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MUST PASS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Which of the following information is necessary to post payments from the RA/EOB? billing CPT codes, patient's name, date of service
When is a referral from a provider required? when contained in the individual policy
When a document is changed in an EHR, the original documentation is? hidden
Which of the following Medicare parts covers inpatient hospital stays? part A
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
A Medicare patient has an 80/20 plan. The charged amount was $300. The amount allowed was $100. Which of the following is the patients coinsurance. $20
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
Which of the following are necessary to complete a CMS 1500 form? diagnosis and CPT codes, physician information, demographic information
When a capitation account is applied to the ledger it is also known as a ? monthly prepayment amount
A physician performed a bilateral L4/L5 Laminectomy on a patient in an ambulatory surgical center. Which of the following place of service codes should be used on the CMS 1500? 24
When should a provider have a patient sign a ABN? when the items may be denied and prior to performing the service
If the insurance and coding specialist suspects Medicare fraud she should contact the? OIG
Which of the following must be verified to process a credit card transaction? account number, credit card number, security code
Which of the following process makes final determination for payment in an appeal board? arbitration
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
When the patient calls to inquire about an account, which of the following does the insurance and coding specialist need to ask for before discussing the account? patient date of birth, patients name, patients insurance ID number
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 patient information is needed to determine a Medicaid sliding fee scale? poverty level, number of dependents, salary
Which of the following should an insurance and coding specialist do when checking for completion of a new patients registration form? check that demographics are complete., Make sure that the patients name matches the insurance card., Make sure that the registration form is signed and dated.
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 compamy date of service, physicians NPI, patients insurance ID number
The insurance and coding specialist is billing the insurance company of a 66-year-old- man who has Medicare and is covered under her husband's private insurance. Which of the following should be billed first? the husband insurance
When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim? physicians office fee
Which of the following protects federal healthcare programs from fraud and abuse by healthcare providers who solicit referrals? Anti-Kickback Statute
When posting an insurance payment via an EOB, the amount that is considered contractual is the? insurance allowed amount
If a married couple is covered under both spouses' health insurance and the husband wishes to schedule and appointment for an annual exam, he should call his primary care provider and? schedule an appointment using both his insurance benefits and his wife's insurance benefits
Which of the following reports is used to follow up on outstanding claims to third party payers? 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 todays service? -79
Created by: cheri le
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