required to pay a $20 copayment. what insurance check amount should be posted? $40
what should a billing and coding specialist use to submit a claim with supporting documents? claim attachment
what medicare policy determines if a particular item or service is covered by medicare? National Coverage Determination (NCD)
what is an example of a remark code from EOB document? contractual allowance
what form should a billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? UB-04
a claim is denied due to termination of coverage (TOC). what action should the billing and coding specialist take next? follow up with the patient to determine the current name, address, and carrier for resubmission
what NPI # is required in block 33a of cms-1500 claim form? billing provider
what reason a claim would be denied? incorrectly linked codes
when the remittance advice is sent from third-party payer to provider; what action should the billing and coding specialist perform first? ensure the proper payment has been made
what term is used to describe the location of the stomach, spleen, part of pancreas, part of liver, and part of the small & large intestines? LUQ
when coding a front torso burn, what percentage should be coded? 18%
which statement is true regarding Medicaid eligibility? patient eligibility is determined monthly
which of the following describes a key component of E/M service? history
which of the following is considered a fraud? a billing and coding specialist unbundles a code to receive higher reimbursement
which of the following is an example of medicare abuse? charging excessive fees
what organization fights waste, fraud, and abuse in medicare and Medicaid? OIG - Office of the Inspector General
medicare part A hospital services
medicare part B provides insurance for outpatient and physician services
medicare part C managed by private, third-party insurance providers approved by medicare
medicare part D prescription services
what part of medicare insurance program is managed by private, third-party insurance providers approved by medicare? medicare part C
a patient's employer has not submitted a premium payment. what claim status should the provider receive from third-party payer? denied
what block on cms-1500 claim form should a billing and coding specialist complete for procedures, services, or supplies? block 24d
what describes an insurance carrier that pays the provider who rendered services to a patient? third-party payer
what format is used to submit electronic claims to a third-party payer? 837
what entity defines essential elements of a comprehensive compliance program? OIG
what causes a claim to be suspended? services required additional information
a medicare non-participating (non-PAR) provider's approved payment amount is $200 for a lobectomy and deductible has been met. what amount is the limiting charge for this procedure? $230
for non-crossover claims, the billing and coding specialist should prepare a copy of what form? primary insurance card
a billing and coding specialist can ensure insurance coverage for an outpatient procedure by using what process? precertification
when a third-party payer requests copies of patient information related to claim, billing and coding specialist must include what document from patient's file? signed release of information form
in the anesthesia section of CPT manual, what is considered a qualifying circumstance? add-on codes
what describes the term "crossover" relating to medicare? when insurance company transfers data to allow (COB) coordination of benefits of a claim
a provider performs an examination of patient's knee joint via small incisions and optical device. what term describes this procedure? arthroscopy
a billing and coding specialist has 4 past-due charges: $400 - 10 weeks past due; $800 - 6 weeks past due; $1,000 - weeks past due; and $2,000 - 8 weeks past due. what charge should be sent to collections first? $2000
the EOB states the amount billed was $170. The allowed amount is $150. The patient has an unmet deductible of $50 and a copayment of $20. what dollar amount is the patient responsible for? $70
what term refers to difference between billed & allowed amounts? adjustment
these <> symbols are used to indicate new and revised text of what description? procedure descriptors
what HIPAA compliance guideline affects electronic health records? electronic transmission & code set standards require every provider to use healthcare transactions, code sets, & identifiers
what describes a code that would be denied? an italicized code as the primary diagnosis
what section of SOAP note indicates a patient's level of pain to a provider? subjective
what HMO managed care services requires a referral? DME
what explains why medicare will deny a service / procedure? ABN - advance beneficiary notice
which block of cms-1500 form should a billing & coding speacialist enter the referring provider's NPI# ? block 17b
coronal, frontal vertical plane divides body into front & back
transverse horizontal plan divides the body into top & bottom sections
sagittal vertical plane divides body into right and left sides
anterior, ventral front of body
posterior, dorsal back of body
superior above
proximal near or towards the origin, closer
distal far / away form origin
inferior below
lateral side
bilateral both sides
medial middle of body
what action should billing & coding specialist take when submitting a claim to medicaid for a patient that has primary & secondary insurance coverage? attach remittance advice from primary insurance along w/ medicaid claim
what term is used to communicate why a claim line item was denied or paid differently than billed? claim adjustment codes
two surgeon successfully performed closure of a vaginal fistiula thru patient's abdomen. for both providers' claims, the billing & coding specialist should use what cpt codes & modifiers? 57305-62
in 1996, cms implemented which entity to detect inappropriate & improper codes? National Correct Code Initiative (NCCI)
what plane divides the body into left & right? sagittal
a billing & coding specialist is preparing a claim form for a provider from a group practice. the billing & coding specialist should enter the rendering providers NPI# in which block on cms-1500 form? 24j
on a remittance advice form, who is responsible for writing off difference between amount billed and the amount allowed by agreement? the provider
what is the purpose o coordination of benefits (COB)? prevent multiple insurers from paying benefits covered by other policies
which block of cms-1500 claims form is the report modifiers section? 24d
as of april 1, 2014 what is the maximum number of diagnoses that can be reported on CMS-1500 claim form before a further claim is required? 12
what best describes medical ethics? medical standard of conduct
a patient has AARP as secondary insurance. what block on cms-1500 claim form should enter information? block 9
Created by: xwyndzhb