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| Question | Answer |
|---|---|
| Which of the following protects federal healthcare programs from fraud and abuse by healthcare providers who solicit referrals? | Anti-kickback Statue |
| A patient presents to the ED with multiple stab wounds to the arms and chest. On examination there are 3 deep lacerations to the arms measuring 1.2cm, 1.4cm and 2.1cm requiring complex closure, and 2 superficial wounds measuring 1.3cm and 2.4cm requiring | intermediate closure. Which of the following is the correct CPT code assignment? 13121, 12032-59 |
| 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 |
| 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 |
| 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? (Select the three (3) correct answers.) | account number, credit card number, security code |
| A physician uses cryotherapy for correction of triachiasis. Which of the following CPT codes should be assigned? | 67825 |
| 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 patient presents with symptoms for gastric reflux. The physician performed EGD, flexible transoral. The scope was advanced to the stomach, but unable to advance to the duodenum due to gastric bolus. Physician will return patient for second EGD after | course of treatment. Which of the following is the correct CPT code assignment? 43235-53 |
| 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 specialist should have which of the following information available when speaking with the insurance company? (Select the three (3) correct answers). | date of service, physician's NPI, patient's 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 | our of network |
| When using an EHR system to enter CPT codes on 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 presents with low back pain. The physician ordered an MRI and discovered the patient has L5/S1 spondylolisthesis. Which of the following is the correct ICD-10-CM code assignment? | M43.17 |
| A patient has called to schedule and 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? Advise the patient to bring current insurance information to the appointment. |
| The patient presents to the ED with RLQ pain and fever. The physician lists appendicitis as a possible diagnosis. Which of the following ICD-10-CM codes should be assigned? | R10.31, R50.9 |
| Patient presents to office with cough, chest tightness, and sore throat. The physician assessment is URI. Which of the following is the correct ICD-10-CM code assignment? | J06.9 |
| Co-insurance is typically due | after the claim has been adjudicated. |
| A patient is seen in the office for a candidal parnychia nail abscess was incised and drained. Which of the follwing is the correct CPT code assignment for physician services only? | 10060 |
| Which of the following patient information is needed to determine a Medicaid sliding fee scale? (Select the three (3) correct answers.) | poverty level, number of dependents, salary |
| A Medicare patient 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 misplaces. |
| 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 |
| The patient returned to the operative suite 10 days postoperative infection. The final lab results discover the organism is pseudomonas mallei. Which of the following is the appropriate ICD-10-CM coding? | T81.4XXA, A24.0 |
| 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 patient as a private patient? | Separate financial and health records must be used. |
| The patient presented with three lacerations. The physician performed the following a simple repair of 2.5 cm lacerations of the arm, a simple repair of a 2.5 cm laceration of the scalp, and a simple repair of 2.5 cm laceration of the hand. Which of the | following is the correct CPT code assignment? 12002 |
| 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-ceritification |
| The patient presents today for upper gastrointestinal (GI) endoscopy and a biopsy of the stomach. Which of the following is the correct CPT code assignment? | 43239 |
| 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 |
| A patient has a home health aide come to his home to clean and dress a burn on his lower leg. The aide uses a special absorptive, sterile dressing to cover 20 sq. in. area. She also covers 15 sq. in. area with a self | A6204, A6219 |
| 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. She notices that the physician upcoded the encounter form. The specialist has the ethical obligation | to first query the physicial |
| 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 must a patient sign prior to an insurance claim being processed? | an Authorization to Release Information |
| Which of the following must a patient sign prior to an insurance claim being processed? |
Created by:
lettycam17