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NCCT missed question
| Question | Answer |
|---|---|
| A Medicare patient has an 80/20 plan. The charged amount was $300. The allowed amount is $100.00. Which of the following is patients coinsurance? | $20 |
| The Patient is sent a statement for an office visit. The total amount of the bill is $100.00 and this amount must be paid before the insurance company will pay on the claim. Which of the following is this called? | deductible |
| 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 |
| Which of the following is the correct procedure for keeping a Workers' Compensation patient's financial and health record when the same physician is also seeing the patient as a private patient? | Separate financial and health record must be used |
| When is a referral from a provider required? | when contained in the individual policy |
| when posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claims? | physician's office fee |
| When posting an insurance payment via on EOB, the amount that is considered contractual is the __ | insurance allowed amount |
| When a patient has signed the assignment of benefits form, the payment for service should be sent to the provider unless the provider is __ | |
| A Medicare patient has an 80/20 plan. The charged amount was $300. The allowed amount is $100.00. Which of the following is patients coinsurance? | $20 |
| The Patient is sent a statement for an office visit. The total amount of the bill is $100.00 and this amount must be paid before the insurance company will pay on the claim. Which of the following is this called? | deductible |
| 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 |
| Which of the following is the correct procedure for keeping a Workers' Compensation patient's financial and health record when the same physician is also seeing the patient as a private patient? | Separate financial and health record must be used |
| When is a referral from a provider required? | when contained in the individual policy |
| when posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claims? | physician's office fee |
| When posting an insurance payment via on EOB, the amount that is considered contractual is the __ | insurance allowed amount |
| When a patient has signed the assignment of benefits form, the payment for service should be sent to the provider unless the provider is __ | out of network |
| collections agencies are regulated by the ___ | Fair Debt Collections Practices Act |
| which of the following forms provides information from the Managed Care Organization that paid on the claim? | EOB (explanation of Benefits) |
| Which of the following patient information is needed to determine a Medicare sliding fee scale? (all 3) | poverty level, number of dependents, salary |
| When should a provider have a patient sign an ABN? | when the items may be denied and prior to performing the service |
| 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 |
| If the insurance and coding specialist suspects Medicare fraud she should contact the ___ | OIG |
| Which of the following protects federal healthcare programs from fraud and abuse by healthcare providers who solicit referrals? | Anti-Kickback Statute |
| A patient was seen in the office. charges were recorded and submitted to the patient's insurance, and an EOB was received by the office with a payment of $70.89. These transactions should be recorded in the ___ | patient ledger |
| Which of the following information is necessary to post payment from the RA/EOB? | billed CPT codes, patient's name, date of service |
| Where there is a professional courtesy awarded to a patient's account the insurance and coding specialist should post the amount under the ___ | adjustment column |
| When the patient calls to inquire about an account, which of the following does the insurance and coding specialist need to ask before discussing the account? | Patients date of birth, patient name, patient's insurance ID number |
| Which of the following should an insurance and coding specialist do when checking for completion of a new patient's registration form? | check demographics are completed., make sure that the patients name matches the insurance card, make sure that the registration form is signed and dated |
| 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 |
| Claims are often rejected because a provider needs to obtain ___ | pre-authorization |
| Collecting statics on the frequency of collection at the time of service is a step in the process of __ | managing A/R |
| Which of the following reports is used to follow up on outstanding claims to third party payers? | aging |
| 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 a capitation account is applied to the ledger it is also known as a __ | monthly prepayment amount |
| A third party payer made an error while adjucation a claim. Which of the following should the insurance and coding specialist do? | resubmit the claim with an attachment explaining the error |
| 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 or service |
| 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 a financial interest |
| The Fair debt Collection Practices Act restricts debt collectors form engaging in conduct that includes __ | calling before 8:00AM or after 9:00PM, unless permission is given |
| Based on CMS manual system, when updating or maintaining the billing code database, which of the following does the "R" denote? | revised |
| Which of the following financial reports produces a quarterly review of any dollar amount a patient still owes after all insurance carriers claim payment have been received? | aging |
| Which of the following fees posted to the patient's account is an example of " usual, customary, and reasonable?" | allowed amount |
| Which of the following Medicare part covers inpatient hospital stays? | Part A |
| Developing an insurance claim begins __q | when the patient calls to schedule and appointment |
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priscilla.c