QUESTION

docx

School

Bossier Parish Community College *

*We aren’t endorsed by this school

Course

200

Subject

Mechanical Engineering

Date

Oct 30, 2023

Type

docx

Pages

Uploaded by beverlykruise

1 QUESTION ANSWER what form used to post payments? remittance advice the authorization number for a service approved before service was rendered is indicated in which block on cms-1500 claim form? block 23 which block of cms-1500 form if the federal tax ID entered? block 25 which block of cms-1500 form indicates an ICD diagnosis code? block 21 which block of cms-1500 form is additional claim information entered? block 18 what standardized format is used in the electronic filing of claims? HIPPA standard transactions which block of cms-1500 form is used to accept assignment of benefit? block 27 on cms-1500 claim form, blocks 14 - 33 contain what information? patients condition and provider's information

2 The EOB states the amount billed was $80. The amount allowed is $60, and the patient is required to pay a $20 copayment. what insurance check amount should be posted? $40 what should a billing and coding specialist use to submit a claim with supporting documents? claim attachment what Medicare policy determines if a particular item or service is covered by Medicare? National Coverage Determination (NCD) what is an example of a remark code from EOB document? contractual allowance what form should a billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? UB-04 a claim is denied due to termination of coverage (TOC). what action should the billing and coding specialist take next? follow up with the patient to determine the current name, address, and carrier for resubmission

3 what NPI # is required in block 33a of cms-1500 claim form? billing provider what reason a claim would be denied? incorrectly linked codes when is the remittance advice sent from third-party payer to provider; what action should the billing and coding specialist perform first? ensure the proper payment has been made what term is used to describe the location of the stomach, spleen, part of pancreas, part of liver, and part of the small & large intestines? LUQ when coding a front torso burn, what percentage should be coded? 18% which statement is true regarding Medicaid eligibility? patient eligibility is determined monthly which of the following describes a key component of E/M service? history which of the following is a billing and coding

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

4 considered a fraud? specialist unbundles a code to receive higher reimbursement which of the following is an example of Medicare abuse? charging excessive fees what organization fights waste, fraud, and abuse in Medicare and Medicaid? OIG - Office of the Inspector General Medicare part A hospital services Medicare part B provides insurance for outpatient and physician services Medicare part C managed by private, third-party insurance providers approved by Medicare Medicare part D prescription services what part of Medicare insurance program is managed by private, third- party insurance providers approved by Medicare? Medicare part C a patient's employer has not submitted a premium payment. what claim status should the provider receive denied

5 from third-party payer? what block on cms-1500 claim form should a billing and coding specialist complete for procedures, services, or supplies? block 24d what describes an insurance carrier that pays the provider who rendered services to a patient? third-party payer what format is used to submit electronic claims to a third-party payer? 837 what entity defines essential elements of a comprehensive compliance program? OIG what causes a claim to be suspended? services required additional information a Medicare non- participating (non-PAR) provider's approved payment amount is $200 for a lobectomy and deductible has been met. what amount is the limiting charge for this procedure? $230

6 for non-crossover claims, the billing and coding specialist should prepare a copy of what form? primary insurance card a billing and coding specialist can ensure insurance coverage for an outpatient procedure by using what process? precertification when a third-party payer requests copies of patient information related to claim, billing and coding specialist must include what document from patient's file? signed release of information form in the anesthesia section of CPT manual, what is considered a qualifying circumstance? add-on codes what describes the term "crossover" relating to Medicare? when insurance company transfers data to allow (COB) coordination of benefits of a claim A provider performs an examination of patient's knee joint via small incisions and an optical arthroscopy

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

7 device. what term describes this procedure? a billing and coding specialist has 4 past-due charges: $400 - 10 weeks past due; $800 - 6 weeks past due; $1,000 - weeks past due; and $2,000 - 8 weeks past due. what charge should be sent to collections first? $2000 The EOB states the amount billed was $170. The allowed amount is $150. The patient has an unmet deductible of $50 and a copayment of $20. what dollar amount is the patient responsible for? $70 what term refers to difference between billed & allowed amounts? adjustment these <> symbols are used to indicate new and revised text of what description? procedure descriptors what HIPAA compliance guideline affects electronic health records? electronic transmission & code set standards require every provider to use healthcare

8 transactions, code sets, & identifiers what describes a code that would be denied? an italicized code as the primary diagnosis what section of SOAP note indicates a patient's level of pain to a provider? subjective what HMO managed care services requires a referral? DME what explains why Medicare will deny a service / procedure? ABN - advance beneficiary notice which block of cms-1500 form should a billing & coding specialist enter the referring provider's NPI#? block 17b coronal, frontal vertical plane divides body into front & back transverse horizontal plan divides the body into top & bottom sections sagittal vertical plane divides body into right and left sides anterior, ventral front of body

9 posterior, dorsal back of body superior above proximal near or towards the origin, closer distal far / away form origin inferior below lateral side bilateral both sides medial middle of body what action should billing & coding specialist take when submitting a claim to Medicaid for a patient that has primary & secondary insurance coverage? attach remittance advice from primary insurance along w/ Medicaid claim what term is used to communicate why a claim line item was denied or paid differently than billed? claim adjustment codes two surgeon successfully performed closure of a vaginal fistula thru patient's abdomen. for both providers' claims, the billing 57305-62

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

10 & coding specialist should use what cpt codes & modifiers? in 1996, cms implemented which entity to detect inappropriate & improper codes? National Correct Code Initiative (NCCI) what plane divides the body into left & right? sagittal a billing & coding specialist is preparing a claim form for a provider from a group practice. the billing & coding specialist should enter the rendering providers NPI# in which block on cms-1500 form? 24j on a remittance advice form, who is responsible for writing off difference between amount billed and the amount allowed by agreement? the provider what is the purpose o coordination of benefits (COB)? prevent multiple insurers from paying benefits covered by other policies which block of cms-1500 claims form is the report 24d

11 modifiers section? as of April 1, 2014 what is the maximum number of diagnoses that can be reported on CMS-1500 claim form before a further claim is required? 12 what best describes medical ethics? medical standard of conduct A patient has AARP as secondary insurance. what block on cms-1500 claim form should enter information? block 9