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NCCT
| Question | Answer |
|---|---|
| Which of the following protects federal healthcare programs from fraud and abuse by healthcare providers who solicit referrals? | Anti-Kickback Statute |
| Which of the following fees posted to the patient's account is an example of "usual, customary, and reasonable?" | Allowed amount |
| When is a referral from a provider required? | when contained in the individual policy |
| 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 |
| Developing an insurance claim begins | when the patient calls to schedule an appointment |
| Which of the following Medicare parts covers inpatient hospital stays? | Part A |
| Which of the following must be verified to process a credit card transaction? | Account number, credit card number, security code |
| 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 |
| 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. |
| 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 |
| If the insurance and coding specialist suspects Medicare fraud she should contact the | OIG |
| Which of the following processes makes a final determination for payment in an appeal board? | arbitration |
| When following up on a denied claim, an insurance and coding specialists should have which of the following information available when speaking with the insurance company? | date of service, physician's NPI, patients insurance ID number |
| When the patient has signed the assignment of benefits form, the payment for services should be sent to the provider unless the provider is | out of network |
| 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 |
| A patient has called to schedule an appointment for an office visit to see the doctor tomorrow for an earache. It is discovered during the scheduling process that the insurance policy on file has been cancelled. | Which of the following should the insurance and coding specialist do next? Advice the patient to bring current insurance information to the appointment |
| Co-insurance is typically due | after the claim has been adjudicated |
| Which of the following patient information is needed to determine a Medicaid sliding fee scale? | poverty level, number of dependents, salary |
| A Medicare has an 80/20 plan. The charged amount was $300.00. The amount allowed was $100.00. Which of the following is the patient's coinsurance? | $20 |
| 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 is the most likely cause of the deposits not agreeing with the credits on the day sheet or the patient ledgers? | payment is misplaced |
| When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim? | physician's office fee |
| When a capitation account is applied to the ledger it is also known as a | monthly prepayment 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 is the correct procedure for keeping a Workers' Compensation patient's financial and health records when the same physician is also seeing the patients as a private patient? | Separate financial and health records must be used. |
| 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 |
| The patient opted to a have a tubal ligation performed. Which of the following is needed in order for the third party payer to cover the procedure? | pre-certification |
| The fair Debt Collection Practices Act restricts debt collectors from engaging in conduct that includes | calling before 8:00 am or after 9:00 pm, unless permission is given |
| Pronation | the act of rotating the arm or leg so that the palm of the hand or sole of the foot is turned downward or backward |
| Dorsiflexion | the movement that bends the foot upward at the ankle |
| Plantar Flexion | the movement that bends the foot downward at the ankle |
| SSO | Second Surgical Opinion |
| TPA | third party administrators |
| UB-04 | Uniform Bill (claim form) created in 2004 also called CMS 1450 |
| WHO | World Health Organization |
| MCO | Manage Care Organization |
| OCR | Optical Character Reader |
Created by:
lettycam17