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NCCT
study
| Question | Answer |
|---|---|
| When reviewing the charges for a patient procedure using computer assisted coding software CAC the insurance and coding specialist should first | review the chart for needed information |
| which of the following forms should be transmitted to obtain reimbursement following a physicians office visit for a patient with active Medicaid coverage | CMS-1500 |
| when posting transactions for electronic claim submissions it is necessary to enter which if the following items onto the claim | physicians office fee |
| a Medicare patient present to an outpatient hospital facility for a scheduled hysterectomy. Which medicare plan should the facility submit the claim to | Part B |
| When the patient calls to inquire about an account which of the following does the insurance specialist need to ask for before discussing the account | patent DOB, patients name, insurance ID # |
| which of the following are necessary to complete a CMS-1500 form | ICD-10 & CPT code, Physician info, demographic info |
| Based on the CMS manual system when updatinv or maintaining the billing codes data base which of the following does the "R" denote | Revised |
| If a married couple is covered under both spouse's health insurance and the husband wishes to schedule an apt for an annual exam he should call his PCP and | schedule an apt using both his and his wife's insurance benefits |
| which of the following information is necessary from the R/AEOB | Billed CPT codes, patients name, date of service |
| HIPPAA allows health care providers to communicate with a patient's family, friends, or other persons who are involved in the patients care regarding their mental health status providing that | the patient does not object |
| when posting an insurance pmt via EOB the amount that is considered contractual is the | insurance allowed amount |
| when filing an electronic claim form the insurance processes which form | CMS-1500 |
| 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 should an insurance and coding specialist do when checking for completion of a new patients registration form | demographic are complete, name matches insurance card, registration form is signed and dated |
| which of the following protects federal healthcare programs from ffraud and abuse by healthcare providers who solicit referrals | anti-kick statue |
| when a capitation account is applied to the ledger it is also known as a | monthly pmt amount |
| birthday rule. minor comes in, both parents have remained married and the child is listed on the mother's father's and stepfather's policies. the mother bday 4/16 stepfather bd 3/19, father bd is 2/19 stepmom 1/20.. which is correct | father's plan is primary, mothers plan is secondary |
| an insurance specialist is reviewing a patient's encounter form that is documented in the medical record prior to completing a CMS 1500. she notices that the physician upcoded the encounter form. the specialist should | query the physician |
| a patient was seen in the office. charges were recorded and submitted to the patients insurance and an EOB was received by the office with a pmt of 709.89. these transaction should be recorded in the | patient ledger |
| WHICH OF THE FOLLOWING PROCESSES MAKES A FINAL DETERMINATION FOR PMT IN AN APPEAL BOARD | arbitration |
| if the insurance specialist suspects medicare fraud she should contact the | OIG |
| a third party payer made an error while adjudicating a claim. which of the following should the insurance specialist do | resubmit the claim with an attachment explaining the error |
| which of the following are violations of the stark law | accepting gift in place of pmt from patient, reffering patients to physicians where provider has financial interest |
| which of the following must be verified to process CC transactions | acct #, CC#, security code |
| which of the following fees posted to the patients account is an example of " usual, customary, and reasonable" | allowed amount |
| a 72 yr old patient is undergoing a corneal transplant. an anesthesiologist is personally permorming monitored anesthesia care. which of the following modifiers should be reported for the anesthesia | -AA-QS |
| which of the following is the procedure for keeping a Worker's Comp patient's financial and health records when the same physician is also the patients as a private patient | separate financial and health records must be used |
| which of the following regulations prohibits the submission of a fraudulent claim or making a false statement or representation in connection with a claim | federal false claim act |
| which of the following financial reports produces a quarterly review of any dollar amount a patient still owes after all insurance carrier's claim pmts have been received | aging |
| the fair debt collection practices act restricts debt collectors from engaging in conduct that includes | calling before 8 am or after 9 pm, unless permission is given |
| claims are often rejected because a provider needs to obtain | preauthorization |
| when there is a professional courtesy awarded to a patient's account the insurance specialist should post the amount under | adjustment column |
| which of the following patient info is needed to determine a Medicaid sliding fee scale. | poverty level, # of dependents, salary |
| the patient is sent a statement for an office visit. the total amount is 100 and this amount must be paid before the insurance will pay on this claim. | deductible |
| 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 following a denied claim an insurance specialist should have which of the following info available when speaking with the insurance company | date of service, physician's NPI, patient ID # |
| which of the following must a patient sign prior to an insurance claim being processed | an authorization to release information |
| which of the following modifiers is required for a return to the operating room for an unplanned procedure or service by the same physician during post operative period. | -78 |
| what is the place of service code for ambulatory surgical center | 24 |
| which of the following forms provides info from the managed care organization that paid on the claim | EOB |
| when a document is changed in an EHR the original documentation is | hidden |
| 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 |
| patient owes 25 for visit. the amount collected for the office visit is called the | copayment |
| the most effective method to manage patient statements and other invoices as well as avoid pmt delays is to | collect fees at the time of service |
| the pt opted to have a tubal ligation performed. which of the following is needed for the third party payer to cover the procedure | pre-certification |
| a patient had surgery 2 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 |
| the patient was hospitalized for diabetes upon release the patient consults with a registerd dietician whoch of the following level II HCPCS modifiers should be assigned | AE |
| what is appendix M in the CPT coding book | renumbered codes |
| which of the following defined the maximum time that a debt can be collected from the time it was incurred or became due | statue of limitations |
| a medicare patient has a 80/20 plan. the charge amount was 300, the allowed amount was 100 which was the patients coinsurance | $20 |
| a claim submitted with all necessary and accurate info so that it can be processed and paid is called a | clean claim |
| which of the following is most likely cause of the deposit not agreeing with the credits on the day sheet or the patient ledger | pmt is misplaced |
| 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 |
| Which of the following items are mandatory in patient financial policies? (Select the three (3) correct answers.) | expectation of payment due at time of service, collection process, statement that responsibility for payment lies with patient |
| When patients sign Block 13 of the CMS-1500 claim to instruct the payer to directly reimburse the provider, it is known as | assignment of benefits |
| When the patient has signed the assignment of benefits form, the payment for services should be sent to the provider unless the provider is | out of network |
| Encounter forms should be audited to ensure the | diagnosis is in proper ICD-10-CM format. |
| A patient has two health insurance policies – a group insurance plan through her full-time employer and another group insurance plan through her husband’s employer. Which of the following policies should be billed as primary? | her policy |
| Which of the following federal regulations requires disclosure of finance charges, late fees, amount, and due dates for all payment plans? | truth in lending act |
| 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? | husband's insurance |
| Which of the following Medicare parts covers inpatient hospital stays? | part A |
| Which of the following reports is used to follow up on outstanding claims to third party payers? | aging |
| When is a referral from a provider required? | when contained in the individual policy |
| Which of the following information is necessary to post payments from the RA/EOB? (Select the three (3) correct answers.) | billed CPT® codes, patient’s name, date of service |
| Developing an insurance claim begins | when the patient calls to schedule an appointment. |
| The Stark Law was enacted to govern the practice of | physician referrals to facilities that she has a financial interest in. |
Created by:
genesish1994