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NCCT Study
| Question | Answer |
|---|---|
| Which of the following items are mandatory in patient financial policies? | Expectation of payment due at time of service, collection process, statement that responsibility for payment lies with patient. |
| Which of the following should an insurance and coding specialist do when checking for completion of a 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. |
| When document is changed in an EHR, the original documentation is | Hidden |
| The patient 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 |
| 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 payment od 70.89. These transactions should be recorded in the | Patient ledger |
| A patient has called to schedule an appointment for an office visit to see the doctor tomorrow for and earache. It discovered during the scheduling process that the insurance policy on file has been cancelled. What should be next | Advise the patient to bring current insurance information to the appointment |
| For the HMO policy the claims are often rejected due to the provider not obtaining | Pre-authorizations |
| When is a referral from a provider required? | When contained in the individual policy |
| The Shark Law was enacted to govern the practice of | Physician referrals to facilities that she has a financial interest in |
| Which of the following financial reports produces a quarterly review of any dollar amount a patient still owns after all insurance carriers claim payments have been received? | Aging |
| 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 |
| Which of the following is the correct procedure for keeping a Workers' Compensation patient's financial and health records when the same physician is also seeing the patient as a private patient? | Separate financial and health records must be used |
| If the insurance and coding specialist suspects Medicare fraud she should contact the | OIG |
| Which of the following patient information is needed to determine a Medicaid sliding fee scale? | Poverty level, number od dependents, salary |
| Which of the following information is necessary to post payments from the RA/EOB? | Billed CPT codes, patient's name, date of service |
| HIPAA allows health care provider to communicate with a patient's family, friends, or other persons who are involved in the patient's care regarding their mental health status providing | The patient does not object |
| A Medicare patient has an 80/20 plan. The charged amount was 300.00. The amount allowed was 100.00. Which of the following is the patient's coinsurance? | 20 |
| 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 |
| Which of the following is most likely cause of the deposits not agreeing with the credits on the sheet or the patient ledgers? | Payment is misplaced |
| When following up on a denied claim, an insurance and coding specialist should have which of the following information when speaking with the insurance company? | Date of service, physician NPI, patient's insurance ID number |
| Which of the following fees posted to the patient's account is an example of "usual customary, and reasonable? | Allowed amount |
| A claim submitted with all necessary and accurate information so that it can be processed and paid is called a | Clean claim |
| Applying the birthday rule, minor child comes in. Both parents have remarried and the child is listed on the mother's, father's, and both step-parent's policies. Which of the following is correct | Father's plan is primary, mother's plan secondary |
| 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 charged denied? | Imaging guidance is an inclusive component of 64493 |
| Collections agencies are regulated by the | Fair Debt Collection Practices Act |
| Which of the following federal regulations requires disclosure of finances 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 is the following should be billed first | The husband's insurance |
| A Medicare patient presents to an outpatient hospital facility for a scheduled hysterectomy. To which Medicare plan should the facility submit the claim? | Part B |
| Which of the following protects federal healthcare programs from fraud and abuse by healthcare providers who solicit referrals? | Anti-Kickback Status |
| Collecting statistics on the frequency of copay collection at time of service is a step in the process of | Managing A/R |
| A new HIM director hired at a hospital. She was advised her health insurance benefits become available in 90 days. Which of he following is correct regarding her health insurance | She will be able to keep her current medical insurance from her previous job through COBRA |
| When posting an insurance payment via an EOB, the amount that is considered contractual is the | insurance allowed amount |
| Which of the following Medicare part covers inpatient hospital stays? | Part A |
| 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 |
| Developing an insurance claim begins | When the patient calls to schedule an appointment |
| When filing and electronic insurance claim, the insurance and coding specialist processes which of the following | CMS-1500 |
| When a capitation account is applied to the ledger it is also known as a | monthly prepayment amount |
| Which of the following are violations of the Shark Law? | Accepting gifts in place of payment from patients. referring patients to facilities where the provider has a financial interest |
| When using the EHR to schedule a patient visit, which of the following screens should be used to complete the scheduling process? | Patient search |
Created by:
alth1445