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NCCT Review
| Question | Answer |
|---|---|
| When posting transactions for electronic claims submissions, it is necessary to enter which of the following items onto the claim? | physician's office fee |
| An insur and coding specialists is reviewing a pt encounter form that is documented in the med rec prior to completing a CMS-1500 form. She notices that the phys up-coded the encounter form. The specialist has the ethical obligation to to first | 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 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 8:00 am or after 9:00 pm, 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 claimed, an insurance and coding specialist should have the following information available when speaking with the insurance company? 3 items | patient's claim number, physicians NPI, patient's insurance ID number |
| If the insurance and coding specialist suspect Medicare fraud she should contact the | OIG (Office of Inspected General) |
| Which of the following reports is used to follow up on outstanding claims to third party payers? | aging |
| Providers may receive payment 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? 3 items | 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 performed a bilateral L4/L5 Laminectomy on a patient in an ambulatory surgical center. Which of the following place if service codes should be used on the CMS-1500? | 24 |
| Developing an insurance claims begins when? | The patient calls to schedule an appointment |
| Which of the following forms provides 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 |
| the patient was hospitalized for diabetes. Upon release the patient consults with a registered dietician. Which of the following Level II HCPCS modifiers should be assigned? | AE |
| 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 form first? | the most resource-intensive procedure or service |
| Based on the CMS manual system, updating or maintaining the billing code database, which of the following does the "R" denote? | Revised |
| Which of the following are necessary to complete a CMS 1500 form? 3 items | diagnosis and cpt codes, physicians information, demographic information |
| Which of the following are needed to submit a prior authorization request form medical equipment? | ICD-CM and HCPCS |
| 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? | Medicare Part A |
| When posting an insurance payment via an EOB, the amount that is considered contractual is the? | insurance allowed amount |
| The insurance and coding specialist is billing the insurace company of a 66 year old woman who has medicare and is covered under her husbands insurance. Which of the following should be billed first? | the husband's insurace |
Created by:
yellowrose61