NCCT Medical office billing and coding Exam Questions and Answers

NCCT Medical office billing and coding Exam Questions and Answers The main purpose for verifying a patient's insurance coverage at every visit is to - Answer-prevent claim rejection due to ineligibility or non-active status. Rationale This also ensures the correct insurer is billed and facilitates timely reimbursement for the provider. The medical assistant should scan into the EHR or make a copy of both sides of the patient's current insurance card. Which of the following must be filled out by the patient in order to forward payment to the physician's office? - Answer-assignment of benefits Rationale If a patient's health insurance contract allows for assignment of benefits, the patient first fills out a form giving permission that any allowable benefit payment be sent to the medical provider. Without the AOB, any reimbursement would then be issued to the patient, then they would have to be billed by the medical office for payment. The AOB process cuts out the extra step. Which of the following documents does the provider or facility need to submit in order to receive reimbursement from an insurance company? - Answer-CMS-1500 Rationale The CMS-1500 is the form to be used to enable the provider or medical facility to receive reimbursement directly from a patient's insurance company. Which of the following forms is used by the medical office to ensure that insurance payments are made directly to the physician? - Answer-assignment of benefits Rationale If a patient's health insurance contract allows for assignment of benefits, the patient first fills out a form giving permission that any allowable benefit payment be sent to the medical provider. The CMS-1500 is the basic form for the Medicare and Medicaid programs for claims from physicians and suppliers. A UB-04 form is the electronic format of the CMS-1450 claim form. A consent form does not allow for payments from an insurance carrier, only for the patient to consent to accept medical treatment. 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? - Answer-Payment is misplaced. Rationale The first step of reconciliation is to first determine if a payment is misplaced. Then issues of duplication or misplaced monies can be addressed. Transactions involving a possible bank error would be the last thing to check before checking the medical office records. When posting an insurance payment via an EOB, the amount that is considered contractual is the - Answer-Insurance allowed amount. Rationale An Explanation of Benefits (EOB) is a document from the insurance company to the patient that includes detailed information regarding a claim that was paid to the health care provider. Once a provider accepts the allowed charges (fee schedule) for a particular procedure, it is accepting assignment. The provider agrees to accept the contractual amount (insurance adjustment) as payment in full from the insurance company. An adjustment is basically a billing discount in accordance with a contract between the health care provider and insurance company. Participating (PAR) and Non- Participating (NON-PAR) providers choose whether to participate in the Medicare program and either accept or not accept assignment on Medicare claims. A list of all account balances and the amounts owed to the medical practice at the end of the day is called an - Answer-accounts receivable report. Rationale A record of account balances and amounts owed the medical practice is call an accounts receivable report. Accounts payable is that which is owed to vendors or suppliers of the medical practice. An aging report will only list of outstanding balances due. An insurance aging report provided an aged summary of the medical offices outstanding charges broken down by insurance provider. When following up on a denied claim, a medical office assistant should have which of the following information available when speaking with the insurance company? (Select the three (3) correct answers). - Answer-patient's claim number, physician's NPI, patient's insurance ID number Rationale Before calling an insurance company to find out why a claim was denied, the medical office assistant should have ready; the physician's NPI (national provider identifier), the patient's claim number and insurance ID number. The insurance provider will already have the claim denied date and their customers mailing address with contact information. A medical office assistant's knowledge of a statute of limitations for collecting an overdue account is an example of managing the collections process while complying with - Answer-state and federal guidelines. Rationale State and federal guidelines exist for the collecting of any over due accounts. The length of time that the office has to request payment varies from state to state. Even with a statue of limitations, that does not mean that you cannot still attempt to collect on payment for services. Office policy and circumstances will determine whether it is cost and time efficient to continue to collect such accounts. HIPAA covers the national standard for privacy and security of medical records and the AMA is a group that aims to promote the art and science of medicine and public health. A patient has refused to pay for a medical procedure that was performed six months ago. The medical procedure was not listed under the patient's schedule of benefits, and