NHA CBCS Study Guide 2023/2024 Graded A+

When submitting claims, which of the following is the outcome if Block 13 is left blank? - ANSWER-The third-party payer reimburses the patient, and the patient is responsible for reimbursing the provider Which of the following do physicians use to electronically submit claims? - ANSWER-clearinghouse When billing a secondary insurance company, which block should the billing and coding specialist fill out on the CMS-1500 claim form? - ANSWER-Block 9a A physician is contracted with an insurance company to accept the allowed amount. The insurance company $80 of a $120 billed amount, and $50 of the deductible has not been met. How much should the physician write off the patient's account? - ANSWER-$40 Which of the following is a requirement of some third-party payers before a procedure is performed? - ANSWER-Preauthorization A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which of the following documents? - ANSWER-a billing worksheet from the patient account Which of the following documents is required to disclose an adult patient's information? - ANSWER-a signed release from the patient After reading a provider's notes about a new patient, a coding specialist decides to code for a longer length of time than the actual office visit. Which of the following describes the specialist's action? - ANSWER-fraud Two providers from the same practice visit a patient in the emergency department using the same CPT code. The claim may be denied due to which of the following reasons? - ANSWER-duplication of services Which of the following security features is required during transmission of protected health information and medical claims to third-party payers? - ANSWER-encryption Which of the following billing patterns is a best-practice action? - ANSWER-documenting the patient's chief complaint, history, exam, assessment and plan for care A provider receives a reimbursement from a third-party payer accompanied by which of the following documents? - ANSWER-explanation of benefits