12993921
Descripción
Test por letty reyes, actualizado hace más de 1 año
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Creado por letty reyes
hace más de 6 años
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Pregunta 1
Pregunta
Which of the following reports is used to follow up on outstanding claims to third party payers?
Respuesta
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financial
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aging
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accounts payable
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audit
Pregunta 2
Pregunta
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?
Respuesta
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there are duplicate cards
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the bank made an error
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cash is missing
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payment is misplaced
Pregunta 3
Pregunta
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 company? (Select the three (3) correct answers).
Respuesta
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physician’s NPI
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date of service
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date the claim was denied
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patient’s mailing address
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patient’s insurance ID number
Pregunta 4
Pregunta
A third party payer made an error while adjudicating a claim. Which of the following should the insurance and coding specialist do?
Respuesta
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Resubmit the claim with a correction.
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Resubmit the claim with an attachment explaining the error.
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Contact the patient to make payment arrangements.
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Contact the insurance commissioner.
Pregunta 5
Pregunta
Which of the following information is necessary to post payments from the RA/EOB? (Select the three (3) correct answers.)
Respuesta
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diagnosis codes
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date of service
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patient’s name
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patient’s date of birth
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billed CPT® codes
Pregunta 6
Pregunta
Which of the following processes makes a final determination for payment in an appeal board?
Respuesta
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arbitration
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deposition
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peer to peer
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special handling
Pregunta 7
Pregunta
A Medicare patient has an 80/20 plan. The charged amount was $300.00. The amount allowed was $100.00. Which of the following is the patient's coinsurance?
Respuesta
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$100
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$80
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$20
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$60
Pregunta 8
Pregunta
How often should the encounter form CPT® codes be updated?
Respuesta
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monthly
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semi-annually
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quarterly
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annually
Pregunta 9
Pregunta
If a married couple is covered under both spouses’ health insurance and the husband wishes to schedule an appointment for an annual exam, he should call his primary care provider and
Respuesta
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schedule an appointment using just his insurance benefits.
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schedule an appointment using both his insurance benefits and his wife’s insurance benefits.
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his wife’s primary care provider and schedule an appointment to visit with both.
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his wife’s primary care provider to see which has the earliest appointment available.
Pregunta 10
Pregunta
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?
Respuesta
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Medigap
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the husband’s insurance
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Medicare
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Medicaid
Pregunta 11
Pregunta
Encounter forms should be audited to ensure the
Respuesta
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practice information is included on each encounter.
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diagnosis is in proper ICD-10-CM format.
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patient’s vitals are present.
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payer’s address and phone are current.
Pregunta 12
Pregunta
Which of the following regulations prohibits the submission of a fraudulent claim or making a false statement or representation in connection with a claim?
Respuesta
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Federal Claims Collection Act
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Federal False Claims Act
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Anti-Kickback Law
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Stark Law
Pregunta 13
Pregunta
Which of the following is an appropriate way to open the discussion when explaining practice fees to a patient?
Respuesta
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“We will bill you for the visit in full.”
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“We can accept your insurance as payment in full.”
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“Do you know what your out of pocket cost is today?”
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“Do you have any questions about the cost of today’s visit?”
Pregunta 14
Pregunta
When using the EHR to schedule a patient visit, which of the following screens should be used to complete the scheduling process?
Respuesta
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accounts receivable
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correspondence
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clinical care
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patient search
Pregunta 15
Pregunta
When posting an insurance payment via an EOB, the amount that is considered contractual is the
Respuesta
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patient responsibility.
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co-insurance.
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NON-PAR payment allowable.
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insurance allowed amount.
Pregunta 16
Pregunta
Which of the following items are mandatory in patient financial policies? (Select the three (3) correct answers.)
Respuesta
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participating insurance companies
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statement that responsibility for payment lies with patient
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provider fee schedule
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collection process
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expectation of payment due at time of service
Pregunta 17
Pregunta
When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim?
Respuesta
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insurance plan’s UCR fee
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insurance plan’s allowable fee
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physician’s contractual fee
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physician’s office fee
Pregunta 18
Pregunta
A claim submitted with all the necessary and accurate information so that it can be processed and paid is called a
Respuesta
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allowable claim.
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clean claim.
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closed claim.
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timely filing.
Pregunta 19
Pregunta
Which of the following defines the maximum time that a debt can be collected from the time it was incurred or became due?
Respuesta
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practice management payment policy
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statute of limitations
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Stark Law
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benchmark
Pregunta 20
Pregunta
When is a referral from a provider required?
Respuesta
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when contained in the individual policy
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if a patient goes to a network hospital for services
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for Workers’ Compensation patients
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within 24 hours of a medical procedure
Pregunta 21
Pregunta
Which of the following must a patient sign prior to an insurance claim being processed?
Respuesta
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a referral form
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the HIPAA waiver form
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an Authorization to Release Information
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the actual insurance claim form
Pregunta 22
Pregunta
Which of the following is the correct procedure for keeping a Workers' Compensation patient’s financial and health records when the same physician is also seeing the patient as a private patient?
Respuesta
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Separate financial and health records must be used.
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The same financial and health records may be used.
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The same health record may be used, but a separate financial record must be maintained.
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The same financial record may be used, but a separate health record must be maintained.
Pregunta 23
Pregunta
If the insurance and coding specialist suspects Medicare fraud she should contact the
Respuesta
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DOJ
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OIG
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FDA
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AMA
Pregunta 24
Pregunta
Which of the following are violations of the Stark Law? (Select the two (2) correct answers.)
upcoding
Respuesta
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billing for services not rendered
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referring patients to facilities where the provider has a financial interest
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negligent handling of protected health information (PHI)
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accepting gifts in place of payment from patients
Pregunta 25
Pregunta
The insurance and coding specialist calls a carrier to verify a patient’s insurance and the representative states that the patient’s insurance was canceled three months ago. Which of the following should the insurance and coding specialist do first?
Respuesta
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Record the information and refer the patient to another provider.
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Discuss self-pay options with the insurance policy holder.
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Ask the patient for another form of insurance coverage.
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Ask the patient to reschedule the appointment.
Pregunta 26
Pregunta
In order to have claims paid as quickly as possible, the insurance specialist must be familiar with which of the following?
Respuesta
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payer's claim processing procedures
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prompt pay laws
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clearinghouse processing procedures
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automated claims status requests
Pregunta 27
Pregunta
Developing an insurance claim begins
Respuesta
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once the charges have been entered into the computer.
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when the patient calls to schedule an appointment.
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after the medical encounter is completed.
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when the patient arrives for the appointment.
Pregunta 28
Pregunta
Which of the following protects federal healthcare programs from fraud and abuse by healthcare providers who solicit referrals?
Respuesta
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Fraud and Abuse Act
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Anti-Kickback Statute
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Utilization Review Act
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Federal Claims Collection Act
Pregunta 29
Pregunta
A Medicare patient presents to an outpatient hospital facility for a scheduled hysterectomy. To which Medicare plan should the facility submit the claim?
Respuesta
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PART A
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PART B
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PART C
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PART D
Pregunta 30
Pregunta
If the insurance carrier’s rate of benefits is 80%, the remaining 20% is known as
Respuesta
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CAPITATION
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COPAYMENT
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DEDUCTIBLE
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COINSURANCE
Pregunta 31
Pregunta
A patient has two health insurance policies – a group insurance plan through her full-time employer and another group insurance plan through her husband’s employer. Which of the following policies should be billed as primary?
Respuesta
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the policy with the highest coverage
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husband’s policy
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both policies
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her policy
Pregunta 32
Pregunta
When filing an electronic insurance claim, the insurance and coding specialist processes which of the following forms?
Respuesta
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CMS-1500
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assignment of benefits
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encounter form
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HIPAA waiver
Pregunta 33
Pregunta
When a capitation account is applied to the ledger it is also known as a
Respuesta
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fee for service.
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copayment amount.
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monthly prepayment amount.
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monthly premium.
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