#1 Nha Cbcs 2020

Which of the following describes the reason for a claim rejection because of Medicare ncci edits? - correct answer Improper code combinations A claim is submitted with a transposed insurance member ID number and returned to the provider. Which of the following describes the status that should be assigned to the claim by the carrier? - correct answer invalid Medigap coverage is offered to Medicare beneficiaries by which of the following? - correct answer Private third-party payers Which of the following provisions ensures that an insureds benefits from all insurance companies do not exceed 100% of allowable medical expenses? - correct answer coordination of benefits A coroner's autopsy is comprised of what examinations? - correct answer Gross examination Which of the following statements is true regarding the release of patients records? - correct answer Patient access to psychotherapy notes may be restricted Which of the following actions by a billing and coding specialist would be considered fraud? - correct answer billing for services not provided Which of the following components of an explanation of benefits expedites the process of a phone appeal? - correct answer claim control number On the cms-1500 claim form, blocks 14 through 33 contain information about which of the following? - correct answer The patient's condition and the provider's information A billing and coding specialist should understand that the financial records source that is generated by a providers office is called a - correct answer Patient ledger account Which of the following medical terms refers to the sac that causes the heart - correct answer Pericardium Hipaa transaction standards apply to which of the following entities? - correct answer Health care clearinghouses All dependents 10 years of age or older are required to have which of the following for tricare? - correct answer Military identification The standard medical abbreviation ECG refers to a test used to assess which of the following body systems? - correct answer cardiovascular system Which of the following is an example of a violation of an adult patient confidentiality? - correct answer Patient information was disclosed to the patient's parent without consent Claims that are submitted without an NPI number will delay payment to the provider because - correct answer the number is needed to identify the provider Which of the following sections of the medical record is used to determine the correct evaluation and management code used for billing and coding? - correct answer history and physical Which of the following actions should be taken if an insurance company denies a service as not medically necessary? - correct answer Appeal the decision with a provider's report Which of the following is the portion of the account balance the patient must pay after services are rendered in the annual deductible is met? - correct answer coinsurance Which of the following is the function of the respiratory system? - correct answer Oxygenating blood cells Which of the following describes a delinquent claim? - correct answer The claim is overdue for payment Which of the following actions should be billing and coding specialist take if he observes a colleague and on ethical situation? - correct answer Report the incident to a supervisor A participating Blue Cross Blue Shield provider receives an explanation of benefits for a patient account. The charge amount was $100. Blue Cross Blue Shield allowed $80 and applied $40 to the patient's annual deductible. Blue Cross Blue Shield paid the balance at 80%. How much should the patient expect to pay? - correct answer $48 Which of the following statements is correct regarding a deductible? - correct answer The deductible is the patient's responsibility A physician ordered a comprehensive metabolic panel for 70-year-old patient who has Medicare as her primary insurance. Which of the following forms is required so no she may be responsible for payment? - correct answer Advance beneficiary notice Which of the following is the purpose of pre-certification? - correct answer Verification of coverage Which of the following claims is submitted and then optically skin by the insurance carrier and converted to an electronic form? - correct answer Paper claim Which of the following information is required on a patient account record? - correct answer Name and address of guarantor Which of the following includes procedures in best practices for correct coding? - correct answer Coding compliance plan A patient who has a primary malignant neoplasm of the lung should be referred to which of the following specialist? - correct answer Pulmonary oncologist A provider performs an examination of a patient's sore throat during an office visit. Which of the following describes a level of the examination? - correct answer Problem focused examination To be compliant with Hipaa which of the following positions should be assigned in each office? - correct answer privacy officer Which of the following indicates a claim should be submitted on paper instead of electronically? - correct answer The claim requires an attachment Which of the following should the billing and coding specialist include in an authorization to release information? - correct answer the entity to whom the information is to be released In the anesthesia section of the CPT manual which of the following are considered qualifying circumstances? - correct answer add-on codes When submitting a clean claim with a diagnosis of kidney stones which of the following procedure names is correct? - correct answer nephrolithiasis Ambulatory surgery centers home health care and hospice organizations use the - correct answer UB-04 claim form Which of the following describes an obstruction of the urethra? - correct answer Urethratresia The symbol is used to indicate new and revised text other than which of the following? - correct answer procedure descriptors A patient's health plan is referred to as the pair of last resort. The patient is covered by which of the following health plans - correct answer Medicaid Which part of Medicare covers prescriptions - correct answer Part D Which of the following actions by the billing and coding specialist prevent fraud? - correct answer Performing periodic audits A patient who is an active member of the military recently returned from overseas and is in need of specialty care. The patient does not have anyone designated with power of attorney. Which of the following is considered a HIPAA violation? - correct answer The billing and coding specialist sends the patient's records to the patient's partner Which of the following is used to code diseases, injuries, impairments, and other health related problems? - correct answer International Classification of Diseases (ICD) An insurance claims register (aged insurance report) facilitates which of the following? - correct answer follow up of insurance claims by date