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CBCS MOD #2
Insurance Eligibility and Other Payer Requirements
| Question | Answer |
|---|---|
| A patient who has Medicare coverage requests a pain medication refill following hip replacement surgery. For which of the following parts of Medicare should the patient's eligibility be verified for the prescription? | Part D |
| A patient fell and was injured while picking up a catering order during their break for an all-employee staff meeting. Which of the following third-party payers is responsible for this encounter? | Workers' compensation |
| A billing and coding specialist is speaking with a patient on the phone regarding the fixed amount due for an upcoming visit. Which of the following terms refers to a fixed payment due per visit? | Copayment |
| A patient is scheduled for a procedure with an allowed amount of $2,500, and the annual deductible of $700 has been met. The coinsurance agreement is 70/30. Which of the following is the patient's responsibility? | $750 |
| A minor patient covered under both parents' group insurance plans, who are married ; also has Medicaid benefits. Parent A has a birthdate of June 6, 1988 and parent B has a birthdate of October 23, 1987. Which of the following third-party payers should | Parent A's insurance |
| A billing and coding specialist is reviewing insurance eligibility for a 49-year-old patient who has end-stage renal disease and multiple third-party payers. The specialist should recognize that which of the following payers is the primary? | Medicare |
| A billing and coding specialist is calculating a patient’s financial responsibility for a procedure. The charge for the procedure is $1,400 and the provider is in the patient's insurance provider's network. The allowable amount for the procedure is $50 | $100 |
| A billing and coding specialist is reviewing a patient's record. The specialist should recognize that which of the following should be signed by the patient if there is a concern that Medicare might not pay for the service? | Advanced Beneficiary Notice (ABN) |
| A billing and coding specialist is reviewing a patient's insurance coverage and notices that the patient is covered by two group insurance plans: one through their own employer and one through their partner's employer. The specialist should recognize | Primary coverage is provided through the patient's plan. |
| A billing and coding specialist is submitting a claim for a patient who experienced an injury from a fall during their lunch break away from the building. The specialist should recognize that which of the following is the correct primary payer for the | The patient's group health insurance |
| Which of the following parts of Medicare determines eligibility for dental services? | Part C |
| Which of the following determines the primary payer when a patient is covered by more than one plan? | Coordination of benefits |
| A billing and coding specialist is preparing a claim for a 16-year-old patient. Which of the following should be contacted to verify the child's demographics? | Policyholder |
| A billing and coding specialist is preparing the registration for a patient who is covered under their spouse’s insurance. Which of the following items is required to complete the registration? | Patient demographics |
| A patient completes their provider’s office registration forms and provides a military ID with a TRICARE card. The billing and coding specialist should use which of the following to verify the patient's third-party payer eligibility? | The Defense Enrollment Reporting System (DEERS) |
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