NCCT: Interactive Review: Medical Insurance Exam Questions and Answers

NCCT: Interactive Review: Medical Insurance Exam Questions and Answers Eligibility for Medicaid may change as quickly as - Answer-monthly. Which of the following processes requires checking and confirming that the patient is a member of the insurance plan and that the member identification number is correct? - Answer-verification The patient is a 3-year-old. Both parents have private insurance coverage on the patient, and the mother has a Healthcare Savings Account. The primary insurance belongs to the parent - Answer-with the earlier birthday in the year. A child was seen by her pediatrician. The child is covered under both her father's and mother's insurance. According to the "Birthday Rule," the mother's insurance is primary. Why? - Answer-The mother's birthday comes first in the calendar year. Which of the following statements is true concerning a court order about children's health coverage after a divorce? - Answer-Divorce rulings override the birthday rule. If a married couple is covered under both spouses' health insurance and the husband is picking up a prescription for himself, he should - Answer-use both of insurance benefits as they apply to this pharmacy purchase. A patient has just left the doctor's office with a new prescription after a scheduled follow up visit. If the patient's primary insurance covers the bill completely, her secondary insurance policy - Answer-will not be used for this visit. The Medicare Secondary Payer Questionnaire is a form that - Answer-patients fill out to determine if there is other insurance designated as the primary insurance. Which of the following should the insurance and coding specialist check in order to determine which payer should be billed as primary or secondary? - Answer-COB: COB stands for Coordination of Benefits and determines the order in which the insurance specialist should bill the payers. Which of the following statements is true for an employee on Medicare if he chooses coverage under the employer's group plan? - Answer-The group plan will be primary and Medicare will be secondary. Which of the following determines the primary policy if two plans cover a dependent child? - Answer-The parent who has the first birthdate of the year. The patient had United Health Care HMO group insurance before she retired. Today she presented her Medicare Part B insurance card and her husband's Blue Cross Blue Shield PPO group insurance card to the insurance and coding specialist. Which of the following is the patient's primary insurance for today's visit? - Answer-Blue Cross Blue Shield PPO: Medicare Part B is not primary when the patient is part of a group sponsored health plan. United Health Care HMO is not in effect as the scenario indicates that the patient "had" the plan. Blue Cross Blue Shield PPO is primary to Medicare when the patient is part of a group sponsored health insurance plan and would be the correct response. Medicare Part A would not be correct because it is not mentioned in the scenario and is not used for office (outpatient) services. A patient was hurt at work and seen in the physician's office today. The patient is covered under Medicare and BCBS and is also covered under Workers' Compensation for this injury. Which of the following is the primary insurance and the secondary insurance? - Answer-Worker's Compensation is the primary, BCBS is the secondary: The patient was injured at work so Worker's Compensation is the primary insurance carrier. Once the claim is processed through Worker's Compensation, it would follow the standard of the patient's health insurance claim process. Since the patient is working and covered under the employers' policy, the claim should be filed with BCBS as the next step of submission and the claim would be filed with Medicare last. Place the options below in order of claim submission, where all insurances are relevant. (Click and drag the options in the left column to their correct position in the right column.): Medicare, Medicaid, Humana, ABC Auto - Answer-ABC Auto, Humana, Medicare, Medicaid: It is highly unlikely that a patient would have all four of these insurances. However, if they do, the order in which the claims are submitted is relevant. It is assumed that since there is auto insurance involved, that this claim has to do with an automobile accident. The auto insurance should be filed first. Humana, a private payer, should be filed next. Government insurance, such as Medicare and Medicaid, should always be submitted last. When both Medicare and Medicaid are valid, Medicaid should be billed last. After a patient is seen for a follow up visit, the physician orders additional diagnostic testing. Which of the following does the insurance and coding specialist need to obtain? - Answer-pre-authorization: A billing and coding specialist must obtain a pre-authorization for the diagnostic testing. A pre-authorization is approval from the insurance company for the testing to be done. An allowed amount is not obtained until receiving the explanation of benefits, after the service is completed. A referral is needed to see a specialist, in some situations, and is provided by the primary care physician. An advanced beneficiary notice is a statement that is signed by the patient when it is known that the insurance company will not pay for the service and the patient is electing to have the service anyway. It is a promise that the patient will pay for the services in full. A patient is referred to a specialist by the primary care provider. Pre-certification is required for this patient's specialty visit. Which of the following actions is required by the insurance and coding specialist to obtain authorization? - Answer-Contact the patient's insurance provider: An insurance and coding specialist must obtain an authorization for a patient to see the specialist. This authorization is obtained by contacting the patient's insurance provider for authorization before the patient can see the specialist When submitting a request for a pre-authorization, the billing and coding specialist should - Answer-submit codes for any scenario that may arise during the procedure: When submitting for a pre-authorization, the billing and coding specialist should use codes for the most complicated service that may be provided. For example, if a physician expects to do a stab phlebectomy, with 18 incisions, the person who is completing the pre-authorization should submit code 37766 (stab phlebectomy, more