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CBCS REVIEW ?'S
| Question | Answer |
|---|---|
| WHAT IS A UB-04 FORM? | The UB-04, also known as the Form CMS-1450, is the uniform institutional provider hardcopy claim form suitable for use in billing multiple third party payers. |
| WHAT IS AN AGING REPORT? | An accounts receivable aging is a report that lists unpaid customer invoices and unused credit memos by date ranges. The aging report is the primary tool used by collections personnel to determine which invoices are overdue for payment. |
| WHAT IS GROSS EXAMINATION? | Gross examination or "grossing" is the process by which pathology specimens are inspected with the bare eye to obtain diagnostic information, while being processed for further microscopic examination. |
| WHAT IS AN ECG? | An electrocardiogram (ECG) is a test which measures the electrical activity of your heart to show whether or not it is working normally. An ECG records the heart's rhythm and activity on a moving strip of paper or a line on a screen. |
| WHAT IS A CLAIM CONTROL NUMBER? | A number assigned by the payer to identify a claim. The number is usually referred to as an Internal Control Number (ICN), Claim Control Number (CCN) or a Document Control Number (DCN). |
| WHAT IS THE PRIMARY INFORMATION USED TO DETERMINE THE PRIORITY OF COLLECTION LETTERS TO PATIENTS? | THE AGE OF THE ACCOUNT |
| A BILLING AND CODING SPECIALIST IS REVIEWING A CMS-1500 CLAIM FORM. THE "ASSIGNMENT OF BENEFITS BOX" HAS BEEN CHECKED YES. WHAT DOES THIS INDICATE? | THE PROVIDER RECEIVES PAYMENT DIRECTLY FROM THE PAYER. |
| AFTER A THIRD-PARTY PAYER VALIDATES A CLAIM WHAT HAPPENS NEXT? | CLAIM ADJUDICATION |
| WHAT WAS DEVELOPED TO REDUCE MEDICARE PROGRAM EXPENDITURES BY DETECTING INAPPROPRIATE CODES AND ELIMINATING IMPROPER CODING PRACTICES? | NCCI The National Council on Compensation Insurance |
| BILLING AND CODING SPECIALIST SHOULD ADD MODIFIER -50 TO CODES WHEN REPORTING WHAT? | A BILATERAL PROCEDURE |
| WHAT IS THE 3RD STAGE OF THE LIFE CYCLE OF A CLAIM? | CLAIMS ADJUDICATION |
| WHAT MODIFIER INDICATES A PROFESSIONAL SERVICE HAS BEEN DISCONTINUED PRIOR TO COMPLETION? | -53 |
| HOW MANY VOLUMES ARE IN THE ICD-9 MANUAL? | 3 |
| WHAT IS AN ADVANCE BENEFICIARY NOTICE? | is a notice you should receive when a provider or supplier offers you a service or item they believe Medicare will not cover. |
| ON A UB-04 CLAIM FORM WHAT DIAGNOSIS CODE IS LISTED FIRST? | PRINCIPAL DIAGNOSIS |
| WHAT IS THE CORRECT WAY TO ENTER $150 IN BLOCK 24F OF A CMS-1500 FORM? | 150 00 |
| WHAT IS A BILLING PATTERN THAT IS A BEST PRACTICE ACTION? | DOCUMENTING THE PATIENTS CHIEF COMPLAINT, HISTORY EXAM, ASESSMENT, AND PLAN FOR CARE |
| NAME A SITUATION THE CONSTITUTES A CONSULTATION | SERVICES RENDERED BY A PHYSICIAN WHOSE OPINION OR ADVICE IS REQUESTED BY ANOTHER PHYSICIAN OR AGENCY |
| WHEN POSTING PAYMENT ACCURATELY, WHAT SHOULD THE BILLING AND CODING SPECIALIST INCLUDE? | PATIENTS RESPONSIBILITY |
| A PROVIDER RECEIVES A REIMBURSEMENT FROM A THIRD - PARTY PAYER ACCOMPANIED BY WHAT? | EXPLANATION OF BENEFITS |
| A BILLER WILL ELECTRONICALLY SUBMIT A CLAIM TO THE CARRIER VIA WHAT? | DIRECT DATA ENTRY |
| A BILLING AND CODING SPECIALIST NEEDS TO KNOW HOW MUCH MEDICARE PAID ON A CLAIM BEFORE BILLING THE SECONDARY INSURANCE. TO WHICH SHOULD THE SPECIALIST REFER? | REMITTANCE ADVICE |
| WHAT IS ALLOWED WHEN BILLING PROCEDURAL CODES? | BILLING USING 2 DIGIT CPT MODIFIERS TO INDICATE A PROCEDURE PERFORMED DIFFERS FROM ITS USUAL 5 DIGIT CODE |
| WHAT SECTION OF MEDICAL RECORD IS USED TO DETERMINE THE CORRECT EVALUATION AND MANAGEMENT CODE USED FOR BILLING AND CODING? | HISTORY AND PHYSICAL |
| WHAT PARTS OF THE BODY SYSTEM REGULATES IMMUNITY? | LYMPHATIC SYSTEM |
| A PROSPECTIVE BILLING ACCOUNT AUDIT PREVENTS FRAUD BY REVIEWING AND COMPARING A COMPLETED CLAIM FORM WITH WHICH DOCUMENT? | A BILLING WORKSHEET FROM THE PATIENTS ACCOUNT |
| THE SYMBOL "O" IN CPT IS USED FOR WHAT? | REINSTATED OR RECYCLED CLAIM |
| WHAT IS THE PURPOSE OF RUNNING AN AGING REPORT? | IT INDICATES WHICH CLAIMS ARE OUTSTANDING |
| WHAT IS THE PORTION OF THE ACCOUNT THE PATIENT MUST PAY AFTER SERVICES ARE RENDERED AND THE ANNUAL DEDUCTIBLE IS MET? | COINSURANCE |
| THE STANDARD MEDICAL ABBREVIATION "ECG" REFERS TO A TEST TO ASSESS WHAT BODY SYSTEM? | CARDIOVASCULAR |
| THE BILLING AND CODING SPECIALIST SHOULD FIRST DIVIDE THE EVALUATION AND MANAGEMENT CODES BY ? | PLACE OF SERVICE |
| IN THE ANESTHESIA SECTION OF THE CPT MANUAL, WHAT ARE CONSIDERED QUALIFYING CIRCUMSTANCES? | ADD ON CODES |
| AS OF APRIL 1, 2014 WHAT IS THE MAXIMUM NUMBER OF DIAGNOSIS CODES CAM BE ON THE CMS-1500 CLAIM FORM BEFROE A FURTHER CLAIM IS REQUIRED? | 12 |
| A PATIENT WITH A PAST DURE BALANCE REQUESTS THAT HIS RECORDS BE SENT TO ANOTHER PROVIDER. WHAT ACTIONS SHOULD BE TAKEN? | ACCOMODATE THE REQUEST AND SEND THE RECORDS |
| THE PT HAS AARP AS A SECONDARY INSURANCE WHICH BLOCK ON THE CMS-1500 CLAIM FORM SHOULD THIS INFORMATION BE ENTERED? | BLOCK 9 |
| ON A REMITTANCE ADVICE FORM WHO IS RESPONSIBLE FOR WRITING OFF THE DIFFERENCE BETWEEN THE AMOUNT BILLED AND THE AMOUNT OWED BY THE AGREEMENT? | THE PROVIDER |
| WHAT INFORMATION SHOULD THE BILLING AND CODING SPECIALIST INPUT INTO BLOCK 33A ON THE CMS - 1500 CLAIM FORM? | NATIONAL PROVIDER NUMBER |
| TO BE COMPLIANT WITH HIPAA WHAT POSITION SHOULD BE ASSIGNED IN EACH OFFICE? | PRIVACY OFFICER |
| WHAT DOES A PATIENT SIGN TO ALLOW PAYMENTS OF CLAIMS DIRECTLY TO THE PROVIDER? | ASSIGNMENT OF BENEFITS |
| WHAT PORTION OF THE ACCOUNT BALANCE MUST THE PATIENT PAY AFTER SERVICES ARE RENDERED AND THE ANNUAL DEDUCTIBLE IS MET? | COINSURANCE |
| THE UNLISTED CAN BE FOUND WHERE IN THE CPT MANUAL? | GUIDELINES PRIOR TO EACH SECTION |
| WHICH BLOCK REQUIRES PATIENTS AUTHORIZATION TO RELEASE MEDICAL INFORMATION TO PROCESS A CLAIM? | BLOCK 12 |
| A BILLING AND CODING SPECIALIST SHOULD UNDERSTAND THAT THE FINANCIAL RECORD SOURCE THE IS GENERATED BY A PROVIDERS OFFICE IS CALLED? | PATIENT LEDGER ACCOUNT |
| WHAT ACTION SHOULD BE TAKEN IF AN INSURANCE COMPANY DENIES A SERVICE AS NOT MEDICALLY NECESSARY? | APPEAL THE DECISION WITH THE PROVIDER'S REPRT |
| WHAT ACTION SHOULD BE TAKEN WHEN A CLAIM IS BILLED FOR A LEVEL 4 OFFICE VISIT AND PAID AT A LEVEL THREE? | SUBMIT AN APPEAL TO THE CARRIE WITH THE SUPPORTING DOCUMENTAION |
| NAME SOMETHING THAT DESCRIBES A DELINQUENT CLAIM? | THE CLAIM IS OVER DUE FOR PAYMENT |
| WHAT IS CONSIDERED PROPER SUPPORTIVE DOCUMENTATION FOR REPORTING CPT AND ICD CODES FOR SURGICAL PROCEDURE? | OPERATIVE REPORT |
| WHAT DO PHYSICIANS USE TO ELECTRONICALLY SUBMIT CLAIMS? | CLEARINGHOUSE |
| WHAT IS THE REASON FOR A CLAIM REJECTION BECAUSE OF MEDICARE NCCI EDIT? | IMPROPER CODE COMBINATIONS |
| WHAT PORTION OF HIPAA ALLOWS A PROVIDER TO SPEAK TO ANOTHER PROVIDER PRIOR TO OBTAINING THE PATIENTS CONSENT? | TITLE II |
| MEDIGAP COVERAGE IS OFFERED TO MEDICARE BENEFICIARIES AS WHAT? | PRIVATE THIRD PARTY PAYERS |
| WHAT IS A PURPOSE OF AN INTERNAL AUDITING PROGRAM IN A PHYSICIANS OFFICE? | VERIFYING THAT THE MEDICAL RECORDS AND THE BILLING RECORD MATCH |
| WHAT IS USED TO SHOW OUTSTANDING BALANCES? | AGING REPORT |
| WHAT COLOR FORMAT IS ACCEPTABLE ON THE CMS -1500 CLAIM FORM | RED |
| WHAT IS A HIPAA COMPLIANCE GUIDELINE AFFECTING ELECTRONIC HEALTH RECORDS? | THE ELECTRONIC TRANSMISSION AND THE CODE SET STANDARDS REQUIRE EVERY PROVIDER TO USE THE HEALTHCARE TRANSACTIONS, CODE SETS, AND IDENTFIERS |
| WHAT INDICATES A CLAIM SHOULD BE SUBMITTED ON PAPER INSTEAD OF ELECTRONICALLY? | IF THE CLAIM REQUIRES AN ATTATCHMENT |
| WHAT FONT DO YOU USE ON A CMS- 1500 CLAIM FORM? | 10 -PITCH PICA FONT |
| WHAT INFORMATION IS IN BLOCKS 14 - 33 ON THE CMS -1500 CLAIM FORM? | THE PT'S CONDITION AND THE PROVIDERS INFORMATION |
| THE "><" IS USED TO INDICATE NEW OR REVISED TEXT EXCEPT WHAT? | PROCEDURE DESCRIPTORS |
| WHAT COMPONENTS OF AN EXPLANATION OF BENEFITS EXPEDITES THE PROCESS OF A PHONE APPEAL? | CLAIM CONTROL NUMBER |
| WHAT IS THE ADVANTAGE OF AN ELECTRONIC CLAIM SUBMISSION? | CLAIMS ARE EXPIERED |
| WHAT PROVISION ENSURES THAT AN INSURED'S BENEFITS FROM ALL INSURANCE COMPANIES DO NOT EXCEDED 100 % OF ALLOWABLE MEDICAL EXPENSES | COORDINATION OF BENEFITS |
| WHAT IS CONSIDERED THE FINAL DETERMINATION OF THE ISSUES INVOVLING SETTLEMENT OF AN INSURANCE CLAIM | ADJUDICATION |
| WHAT PLANE DIVIDES THE BODY INTO LEFT AND RIGHT? | SAGITTAL |
| WHAT ACTION SHOULD BE TAKEN WHEN REVIEWING A DELINQUENT CLAIM? | VERIFY THE AGE OF THE ACCOUNT |
| WHAT COMPONENTS OF AN EXPLANATION OF BENEFITS EXPEDITES THE PROCESS OF THE PHONE APPEAL? | CLAIM CONTROL NUMBER |
| WHAT DO PHYSICIANS USE TO ELECTRONICALLY SUBMIT CLAIMS? | CLEARINGHOUSE |
| WHAT SHOULD THE BILLING AND CODING SPECIALIST USE TO TRANSMIT TO THE INSURANCE CARRIER FOR REIMBURSEMENT OF INPATIENT HOSPITAL STAYS? | UB-04 FORM |
| THE NURSE IS REVIEWING LABS AND SEES THAT THE PT HAS AN ELEVATED GLUCOSE BEFORE DISCHARGING THE PT. WHO SHOULD SHE NOTIFY? | THE ATTENDING PHYSICIAN |
| WHAT CHARACTER IN THE ICD-10-PCS INDICATES BODY PARTS? | 4TH CHARACTER |
| WHAT SECTION OF THE MEDICAL RECORD IS USED TO DETERMINE THE CORRECT EVALUATION AND MANAGEMENT CODE FOR BILLIBG AND CODING? | HISTORY AND PHYSICAL |
| WHEN A PHYSICIAN DOCUMENTS A PT'S RESPONSE TO SYMPTOMS AND VARIOUS BODY SYSTEMS, THE RESULTS ARE DOCUMENTED WHERE? | REVIEW OF SYMPTOMS |
| WHAT IS THE CORRECT TERM FOR AN AMOUNT THAT HAS BEEN DETERMINED TO BE UNCOLLECTABLE? | BAD DEBT |
| WHAT BLOCK ON THE CMS-1500 FORM IS USED TO BILL ICD CODES? | BLOCK 21 |
| PT CHARGES THAT HAVE NOT BEEN PAID WILL APPEAR WHERE? | ACCOUNTS RECEIVABLE |
| WHAT FORM MUST THE PT OR REPRESENTATIVE SIGN TO ALLOW THE RELEASE OF PHI? | AUTHORIZATION FORM |
| AFTER A THIRD PARTY PAYER VALIDATES A CLAIM WHAT TAKES PLACE NEXT? | CLAIM ADJUDICATION |
| WHEN A PT HAS A CONDITION THAT IS BOTH ACUTE AND CHRONIC, HOW SHOULD IT BE REPORTED? | CODE BOTH ACUTE AND CHRONIC, ACUTE IS FIRST |
| A BILLER WILL ELECTRONICALLY SUBMIT THE CLAIM TO THE CARRIER WITH WHAT? | DIRECT DATA ENTRY |
| WHAT IS VERBAL OR WRITTEN AGREEMENT THAT GIVES APPROVAL TO RELEASE PHI? | CONSENT |
| Z CODES ARE USED TO IDENTIFY WHAT? | IMMUNIZATIONS |
| WHAT STEP WOULD BE A PART OF A PHYSICIANS PRACTICE COMPLIANCE PROGRAM? | INTERNAL MONITORING AND AUDITING |
| WHAT REGULATES THE IMMUNE SYSTEM? | LYMPHATIC SYSTEM |
| IN AN OUTPATIENT SETTING WHAT FORM IS USED AS A FINANCIAL REPORT OF ALL SERVICES PROVIDED TO PT'S ? | PATIENT ACCOUNT RECORD |
| WHAT BLOCK WOULD A PREAUTHORIZATION NUMBER ON THE CMS - 1500 FORM? | BLOCK 23 |
| WHAT IS THE PRIMARY INFORMATION USED TO DETERMINE THE PRIORITY OF COLLECTION LETTERS TO PTS'? | THE AGE OF THE ACCOUNT |
| WHAT IS TRUE WHEN DETERMINING PT'S FINANCIAL RESPONSIBILITY BY REVIEWING REMITTANCE ADVICE? | ALL COINSURANCE AND DEDUCTIBLES ARE ALL RESPONSIBILITIES OF THE PT |
| ON THE CMS-1500 FORM BLOCKS 14-33 CONTAIN INFORMATION ABOUT WHAT? | PT'S CONDITION AND PROVIDER INFORMATION |
| WHAT INCLUDES PROCEDURES AND BEST PRACTICE FOR CORRECT CODING? | CODING COMPLIANCE PLAN |
| MEDIGAP COVERAGE IS OFFERED TO MEDICARE BENEFICIARIES BY? | THIRD PARTY PAYERS |
| A BILLING AND CODING SPECIALIST UNDERSTAND THAT THE FINANCIAL RECORD SOURCE THAT IS GENERATED BY A PROVIDERS OFFICE IS CALLED A WHAT? | PATIENT LEDGER ACT |
| A CORONERS AUTOPSY IS COMPROMISED BY WHAT EXAMINATION? | GROSS EXAMINATION |
| WHAT ACTION SHOULD THE BILLING AND CODING SPECIALIST TAKE IF HE OBSERVES A COLLEAGUE IN AN UNETHICAL SITUATION? | REPORT THE INCIDENT TO THE SUPERVISOR |
| A PROVIDER PERFORMS AN EXAMINATION OF A PT'S SORE THROAT DURING AN OFFICE VISIT. WHAT IS THE LEVEL OF THE EXAM? | PROBLEM FOCUSED EXAMINTAION |
| WHAT CAN CAUSE A CLAIM CAN BE DENIED OR REJECTED? | 24D CONTAINS THE DIAGNOSIS CODE |
| WHAT IS TRUE REGARDING THE RELEASE OF PT RECORDS? | PT ACCESS TO PSYCHOTHERAPY NOTES MAY BE RESTRICTED |
| IN WHAT BLOCK ON THE CMS-15000 SHOULD A SECONDARY INSURANCE INFORMATION BE ENTERED? | BLOCK 9 |
| A PT WITH A PAST DUE BALANCE REQUESTS A COPY OF HIS BE SENT TO ANOTHER PROVIDER. WHAT SHOULD YOU DO? | ACCOMODATE THE REQUEST AND SEND THE RECORDS |
| A CLAIM IS SUBMITTED WITH A TRANSPOSED MEMBER NUMBER RETURNED TO THE PROVIDER. WHAT IS THE STATUS OF THE CLAIM? | INVALID |
| IF A PT HAS A PROBLEM WITH OSTEOMYELITIS , HE HAS A PROBLEM WITH WHAT? | BONES AND BONE MARROW |
| WHAT INFORMATION IS LISTED IN BLOCK 17B ON THE CMS -1500? | REFFERING PHYSICIANS NPI |
| WHAT ACT APPLIES TO SIMPLIFICATION GUIDELINES? | HIPAA |
| WHAT WAS DEVELOPED TO REDUCE MEDICARE PROGRAM EXPENDITURES BY DETECTING INAPPROPRIATE CODES AND ELIMINATING IMPROPER CODING PRACTICES? | NCCI |
| WHAT CONSTITUTES A CONSULTATION? | SERVICES RENDERED BY A PROVIDER WHOSE OPINION OR ADVICE IS REQUESTED BY ANOTHER PROVIDER OR AGENCY |
| WHAT TIME PERIOD SHOULD THE BILLING AND CODING SPECIALIST TRACK UNPAID CLAIMS BEFORE TAKING FOLLOW UP ACTION? | 30 DAYS |
| WHAT INFORMATION IS REQUIRED TO INCLUDE ON A ADVANCE BENEFICIARY NOTICE? | THE REASON WHY MEDICARE MAY NOT PAY |
| WHAT BLOCK ON THE CMS -1500 WOULD BE REQUIRED TO IMPLY ITS A WORKERS COMP CLAIM? | 10A |
| WHAT TYPE OF CLAIM IS 120 DAYS OLD? | DELINQUENT |
| WHAT IS TRUE REGARDING MEDICAID ELIGIBILITY? | PT'S ELIGIBILITY IS DETERMINED MONTHLY |
| WHAT IS AN EXAMPLE OF FRAUD? | BILLING AND CODING SPECIALIST UNBUNDLES CODE TO RECEIVE HIGHER PAYMENT |
| WHAT MEDICARE POLICIES DETERMINES IF A PARTICULAR ITEM OR SERVICE IS COVERED BY MEDICARE? | NATIONAL COVERAGE DETERMINATION (NCD) |
| WHAT IS AN EXAMPLE OF A REMARK CODE FROM AN EOB DOCUMENT? | CONTRACTUAL ALLOWANCE |
| WHAT IS AN AN EXAMPLE OF A CODE SYMBOL FOUND IN THE CPT MANUEL? | A PRODUCT PENDING FDA APPROVAL IS INDICATED BY AS A LIGHTNING BOLT SYMBOL |
| WHAT IS AN EXAMPLE THAT WOULD RESULT IN A CLAIM BEING DENIED? | AN ITALICIZED CODE USED AS THE FIRST LISTED DIAGNOSIS |
| WHAT WOULD CAUSE A CLAIM TO BE SUSPENDED? | SERVICES REQUIRE ADDITIONAL INFORMATION |
| WHAT INFORMATION IS IN BLOCK 32 ON THE CMS-1500 FORM? | SERVICE FACILITY LOCATION INFORMATION |
| WHAT ENTITY DEFINES THE ESSENTIAL ELEMENTS OF A COMPREHENSIVE COMPLIANCE PROGRAM? | OFFICE OF INSPECTOR GENERAL (OIG) |
| WHEN CODING A FRONT TORSO BURN, WHAT PERCENTAGE WOULD BE CODED? | 18% |
| WHAT BLOCK ON THE CMS-1500 FORM SHOULD YOU ENTER THE RENDERING PHYSICIANS NPI? | BLOCK 24J |
| WHAT DESCRIBES THE ORGANIZATION OF AN AGING REPORT? | BY DATE |
| WHAT DESCRIBES AN INSURANCE CARRIER THAT PAYS THE PROVIDER WHO RENDERED SERVICES TO A PT? | THIRD - PARTY PAYER |
| A BILLIBG AND CODING SPECIALIST CAN ENSURE APPROPRIATE INSURANCE COVERAGE FOR AN OUTPATIENT PROCEDURE BY GETTING WHAT FIRST? | PRECERTIFICATION |
| WHAT TERM IS USED TO COMMUNICATE WHY A CLAIM LINE ITEM WAS DENIED OR PAID DIFFERENTLY THAN IT WAS BILLED? | CLAIM ADJUSTMENT CODES |
| WHAT DESCRIBES A TWO DIGIT CPT CODE USED TO INDICATE THAT THE SUPERVISED AND INTERPRETED A RADIOLOGY PROCEDURE? | PROFESSIONAL COMPONENT |
| WHAT BEST DESCRIBES MEDICAL ETHICS? | MEDICAL STANDARD OF CONDUCT |
| WHAT DESCRIBES THE TERM "CROSSOVER" AS IT RELATES TO MEDICARE? | WHEN AN INSURANCE COMPANY TRANSFERS DATA TO ALLOW COORDINATION OF BENEFITS OF A CLAIM |
| WHAT IS AN EXAMPLE OF MEDICAL ABUSE? | CHARGING EXCESSIVE FEES |
| WHAT STANDARDIZED FORMATS ARE USED IN THE ELECTRONIC FILING OF CLAIMS? | HIPAA STANDARD TRANSACTIONS |
| WHAT SYMBOL INDICATES A REVISED CODE ? | TRIANGLE |
| WHAT IS A KEY COMPONENT OF AN EVALUATION AND MANAGEMENT SERVICE ? | HISTORY |
| WHAT IS THE MAXIMUM NUMBER OF MODIFIERS THAT THE BILLING AND CODING SPECIALIST CAN REPORT ON A CMS -1500 FORM IN BLOCK 24D? | 4 |
| WHAT FORMAT IS USED TO SUBMIT ELECTRONIC CLAIMS TO A THIRD PARTY PAYER? | 837 |
| WHAT ORGANIZATION FIGHTS WASTE, FRAUD, AND ABUSE IN MEDICARE AND MEDICAID? | OFFICE OF INSPECTOR GENERAL (OIG) |
| WHAT IS THE DEADLINE FOR MEDICARE CLAIM SUBMISSION? | 12 MONTHS FROM DATE OF SERVICE |
| WHAT PROHIBITS A PROVIDER FROM REFERRING MEDICARE PT'S TO A CLINICAL LABORATORY SERVICE IN WHICH THE PROVIDER HAS A FINANCIAL INTEREST? | STARK LAW |
| WHEN THE REMITTANCE ADVISE IS SENT FROM THE THIRD PARTY PAYER, WHAT ACTION SHOULD THE BILLING AND CODING SPECIALIST PERFORM FIRST? | ENSURE PROPER PAYMENT HAS BEEN MADE |
| WHAT IS INCLUDED IN THE RELEASE OF PT INFORMATION? | THE DATE OF THE LAST DISCLOSURE |
| WHEN REVIEWING AN ESTABLISHED PT'S INSURANCE CARD THE BILLING AND CODING SPECIALIST NOTICES A MINOR CHANGE FROM THE EXISTING ONE ON FILE. WHAT ACTION SHOULD BE TAKEN? | PHOTOCOPY BOTH SIDES OF THE NEW CARD |
| THE PHYSICIAN BILLS $500 TO A PT. AFTER SUBMITTING THE CLAIM TO THE INSURANCE COMPANY, THE CLAIM IS SENT BACK WITH NO PAYMENT. THE PT STILL OWES THE $500 FOR THE YEAR. THE AMOUNT IS CALLED WHAT? | DEDUCTABLE |
| WHAT TERM IS USED TO DESCRIBE THE LOCATION OF THE STOMACH, THE SPLEEN,PART OF THE PANCREAS, PART OF THE LIVER AND PART OF THE SMALL AND LARGE INTESTINES? | LEFT UPPER QUADRANT |
| A BILLING AND CODING SPECIALIST HAS FOUR PAST DUE CHARGES: $400 THAT IS 10 WEEKS PAST DUE; $800 THAT IS 6 WEEKS PAST DUE; $1000 THAT IS 4 WEEKS PAST DUE; AND $2000 THAT IS 8 WEEKS PAST DUE. WHICH ONE SHOULD BE SENT TO COLLECTIONS FIRST? | THE $2000 ONE. THE LARGEST PAST DUE CHARGE SHOULD BE SENT TO COLLECTIONS FIRST. |
| WHAT BLOCK ON THE CMS-1500 FORM IS USED TO ACCEPT ASSIGNMENT OF BENEFIT? | BLOCK 27 |
| WHAT EXPLAINS WHY MEDICARE WILL DENY A PARTICULAR SERVICE OR PROCEDURE? | ADVANCE BENEFICIARY NOTICE (ABN) |
| A MEDICARE NON-PARTICIPATING (non- PAR) PROVIDER'S APPROVED PAYMENT AMOUNT IS $200 FOR A LOBECTOMY AND THE DEDUCTIBLE HAS BEEN MET. WHAT IS THE LIMITING CHARGE FOR THIS PROCEDURE? | $230 A non-PAR WHO DOES NOT ACCEPT ASSIGNMENT CAN COLLECT A MAXIMUM OF 15% OVER THE FEE SCHEDULE |
| WHEN SUBMITTING A CLEAN CLAIM WITH A DIAGNOSIS OF KIDNEY STONES, WHAT IS THE NAME OF THE PROCEDURE? | NEPHROLITHIASIS |
| HIPAA TRANSACTION STANDARDS APPLY TO WHAT ENTITIES? | HEALTH CARE CLEARINGHOUSE |
| WHAT IS AN ADVANTAGE OF ELECTRONIC CLAIM SUBMISSION? | CLAIMS ARE EXPIDITED |
| A PHYSICIAN ORDERED A COMPREHENSIVE METABOLIC PANEL FOR A 70 YR OLD PT WHO HAS MEDICARE AS HER PRIMARY INS. WHAT FORM IS REQUIRED SO THE PT KNOWS SHE MAY BE RESPONSIBLE FOR PAYMENT? | ADVANCE BENEFICIARY NOTICE |
| AN INSURANCE CLAIMS REGISTER ( AGED INSURANCE REPORT) FACILITATES WHAT? | FOLLOW UP OF INSURANCE CLAIMS BY DATE |
| WHAT DESCRIBES AN OBSTRUCTION OF THE URETHRA? | URETHRATRESIA |
| WHAT DESCRIBES A REASON FOR A CLAIM REJECTION BECAUSE OF MEDICARE NCCI EDITS? | IMPROPER CODE COMBINATIONS |
| WHEN COMPLETING A CMS - 1500 PAPER CLAIM FORM, WHAT IS AN ACCEPTABLE ACTION FOR THE BILLING AND CODING SPECIALIST TO TAKE? | USE ARIAL SIZE 10 FONT |
| WHAT IS THE PURPOSE OF RUNNING AN AGING REPORT EACH MONTH? | IT INDICATES WHICH CLAIMS ARE OUTSTANDING |
| AMBULATORY SURGERY CENTERS, HOME HEALTH CARE AND HOSPICE ORGANIZATIONS USE WHAT FORM? | UB-04 |
| A THIRD PARTY PAYER VALIDATES A CLAIM. WHAT HAPPENS NEXT? | CLAIM ADUDICATION |
| A BENEFICIARY OF A MEDICARE/ MEDICAID CROSSOVER CLAIM SUBMITTED BY A PARTICIPATING PROVIDER IS RESPONSIBLE FOR WHAT PERCENTAGE? | 0% |
| IN 1995 AND IN 1997 WHO INTRODUCED DOCUMENTATION GUIDELINES TO MEDICARE CARRIERS TO ENSURE THAT SERVICES PAID FOR HAVE BEEN PROVIDED AND WERE MEDICALLY NECESSARY? | CMS |
| WHEN AN ELECTRONIC CLAIM IS REJECTED DUE TO INCOMPLETE INFORMATION, WHAT ACTION SHOULD THE MEDICAL BILLING SPECIALIST TAKE? | COMPLETE THE INFORMATION AND RE-TRANSMIT ACCORDING TO THE THIRD PARTY STANDARDS |
| WHAT ORGANIZATION IDENTIFIES IMPROPER PAYMENTS MADE ON CMS CLAIMS? | RECOVERY AUDIT CONTRACTOR (RAC) |
| THE DESTRUCTION OF LESIONS USING CRYOSURGERY WOULD USE WHAT TREATMENT? | COLD TREATMENT |
| IN AN OUTPATIENT SETTING, WHAT FORM IS USED AS A FINANCIAL REPORT OF ALL SERVICES PROVIDED TO PTS? | PATIENT ACCOUNT RECORD |
| WHAT DESCRIBES THE STATUS OF A CLAIM THAT DOES NOT INCLUDE REQUIRED PREAUTHORIZATION FOR A SERVICE? | DENIED |
| WHAT ACT APPLIES TO THE ADMINISTRATIVE SIMPLIFICATION GUIDELINES? | HIPAA |
Created by:
tarajean1974