Medical coding lesson 3 h07v
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School
Ashworth College *
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Course
H07V
Subject
Health Science
Date
Dec 6, 2023
Type
docx
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8
Uploaded by janet0812
Medical coding lesson 3 h07v n 1
5 / 5 points
Documenting the appropriate medical information in the patient's health record is the responsibility of the
Question options:
a) healthcare provider.
b) patient's parents or legal guardian.
c) patient (if of legal age).
d) insurance company.
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To review this content, see Chapter 7 of your textbook.
n 2
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A company that helps coordinate claims to be sent to the insurance provider is a
Question options:
a) vendor.
b) clearinghouse.
c) claims scrubber.
d) benefits administrator.
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n 3
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What's the paper claim form approved by the AMA Council on Medical Services, which was subsequently
adopted by all government healthcare programs?
Question options:
a) Version 5010
b) CMS-1500
c) AMA-1040
d) UB-04
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n 4
0 / 5 points
What size practice is exempt from electronic billing?
Question options:
a) Five providers or less
b) 15 full-time employees or less
c) 10 providers or less
d) 25 full-time employees or less
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To review this content, see Chapter 6 of your textbook.
n 5
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One category that may be exempt from mandatory electronic claim submission is a/an
Question options:
a) oral surgeon.
b) veterinarian.
c) small provider.
d) chiropractor.
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n 6
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The driving factor for healthcare reimbursement is the appropriateness of the services delivered to the patient given their diagnosis, which is termed
Question options:
a) medical necessity.
b) local carrier determination.
c) data-driven decision-making.
d) value-based care.
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n 7
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The process where the insurance company determines the payment and validity of a claim is called
Question options:
a) processing.
b) assentation.
c) adjudication.
d) arbitration.
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n 8
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Generally, if a claim is reduced or rejected, the problem lies with the
Question options:
a) provider's office.
b) insurance company.
c) patient.
d) fiscal intermediary.
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n 9
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A nine-digit number required by businesses to serve as their taxpayer identifying number is the
Question options:
a) National Provider Identifier (NPI).
b) Employer Identification Number (EIN).
c) Medical Practice Group Number (MGP).
d) Social Security Number (SSN).
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n 10
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For an insurance company to pay the provider and not the patient, the patient must sign a/an
Question options:
a) assignment of benefits.
b) consent to treat.
c) release of information.
d) Notice of Privacy Practices.
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n 11
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A claim that has been denied for timely filing means that a clean claim hasn't been submitted for how many days?
Question options:
a) 365
b) 90
c) 210
d) 180
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n 12
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A significant piece of legislation that Congress passed in 1996 that impacted healthcare and medical billing was the
Question options:
a) HIPAA.
b) OCR.
c) HCFA.
d) COBRA.
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n 13
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What denial reason will you receive if you resubmit a corrected claim without information in box 22 of the CMS-1500?
Question options:
a) Deductible
b) Rejected
c) Duplicate
d) Clean
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n 14
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The statement issued by the insurance company that details how a claim is paid to the provider is called a/an
Question options:
a) explanation of benefits.
b) electronic remittance advice.
c) statement of coverage.
d) benefit and claim advice.
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n 15
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An automated machine that can respond to prompts about claim status and insurance information is called a/an _______ system.
Question options:
a) interactive voice response
b) robotic answering
c) artificial intelligence
d) tele-insurance
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n 16
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What must be included on any form that requires a patient's Social Security number?
Question options:
a) Disclosure statement
b) Copy of patient's photo ID
c) 16-bit encryption
d) Security mask
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n 17
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A physician submits a claim for three different procedures, and all but the first one are denied. What could a coder advise to get all procedures paid?
Question options:
a) Increasing the cost of the first procedure
b) Adding a modifier to indicate separate procedures
c) Finding a code that has most of the procedures in a combination code
d) Following NCCI edits
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n 18
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ASCA has identified that providers with 25 or fewer full-time employees (FTEs) and physicians, practitioners, and suppliers with 10 or fewer FTEs should be referred to as
Question options:
a) qualifying entities.
b) roster billers.
c) ASCA units.
d) small providers.
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n 19
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How often should patients fill out a patient information form?
Question options:
a) Once a year
b) Whenever the patient's contact information changes
c) Every six months
d) Every time the patient comes in
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n 20
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What's the first key to successful claims processing?
Question options:
a) Proofreading to avoid errors
b) Obtaining necessary preauthorization
c) Following payer guidelines
d) Collecting and verifying patient information