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NCCT
MOA
| Question | Answer |
|---|---|
| Co-insurance is typically due | after the claim has been adjudicated |
| The patient opted 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 |
| which of the following modifiers is required for a return to the operating room for an unplanned related procedure or service by the same physician during the post operative period? | -78 |
| Collecting statistics on the frequency of copay collection at time of service is a step in the process of? | managing A/R |
| Which of the following information is necessary to post payments from the RA/EOB? | -Billed CPT codes -patient's name -date of service |
| which of the following processes makes a final determination for payment in an appeal board? | arbitration |
| The provider is paid the same rate per patient whether or not they provide services and no matter which services were provided. This payment is known as? | capitation |
| A patient had surgery two weeks ago to repair a dislocated ankle, and returns today to have a flexor tendon in the hand repaired. Which of the following modifiers should be reported for today's service? | -79 |
| If the insurance and coding specialist suspects Medicare fraud she should contact the ? | OIG |
| 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 medial insurance from her previous job through COBRA. |
| When a patient calls to inquire about an account, which of the following does the insurance coding specialist need to ask before discussing the account? | -patient's date of birth -patient's name -patient's insurance ID number |
| When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim? | physician's office fee |
| 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 |
| which of the following is an appropriate way to open the discussion when explaining practice fees to a patient? | "Do you have any questions about the cost of today's visit? |
| An insurance & coding specialist is reviewing a patients encounter form that is documented in the medical record prior to completing a CMS1500 form She notices that the physician upcoded the encounter form The specialist has the ethical obligation to 1st | query the physician |
| when a capitation account is applied to the ledger it is also known as a? | monthly prepayment amount |
| claims are often rejected because a provider needs to obtain | pre-authorization |
| 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 |
| when posting and insurance payment via an EOB, the amount that is considered contractual is the? | insurance allowed amount |
| which of the following reports is used to follow up on outstanding claims to third party payers? | aging |
| which of the following patient information is needed to determine a Medicaid sliding fee scale? | - poverty level - number of dependents - salary |
| a PT has called to schedule an appointment for an office visit to see the Dr tomorrow for an earache It s discovered during the scheduling process that the insurance policy on file has been canceled. which of the following should the B&C specialist do | advice the PT (patient) to bring current insurance information to the appointment. |
| which of the following must a patient sign prior to an insurance claim being processed? | an Authorization to Release Information |
| 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 fees posted to the patient's account is an example of "usual, customary, and reasonable?" | allowed amount |
| 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 forms should be transmitted to obtain reimbursement following a physician's office visit for a patient with active Medicaid coverage? | CMS-1500 |
| When reviewing the charges for a patient procedure using computer assisted coding software (CAC), the insurance and coding specialist should first | review the chart for needed information |
| A Medicare patient has nan 80/20 plan. The charged amount was $300. The amount allowed was $100. Which of the following is the patient's co-insurance? | $20 |
| A third party payer mad and 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 |
| which of the following Medicare parts covers inpatient hospital stays? | Part A |
| When is a referral from a provider required? | when contained in the individual policy |
| which of the following are necessary to complete a CMS 1500 form? | - diagnosis and CPT codes - physician information - demographic information |
| If a married couple is covered under both spouse's health insurance and the husband wishes to schedule an appointment for an annual exam, he should call his primary care provider and | schedule and appointment using both his insurance benefits and his wife's insurance benefits |
| Developing an insurance claim begins? | when the patient calls to schedule an appointment. |
| 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 |
| A Medicare patient presents to an outpatient hospital facility for a schedule hysterectomy. To which plan should the facility submit the claim? | Part B |
| When filing an electronic insurance claim, the insurance and coding specialist processes which of the following forms? | CMS-1500 |
| An established 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 |
| which of the following forms provides information from the Managed Care Organization that paid the claim? | EOB |
| HIPPA 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 following up on a denied claim, an insurance and coding specialist should have which of the following information available when speaking with the insurance company? | - Date of service - physician's NPI - patient's insurance ID number |
Created by:
mayra559