MUST PASS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Which of the following information is necessary to post payments from the RA/EOB? | billing CPT codes, patient's name, date of service
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| When is a referral from a provider required? | when contained in the individual policy
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| When a document is changed in an EHR, the original documentation is? | hidden
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| Which of the following Medicare parts covers inpatient hospital stays? | part A
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| In order to have claims paid as quickly as possible, the insurance specialist must be familiar with which of the following? | payer's claim processing procedures
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| A Medicare patient has an 80/20 plan. The charged amount was $300. The amount allowed was $100. Which of the following is the patients coinsurance. | $20
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| Which of the following is the most likely cause of the deposits not agreeing with the credits on the day sheet or the patient ledgers? | payment is misplaced
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| Which of the following are necessary to complete a CMS 1500 form? | diagnosis and CPT codes, physician information, demographic information
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| When a capitation account is applied to the ledger it is also known as a ? | monthly prepayment amount
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| A physician performed a bilateral L4/L5 Laminectomy on a patient in an ambulatory surgical center. Which of the following place of service codes should be used on the CMS 1500? | 24
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| When should a provider have a patient sign a ABN? | when the items may be denied and prior to performing the service
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| If the insurance and coding specialist suspects Medicare fraud she should contact the? | OIG
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| Which of the following must be verified to process a credit card transaction? | account number, credit card number, security code
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| Which of the following process makes final determination for payment in an appeal board? | arbitration
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| Which of the following are violations of the Stark Law? | accepting gifts in place of payment from patients, referring patients to facilities where the provider has a financial interest
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| 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 date of birth, patients name, patients insurance ID number
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| Collecting statistics on the frequency of copay collection at time of service is a step in the process of? | managing A/R
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| Which of the following patient information is needed to determine a Medicaid sliding fee scale? | poverty level, number of dependents, salary
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| Which of the following should an insurance and coding specialist do when checking for completion of a new patients registration form? | check that demographics are complete., Make sure that the patients name matches the insurance card., Make sure that the registration form is signed and dated.
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| 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 compamy | date of service, physicians NPI, patients insurance ID number
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| The insurance and coding specialist is billing the insurance company of a 66-year-old- man who has Medicare and is covered under her husband's private insurance. Which of the following should be billed first? | the husband insurance
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| When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim? | physicians office fee
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| Which of the following protects federal healthcare programs from fraud and abuse by healthcare providers who solicit referrals? | Anti-Kickback Statute
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| When posting an insurance payment via an EOB, the amount that is considered contractual is the? | insurance allowed amount
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| If a married couple is covered under both spouses' health insurance and the husband wishes to schedule and appointment for an annual exam, he should call his primary care provider and? | schedule an appointment using both his insurance benefits and his wife's insurance benefits
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| Which of the following reports is used to follow up on outstanding claims to third party payers? | aging
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| A patient had surgery two weeks ago to repair a dislocated ankle, and returns today to have a flexor tendon in the hand repaired. Which of the following modifiers should be reported for todays service? | -79
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