letty reyes
Test por , creado hace más de 1 año

LETTY PRACTICE EXAM

5
0
0
letty reyes
Creado por letty reyes hace más de 6 años
Cerrar

LETTY PRACTICE EXAM

Pregunta 1 de 33

1

Which of the following reports is used to follow up on outstanding claims to third party payers?

Selecciona una de las siguientes respuestas posibles:

  • financial

  • aging

  • accounts payable

  • audit

Explicación

Pregunta 2 de 33

1

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?

Selecciona una de las siguientes respuestas posibles:

  • there are duplicate cards

  • the bank made an error

  • cash is missing

  • payment is misplaced

Explicación

Pregunta 3 de 33

1

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).

Selecciona una o más de las siguientes respuestas posibles:

  • physician’s NPI

  • date of service

  • date the claim was denied

  • patient’s mailing address

  • patient’s insurance ID number

Explicación

Pregunta 4 de 33

1

A third party payer made an error while adjudicating a claim. Which of the following should the insurance and coding specialist do?

Selecciona una de las siguientes respuestas posibles:

  • Resubmit the claim with a correction.

  • Resubmit the claim with an attachment explaining the error.

  • Contact the patient to make payment arrangements.

  • Contact the insurance commissioner.

Explicación

Pregunta 5 de 33

1

Which of the following information is necessary to post payments from the RA/EOB? (Select the three (3) correct answers.)

Selecciona una o más de las siguientes respuestas posibles:

  • diagnosis codes

  • date of service

  • patient’s name

  • patient’s date of birth

  • billed CPT® codes

Explicación

Pregunta 6 de 33

1

Which of the following processes makes a final determination for payment in an appeal board?

Selecciona una de las siguientes respuestas posibles:

  • arbitration

  • deposition

  • peer to peer

  • special handling

Explicación

Pregunta 7 de 33

1

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?

Selecciona una de las siguientes respuestas posibles:

  • $100

  • $80

  • $20

  • $60

Explicación

Pregunta 8 de 33

1

How often should the encounter form CPT® codes be updated?

Selecciona una de las siguientes respuestas posibles:

  • monthly

  • semi-annually

  • quarterly

  • annually

Explicación

Pregunta 9 de 33

1

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

Selecciona una de las siguientes respuestas posibles:

  • schedule an appointment using just his insurance benefits.

  • schedule an appointment using both his insurance benefits and his wife’s insurance benefits.

  • his wife’s primary care provider and schedule an appointment to visit with both.

  • his wife’s primary care provider to see which has the earliest appointment available.

Explicación

Pregunta 10 de 33

1

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?

Selecciona una de las siguientes respuestas posibles:

  • Medigap

  • the husband’s insurance

  • Medicare

  • Medicaid

Explicación

Pregunta 11 de 33

1

Encounter forms should be audited to ensure the

Selecciona una de las siguientes respuestas posibles:

  • practice information is included on each encounter.

  • diagnosis is in proper ICD-10-CM format.

  • patient’s vitals are present.

  • payer’s address and phone are current.

Explicación

Pregunta 12 de 33

1

Which of the following regulations prohibits the submission of a fraudulent claim or making a false statement or representation in connection with a claim?

Selecciona una de las siguientes respuestas posibles:

  • Federal Claims Collection Act

  • Federal False Claims Act

  • Anti-Kickback Law

  • Stark Law

Explicación

Pregunta 13 de 33

1

Which of the following is an appropriate way to open the discussion when explaining practice fees to a patient?

Selecciona una de las siguientes respuestas posibles:

  • “We will bill you for the visit in full.”

  • “We can accept your insurance as payment in full.”

  • “Do you know what your out of pocket cost is today?”

  • “Do you have any questions about the cost of today’s visit?”

Explicación

Pregunta 14 de 33

1

When using the EHR to schedule a patient visit, which of the following screens should be used to complete the scheduling process?

Selecciona una de las siguientes respuestas posibles:

  • accounts receivable

  • correspondence

  • clinical care

  • patient search

Explicación

Pregunta 15 de 33

1

When posting an insurance payment via an EOB, the amount that is considered contractual is the

Selecciona una de las siguientes respuestas posibles:

  • patient responsibility.

  • co-insurance.

  • NON-PAR payment allowable.

  • insurance allowed amount.

Explicación

Pregunta 16 de 33

1

Which of the following items are mandatory in patient financial policies? (Select the three (3) correct answers.)

Selecciona una o más de las siguientes respuestas posibles:

  • participating insurance companies

  • statement that responsibility for payment lies with patient

  • provider fee schedule

  • collection process

  • expectation of payment due at time of service

Explicación

Pregunta 17 de 33

1

When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim?

Selecciona una de las siguientes respuestas posibles:

  • insurance plan’s UCR fee

  • insurance plan’s allowable fee

  • physician’s contractual fee

  • physician’s office fee

Explicación

Pregunta 18 de 33

1

A claim submitted with all the necessary and accurate information so that it can be processed and paid is called a

Selecciona una de las siguientes respuestas posibles:

  • allowable claim.

  • clean claim.

  • closed claim.

  • timely filing.

Explicación

Pregunta 19 de 33

1

Which of the following defines the maximum time that a debt can be collected from the time it was incurred or became due?

Selecciona una de las siguientes respuestas posibles:

  • practice management payment policy

  • statute of limitations

  • Stark Law

  • benchmark

Explicación

Pregunta 20 de 33

1

When is a referral from a provider required?

Selecciona una de las siguientes respuestas posibles:

  • when contained in the individual policy

  • if a patient goes to a network hospital for services

  • for Workers’ Compensation patients

  • within 24 hours of a medical procedure

Explicación

Pregunta 21 de 33

1

Which of the following must a patient sign prior to an insurance claim being processed?

Selecciona una de las siguientes respuestas posibles:

  • a referral form

  • the HIPAA waiver form

  • an Authorization to Release Information

  • the actual insurance claim form

Explicación

Pregunta 22 de 33

1

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?

Selecciona una de las siguientes respuestas posibles:

  • Separate financial and health records must be used.

  • The same financial and health records may be used.

  • The same health record may be used, but a separate financial record must be maintained.

  • The same financial record may be used, but a separate health record must be maintained.

Explicación

Pregunta 23 de 33

1

If the insurance and coding specialist suspects Medicare fraud she should contact the

Selecciona una de las siguientes respuestas posibles:

  • DOJ

  • OIG

  • FDA

  • AMA

Explicación

Pregunta 24 de 33

1

Which of the following are violations of the Stark Law? (Select the two (2) correct answers.)
upcoding

Selecciona una o más de las siguientes respuestas posibles:

  • billing for services not rendered

  • referring patients to facilities where the provider has a financial interest

  • negligent handling of protected health information (PHI)

  • accepting gifts in place of payment from patients

Explicación

Pregunta 25 de 33

1

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?

Selecciona una de las siguientes respuestas posibles:

  • Record the information and refer the patient to another provider.

  • Discuss self-pay options with the insurance policy holder.

  • Ask the patient for another form of insurance coverage.

  • Ask the patient to reschedule the appointment.

Explicación

Pregunta 26 de 33

1

In order to have claims paid as quickly as possible, the insurance specialist must be familiar with which of the following?

Selecciona una de las siguientes respuestas posibles:

  • payer's claim processing procedures

  • prompt pay laws

  • clearinghouse processing procedures

  • automated claims status requests

Explicación

Pregunta 27 de 33

1

Developing an insurance claim begins

Selecciona una de las siguientes respuestas posibles:

  • once the charges have been entered into the computer.

  • when the patient calls to schedule an appointment.

  • after the medical encounter is completed.

  • when the patient arrives for the appointment.

Explicación

Pregunta 28 de 33

1

Which of the following protects federal healthcare programs from fraud and abuse by healthcare providers who solicit referrals?

Selecciona una de las siguientes respuestas posibles:

  • Fraud and Abuse Act

  • Anti-Kickback Statute

  • Utilization Review Act

  • Federal Claims Collection Act

Explicación

Pregunta 29 de 33

1

A Medicare patient presents to an outpatient hospital facility for a scheduled hysterectomy. To which Medicare plan should the facility submit the claim?

Selecciona una de las siguientes respuestas posibles:

  • PART A

  • PART B

  • PART C

  • PART D

Explicación

Pregunta 30 de 33

1

If the insurance carrier’s rate of benefits is 80%, the remaining 20% is known as

Selecciona una de las siguientes respuestas posibles:

  • CAPITATION

  • COPAYMENT

  • DEDUCTIBLE

  • COINSURANCE

Explicación

Pregunta 31 de 33

1

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?

Selecciona una de las siguientes respuestas posibles:

  • the policy with the highest coverage

  • husband’s policy

  • both policies

  • her policy

Explicación

Pregunta 32 de 33

1

When filing an electronic insurance claim, the insurance and coding specialist processes which of the following forms?

Selecciona una de las siguientes respuestas posibles:

  • CMS-1500

  • assignment of benefits

  • encounter form

  • HIPAA waiver

Explicación

Pregunta 33 de 33

1

When a capitation account is applied to the ledger it is also known as a

Selecciona una de las siguientes respuestas posibles:

  • fee for service.

  • copayment amount.

  • monthly prepayment amount.

  • monthly premium.

Explicación

Anterior
Revisar respuesta
Siguiente