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NHA: Module 2
Medical Billing and Coding
| Question | Answer |
|---|---|
| A b/c 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 claim? | The patient's group health insurance |
| A b/c 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 b/c 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 b/c 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 minor patient, whose parents are married, is covered under both parents' group insurance plans and 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 parent will be billed? | Parent A's insurance |
| A b/c 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 fell and was injured while picking up a catering order during their break for an all-employment staff meeting. Which of the following third-party payers is responsible for this encounter? | Workers' compensation |
| A billing specialist calculates a patient’s responsibility for a $1,400 procedure. The provider is in-network, and the allowable amount is $500 with no deductible. If the plan pays 80/20, what is the patient’s coinsurance amount?? | $100 |
| Which of the following determines the primary payer when patient is covered by more than one plan? | Coordination of benefits |
| Which of the following parts of Medicare determines eligibility for dental services? | Part C |
| A b/c 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 patient who has Medicare coverage requests a plan 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 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? | $700 |
| A billing/coding specialist reviews a patient with two group insurance plans—one through their employer and one through their partner’s. Which plan should be considered the patient’s primary insurance coverage? | Primary coverage is provided through the patient's plan |
| 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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Tagcal