Download NHA CBCS Exam: Expected Questions and Answers for Medical Billing and Coding and more Exams Andragogy in PDF only on Docsity!
- Billing and coding specialists should first divide the E & M Code by
Ans>> Place of Service
- Compliant with HIPPA the following position should be assigned in each office
Ans>> Privacy Officer
- Coding on theUB-04 Form, mustsequence the diagnosis code.Which is the first listed diagnosis? Ans>> Principal Diagnosis
NHA CBCS EXAM
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- Obstruction of the urethra is Ans>> Urethratresia
- Ambulatory surgery centers, home health center, and hospice use what form?
Ans>> UB04 Forms
- Form that contains of DOS, CPT, ICD codes, fees and copay information is called
Ans>> Encounter forms
- Anesthesia section of CPTmanual which are considered qualifying circum- stances
Ans>> Add on Codes
- Patient presents with chest pain & shortness of breath with abnormal ECG provider call a cardiologist. What portion of the HIPPA allows this Ans>> Title 11
Ans>> Sagittal
- 3rd Party payer validates a claim which takes place next
Ans>> Claim adjudica- tion The term used in the industry to refer to the process of paying claims submitted on denying them after comparing claims to the benefit or coverage requirements)
- Developed to reduced Medicare Program expenditure by detecting in ap- propriate codes & eliminating improper coding Ans>> NCCI ( National Correct Coding Initiative)
- Beneficiary of Medicaid/ Medicare crossover claim is responsible for the percentage Ans>> 0%
- Which of the following steps would be part of a physicians practice com- pliance program
Ans>> Internal monitoring and auditing
- Which of the following acts applies to the administrative simplification guidelines?
Ans>> HIPPA
- Patient charges that have not been paid will appear in which of the follow- ing
Ans>> Accounts recievable
- Which of the following is considered the final determination of the issues involving settlement of an insurance claim
Ans>> adjudication
Ans>> Bone and bone marrow
- Which of the following is a requirement of some third-party payers before a procedure is performed? Ans>> Preauthorization form
- Ensure appropriate insurance coverage for an outpatient procedure by first using the following process
Ans>> Precertification
- Keycomponent if an evaluationand management service
Ans>> History
- Format used to submit electronic claims and 3rd Party payer
Ans>> 837
- Entity that defines the essential element of a comprehensive compliance program
Ans>> Office of the Inspector General (OIG)
- Medicare Policydeterminesif a particularitem orservice is covered
Ans>> Na- tional Coverage Determination
- Location of the stomach, spleen, part of the pancreas and liver
Ans>> Left upper quadrant
- Coding a front torso burn, what % should be used?
Ans>> 18%
- Result of a claim being denied
Ans>> An italicized code used as the 1st listed diagnosis
- ExampleofMedicareabuse
Ans>> Charging excessive fees
- Diagnostic codes in Block 21 of the CMS form
Ans>> Codes must correspond to the diagnosis pointer in block 24E
- Soap note to indicate patient level of pain to provider
Ans>> (S) Subjective
- Standardized format used in electronic filing of claims
Ans>> HIPPA Standard transaction
- Insurance Carrier is a
Ans>> 3rd Party Payer
be performed. Signature is NOT required Ans>> Implied consent
- Agency, that converts claims into standardized electronic format, looks for errors,and formats them according to HIPPA and insurance standards
Ans>> Clear- inghouse
- Information that does not identify and individual because unique and personalcharacteristicshavebeenremoved Ans>> De- identifiable information
- A patients permission evidenced by signature
Ans>> Consent
- Permission granted by the patient or the patients representative to release information for reasons other than treatment, payment, or health care opera- tions Ans>> Authorization
- Payment for services rendered from a 3rd Party Payer
Ans>> Reimbursment
- Review of claimsforaccuracyand completeness
Ans>> Auditing
- Assigning a diagnosis or procedure code at a higher level than the doc-
umentation supports, such as single code that describes all steps of the procedure Ans>> Upcoding
- Using multiple codes that describe different components of a treatment instead of using a single code that describes all steps of the procedure
Ans>> Un- bundling
- Making false statements of representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist Ans>> - Fraud
- Practices that directly or indirectly result in unnecessary cost to the Medicare program Ans>> Abuse
Ans>> Crossover claim
- Missing or invalid patient identification number and lack of authorization or referral number Ans>> Two causes of a claim transmission errors
- Contract in which the provider directly bills the payer and accepts the allowablecharge.
Ans>> Assignment of Benefits
- Claim that is accurate and complete
Ans>> Clean claim
- Claim that inaccurate, incomplete, or contains other errors
Ans>> Dirty claim
- Processes Medicare Parts A & B claims from hospitals, physicians, and other providers
Ans>> Medicare administrative Contractor (MAC)
- The report sent from the third-party payer to the provider that reflects any changes made to the original billing.
Ans>> Remittance Advice (RA)
- Patients name and date of birth
Ans>> 2 Pieces of Information that need to be collected from patients
- Amount you must pay out of pocket before you begin receiving any bene- fits from your insurance company Ans>> Deductible
- Pre established percentage of expensespaid by the insurance company after the deductible has been met
Ans>> Coinsurance
- A fixed dollar amount that must be paid each time a patient visits a provider.
Ans>> Copayment
- Determines which insurance plan is primary and which is secondary
Ans>> Co- ordination of Benefit rules
- Important to make sure that the insurances valid and the services are covered benefits
Ans>> Importance of verifying insurance information
A& B
Ans>> Medigap
- Written recommendation to a specialist
Ans>> Referral
- A review that looks at whether the procedure could be performed safely but less expensively in an outpatient setting.
Ans>> Precertification
- A written request for a verification of benefits.
Ans>> predetermination
- primary care physician
Ans>> Who is the gatekeeper
- Approval for the health plan for an inpatient hospital stay or surgery
Ans>> Preau- thorization
- Providers and facilities in a PPO network
Ans>> Tier 1
- Providers and facilities within the broader, contracted network
Ans>> Tier 2
- Providers and facilities out of the network
poisoning, and other adverse events Ans>> V Codes
- classify external causes of environmental events, circumstances, or con- ditions that caused injury, condition, or poisoning (i.e. how an accident hap- pened, if drug overdose was accidental or intentional)
Ans>> E Codes
- Primarily cover physicians services but are used for hospital outpatient. Modifiers are used
Ans>> CPT Category 1 Codes
- Designed to serve as supplemental tracking codes that can be used for performance measurement. Modifiers are used Ans>> CPT Category II Codes
- Temporary coding for new technology and services that have not met the requirementsneeded Ans>> CPT Category III
- National Codes,Uses modifiers
Ans>> HCPS Level II
- Temporary Codes
Ans>> HCPS Level 3 Codes
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