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MOP110
CLO #1
| Question | Answer |
|---|---|
| Is correcting claims processing errors a typical responsibility of a health insurance specialist? | Yes |
| Conduct and qualities that characterize a professional person is know as what? | professionalism |
| Which of the following are roles of conduct of the health insurance specialist? | All except Accurately Diagnose & analyze |
| The insurance and coding specialist calls a carrier to verify a patient's insurance and the representative states that the patient's insurance was cancelled months ago. Which of the following should the coding specialist do first? | Ask the patient for another form of insurance coverage. |
| Which of the following must be verified to process a credit card transaction? (3) | 1. Credit Card # 2. Account # 3. Security Code |
| When the patient calls to inquire about an account, which of the following does the insurance and coding specialist need before discussing the account? (3) | 1. Patient's Insurance ID # 2. Patient's Name 3. Patient's DOB |
| The provider is a non-PAR with the patient's insurance and the patient's insurance company states that they will cover 60% of allowed charges. | $50.00 (charge the amount of owe and Payment) |
| A Medicare patient has an 80/20 plan. the charges amount was $300 The amount was $100 Which of the following I a patient's coininsurance? | $20.00 |
| When should a provider have a patient sign an ABN? | When the items may be denied and prior to performing the service |
| The most effective method to manage patient statements and other financial invoices as well as avoid payments delays is to ____? | Collect fees at the time of service |
| When following up on a denied claim, an insurance & coding specialist should have which of the following information available when speaking with the insurance company? (3) | Patient's ID #, Date the claim was denied, Date of service |
| Which of the following financial reports procedures a quarterly review of any dollar amount a patient still owes after all insurance carriers clam payments have been received? | Aging |
| An insurance & coding specialist is reviewing Appendix M in the CPT book. Which of the following tasks is she most likely performing? | Checking for renumbered code |
| A patient has called to schedule an appointment for an office visit to see the doctor tomorrow for an earache. It is discovered during the scheduling that the insurance policy on file has been canceled. Which of the following should we do? | Advise the patient to bring current insurance information to the appointment. |
| Which of the following is an appropriate way to open the discussion when explaining practice fee s to a patient? | Do you have any questions about the cost of today's visit? |
| Which of the following information is necessary to post payments from the RA/EOB (3) | Patient's name, Date of Service, Billed CPT codes |
| When there is professional courtesy awarded to a patient's account the insurance and coding specialist should post the amount under the | Adjustment column |
| Which of the following should a patient sign prior to an insurance claim being processed? | An Authorization to Release Information |
| Which of the following are necessary to complete a CMS-1500 form? (3) | Demographic info, Pysician Info, Diagnosis and CPt codes |
Created by:
juanelizgalvan