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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
When a capitation account is applied to the ledger it is also know as a monthly payment amount
Which of the following is the correct procedure for keeping a Worker's Compensation patient's financial and health records when the same physician is also seeing the patient as a private patient? separate financial health records must be used
When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim physician's office fee
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
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 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
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
When is a referral from a provider required? when contained in the individual policy
The provider is paid the same rate per patient whether or not they provide services and no matter which services were provided. This payment is known as capitation
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's date of birth, patient's name, patient's insurance ID number
When a document is changed in an EHR, the original document is hidden
When filling out an electronic insurance claim, the insurance and coding specialist processes which of the following forms CMS-1500
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 protects federal healthcare programs from fraud and abuse by healthcare providers who solicit referrals? anti-kickback statute
which of the following should an insurance and coding specialist do when checking for completion of new patient's registration form? check that demographics are completed, make sure that the patient's name matches the insurance card, make sure that the registration form is signed and dated
Claims are often rejected because a provider needs to obtain pre-authorizations
when following up on a denied claim, an insurance and coding specialist would have which of the following information available when speaking with the insurance company date of service, physician's NPI, patient's insurance ID number
the insurance and coding specialist is billing the insurance company of a 66 year old woman who has Medicare and is covered under her husband's private insurance. Which of the following should be billed first the husbands insurance
which of the following Medicare parts covers inpatient hospital stays part A
Created by: jessica8653