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|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?
|Which of the following Medicare parts covers inpatient hospital stays?
|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.
|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?
|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?
|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?
|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?
|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?
|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?
|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?