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NCCT Prep
| Question | Answer |
|---|---|
| When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim? | Physician's office fee |
| An insurance and coding specialist is reviewing a patient's encounter form that is documented in the medical record prior to completing a CMS-1500 form. The Dr. updcoded, she obligated to? | Query the physician. |
| When should a provider have a patient sign an ABN? | When the items may be denied and prior to performing the service. |
| Which of the following must a patient sign prior to an insurance claim being processed? | An Authorization to Release Information |
| A third party payer made an error while adjudicating a claim. Which of the following should the insurance and coding specialist do? | Resubmit the claim with an attachment explaining the error. |
| The Fair Debt Collection Practices Act restricts debt collectors from engaging in conduct that include? | Calling before 8am or after 9pm, unless permission is given. |
| When a document is changed in an EHR, the original documentation is _____? | Hidden |
| A claim submitted with all the necessary and accurate information so that it can be processed and paid is called a ____? | Clean claim |
| When following up on a denied claim, and insurance and coding specialist should have which of the following information available when speaking with the insurance company? | - Patients claim number, - Physician's NPI, - Patient's insurance ID number |
| If the insurance and coding specialist suspects medicare fraud she should contact the ____? | OIG - Office of the Inspector General |
| Which of the following reports is used to follow up on outstanding claims to third party payers? | Aging |
| Providers may receive payments directly from the insurance carrier by accepting an _____? | Assignment of Benefits |
| Which of the following should an insurance and coding specialist do when checking for completion of a new patient's registration form? | - Check demographics are completed. - Make sure that the patient's name matches the insurance card. - Make sure that the registration form is signed and dated. |
| A physician preformed a bilateral L4/L5 Laminectomy on a patient in an Ambulatory Surgical Center. Which of the following place of service codes should be used on the CMS 1500. | 24 |
| Developing an insurance claim beings ____? | When the patient calls to schedule an appointment |
| Which of the following forms provide information from the Managed Care Organization that paid on the claim? | EOB |
| Which of the following financial reports produces a quarterly review of any dollar amount a patient still owes after all insurance carriers claim payments have been received? | Aging |
| when there is a professional discount awarded to a patient's account the insurance and coding specialist should post the discounted amount under the _____? | Adjustment column |
| When is a referral from a provider required? | When contained in the individual policy |
| When using an EHR system to enter CPT codes on a CMS 1500 claim form for electronic submission, which of the following should be entered on the claim for first? | The most resource-intensive procedure or service |
| Based on the CMS manual system, when updating or maintaining the billing code database, which of the following does the "R" denote? | Revised |
| Which of following are necessary to complete a CMS 1500 form? | -Diagnosis and CPT codes, -Physician Information, -Demographic Information |
| Which of the following are needed to submit a prior authorization request for medical equipment/ | ICD-CM and HCPCS codes |
| In order to have claims paid as quickly as possible, the insurance specialist must be familiar with which of the following? | Payer's claim processing procedures |
| Which of the following Medicare parts covers inpatient hospital stays? | Part A |
| When posting an insurance payment via an EOB, the amount that is considered contractual is the? | Insurance allowed amount |
| When billing for Medicare and a Private Insurance, which would you bill first? | The private insurance, medicare is always secondary unless it is the only insurance given by the patient. |
| The most effective method to manage patient statements and other financial invoices as well as avoid payment delays is to _____? | Collect fees at the time of service. |
| The patient needs to have a tubal ligation performed. Which of the following is needed in order for the third party payer to cover the procedure/ | Pre-certification. |
| If a married couple is covered under both spouses' health insurance and the husband wishes to schedule an appointment for an annual exam, he should call his primary care provider and _____? | Schedule an appointment using both his insurance benefits and his wife's insurance benefits. |
| Which of the following patient information is needed to work out payment plans/ | -Poverty level, -Amount of the bill, -Number of dependents. |
| The provider is paid the same rate per patient whether or not they provide service and no matter which services were provided. This payment is known as _____? | Capitation |
| When the patient calls to inquire about an account, which of the following does the insurance and coding specialist need to ask for before discussing the account? | -Patient's DOB, -Patient's name, -Patient's insurance ID number |
| A new patient comes to the window to find out what the abbreviation LMP on her form means. The insurance and coding specialist blurts out the answer for the office to hear. Which of the following standards have been violated? | HIPAA |
| When the patient has signed the assignment o benefits form, the payment for services should be sent to the provider unless the provider is _____? | Out of network. |
| An insurance and oding specialist is reviewing Appendix B in the CPT book. Which of the following tasks is she most likely performing? | Checking for renumbered codes. |
| HIPAA allows a health care provider to communicate with a patient's family, friends, or other persons who are involved in the patient's care regarding their mental health status providing ______? | The patient does not object. |
| When a capitation account is applied to the ledger it is also known as a _____? | Monthly prepayment amount. |
| When reviewing the charges for a patient procedure using computer assisted coding software (CAC), the insurance and coding specialist shoulf first _____? | Review the chart for needed information. |
| The patient is sent a statement for an office visit, 100 is the amount that must be paid before the insurance company will pay on the claim. This is called the _____? | Deductible |
| Collection agencies are regulated by the _____? | Fair Debt Collections Practices Act |
| Which of the following information is necessary to post payments from the RA/EOB? | -Billed CPT codes, -Patient's name, -Date of Service |
| A patient has an HMO. After the appointment, the physician wants the patient to meet with a general surgeon. Which of the following should be the next step for the coding specialist? | Request a referral to a network surgeon. |
| Which of the following is the correct procedure for keeping a Worker's Compensation patient's financial and health records when the same physician is also seeing the patient as a private patient? | Separate financial and health records must be used. |
| when filing an electronic insurance claim, the insurance and coding specialist processes which of the following forms? | CMS-1500 |
| Which of the following fees posted to the patient's account is an example of "usual, customary, and reasonable?" | Allowed amount |
| A patient was seen in the office. Charges were recorded and submitted to the patient's insurance, and an EOB was received by the office with a payment of $70.98. These transactions should be recorded in the _____? | Patient Ledger |
| An establish patient is being seen by the physician today. The patient owes $25.00 for the visit. The amount collected for the office visit is called the _____? | Copayment |
| A new HIM director was recently hired at a hospital. She was advised her health insurance benefits become available in 90 days. Which of the following is correct regarding her health insurance? | She will be able to keep her current medical insurance from her previous job through COBRA. |
| A patient has called to schedule an appointment for an office visit. The insurance policy on file has been cancelled. Which of the following should the insurance and coding specialist do next? | Advise the patient to bring current insurance information to the appointment. |
| Which of the following forms should be transmitted to obtain reimbursement following a physician's office visit for a patient with active Medicaid coverage? | CMS-1500 |
| Which of the following must be verified to process a credit card transactions/ | -Account number, -Credit card number, -Security code |
| Which of the following are violations of the Stark law? | -Accepting gifts in place of payment from patients & -Referring patients to facilities where the provider has financial interest. |
| Which of the following regulations prohibits the submission of a fraudulent claim or making a false statement or representation in connection with a claim? | Federal False Claims Act. |
| A Medicare patient presents to an outpatient hospital facility for a scheduled hysterectomy. To which Medicare plan should the facility submit the claim? | Part B |
| Which of the following refers to documentation obtained from an insurance company that allows patients to receive treatment using their benefits? | Preauthorization |
| Which of the following defines the maximum time that a debt can be collected from the time it was incurred or became due? | Statue of limitations |
| When using the EHR to schedule a patient visit, which of the following screens should be used to complete the scheduling process? | Patient search. |
Created by:
brittbabiiex