NCCT
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| The patient 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
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| When a capitation account is applied to the ledger it is also know as a | monthly payment amount
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| Which of the following is the correct procedure for keeping a Worker's Compensation patient's financial and health records when the same physician is also seeing the patient as a private patient? | separate financial health records must be used
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| When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim | physician's office fee
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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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| 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
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| 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 a payment of $70.89. These transactions should be recorded in the | patient ledger
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| 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
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| When is a referral from a provider required? | when contained in the individual policy
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| The provider is paid the same rate per patient whether or not they provide services and no matter which services were provided. This payment is known as | capitation
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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's date of birth, patient's name, patient's insurance ID number
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| When a document is changed in an EHR, the original document is | hidden
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| When filling out an electronic insurance claim, the insurance and coding specialist processes which of the following forms | CMS-1500
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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 protects federal healthcare programs from fraud and abuse by healthcare providers who solicit referrals? | anti-kickback statute
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| which of the following should an insurance and coding specialist do when checking for completion of 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
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| Claims are often rejected because a provider needs to obtain | pre-authorizations
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| when following up on a denied claim, an insurance and coding specialist would have which of the following information available when speaking with the insurance company | date of service, physician's NPI, patient's insurance ID number
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| 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 of the following should be billed first | the husbands insurance
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| which of the following Medicare parts covers inpatient hospital stays | part A
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