NHA - Certified Billing and Coding Specialist (CBCS) Study Guide

The symbol "O" in the Current Procedural Terminology reference is used to indicate what? - AnsReinstated or recycled code In the anesthesia section of the CPT manual, what are considered qualifying circumstances? - AnsAdd-on codes As of April 1, 2014 what is the maximum number of diagnoses that can be reported on the CMS- 1500 claim form before a further claim is required? - Ans-12 What is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - Ans-Operative report What action should be taken first when reviewing a delinquent claim? - Ans-Verify the age of the account A claim can be denied or rejected for which of the following reasons? - Ans-Block 24D contains the diagnosis code A coroner's autopsy is comprised of what examinations? - Ans-Gross Examination Medigap coverage is offered to Medicare beneficiaries by whom? - Ans-Private third-party payers What part of Medicare covers prescriptions? - Ans-Part C What plane divides the body into left and right? - Ans-SagittalWhere can unlisted codes be found in the CPT manual? - Ans-Guidelines prior to each section Ambulatory surgery centers, home health care, and hospice organizations use which form to submit claims? - Ans-UB-04 Claim Form What color format is acceptable on the CMS-1500 claim form? - Ans-Red Who is responsible to pay the deductible? - Ans-Patient A patient's health plan is referred to as the "payer of last resort." What is the name of that health plan? - Ans-Medicaid Informed Consent - Ans-Providers explain medical or diagnostic procedures, surgical interventions, and the benefits and risks involved, giving patients an opportunity to ask questions before medical intervention is provided. Implied Consent - Ans-A patient presents for treatment, such as extending an arm to allow a venipuncture to be performed. Clearinghouse - Ans-Agency that converts claims into standardized electronic format, looks for errors, and formats them according to HIPAA and insurance standards. Individually Identifiable - Ans-Documents that identify the person or provide enough information so that the person can be identified. De-identified Information - Ans-Information that does not identify an individual because unique and personal characteristics have been removed. Consent - Ans-A patient's permission evidenced by signature. Authorizations - Ans-Permission granted by the patient or the patient's representative to release information for reasons other than treatment, payment, or health care operations.Reimbursement - Ans-Payment for services rendered from a third-party payer. Auditing - Ans-Review of claims for accuracy and completeness.