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ncct practice test
ncct
| Question | Answer |
|---|---|
| when is a referral from a provider required | when contained in the individual policy |
| which of the following must be verified to process a credit card transaction? | account number, credit card number, security code |
| which of the following medicare parts covers inpatient hospital stays? | part A |
| which of the following defines the maximum time that a debt can be collected from the time it was incurred or became due? | statue of limitations |
| the insurance and coding specialist is billing the insurance company of a 66 year old woman who has medicare an is covered under her husbands private insurance. which of the following should be billed first | the husbands insurance |
| the pts is sent a statement for an office visit. the total amount of the bill is $100.00 and this amount must be paid before the insurance company will pay on the claim. which of the following is this called? | deductible |
| when posting an insurance payment via an EOB, the amount that is considered contractual is the | insurance allowed amount |
| which of the following information is necessary to post payments from the RA/EOB? | billed CPT codes, patients name, date of service |
| when the pts calls to inquire about an account, which of the following does the insurance and coding specialist need to ask before discussing the account? | pts date of birth, pts name, pts insurance ID number |
| which of the following protects federal healthcare programs from fraud and abuse by healthcare providers who solicit referrals? | anti-kickback statute |
| if the insurance carriers rate of benefits is 80%, the remaining 20% is known as | coinsurance |
| which of the following fees posted to the pts account is and example of "usual customary, and reasonable?" | allowed amount |
| 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 company? | date of service, physician's NPI, pts insurance ID number |
| which of the following are violations of the stark law? | accepting gifts in place of payment from pts, referring pts to facilities where the provider has a financial interest |
| when the pts has signed the assignment of benefits form, the payment for services should be sent to the provider unless the provider is | out of network |
| the stark law was enacted to govern the practice of | physician referrals to facilities that she has a financial interest in |
| which of the following pt information is needed to determine a Medicaid sliding fee scale? | poverty level, number of dependents, salary |
| HIPAA allows a health care provider to communicate with a pts family, friends, or other persons who are involved in the pts care regarding their mental health status providing | the patient does not object |
| which of the following items are mandatory in pts financial policies? | expectation of payment due at the time of service, collection process, statement that responsibility for payment lies with patient |
| how often should encounter form CPT codes be updated | annually |
| which of the following are necessary to complete a CMS 1500 form? | diagnosis and CPT codes, physicians information, demographic information |
| The pts 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 |
| a provider performed a right sided facet joint injection using fluoroscopic guidance, the billed codes were 64493 and 77003. an EOB was returned denying the charge of 77003. why was this charge denied? | imaging guidance is an inclusive component of 64493 |
| 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 |
| the fair debt collection practices act restricts debt collectors form engaging in conduct that includes | calling before 8:00 am or after 9:00 pm unless permission is given |
| which of the following should an insurance and coding specialist do when checking for completion of a new pts registration form? | check that demographics are completed, make sure that the pts name matches insurance card, make sure that the registration form is signed and dated |
| 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 |
| when filing an electronic insurance claim, the insurance and coding specialist processes which of the following forms? | cms 1500 |
| the pts total charges are $300. the allowed amount is $150. benefits pay at 60% which of the following will the patient have to pay? | $60 |
| an insurance and coding specialist is reviewing appendix M in the CPT book. which of the following tasks is she most likely performing? | checking for renumbered codes |
| 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 |
| 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 |
| When a capitation account is applied to the ledger it is also known as a | monthly prepayment amount. |
| The most effective method to manage patient statements and other financial invoices as well as avoid payment delays is to | collect fees at the time of service. |
| Which of the following MCOs always requires an authorization before seeing a specialist? | HMO |
| Which of the following reports is used to follow up on outstanding claims to third party payers? | aging |
| The insurance and coding specialist calls a carrier to verify a patient’s insurance and the representative states that the patient’s insurance was canceled three months ago. Which of the following should the insurance and coding specialist do first? | Ask the patient for another form of insurance coverage. |
| For an HMO policy the claims are often rejected due to the provider not obtaining | pre-authorizations. |
| When should a provider have a patient sign an ABN? | when the items may be denied and prior to performing the service. |
| An established patient is being seen by the physician today. The patient owes $25.00 for the visit. The amount collected for the office visit is called the | copayment. |
| When a document is changed in an EHR, the original documentation is | hidden. |
Created by:
Trosel