NCCT MEDICAL OFFICE BILLING AND CODING QU
CORRECT ANSWERS
The cmain cpurpose cfor cverifying ca cpatient's cinsurance ccoverage cat cevery cvisit cis cto c- cCORREC
crejection cdue cto cineligibility cor cnon-active cstatus.
Rationale
This calso censures cthe ccorrect cinsurer cis cbilled cand cfacilitates ctimely creimbursement cfor cthe cpr
cshould cscan cinto cthe cEHR cor cmake ca ccopy cof cboth csides cof cthe cpatient's ccurrent cinsurance c
Which cof cthe cfollowing cmust cbe cfilled cout cby cthe cpatient cin corder cto cforward cpayment cto cthe c
cCORRECT cANS✔✔assignment cof cbenefits
Rationale
If ca cpatient's chealth cinsurance ccontract callows cfor cassignment cof cbenefits, cthe cpatient cfirst cfills
cthat cany callowable cbenefit cpayment cbe csent cto cthe cmedical cprovider. cWithout cthe cAOB, cany c
cissued cto cthe cpatient, cthen cthey cwould chave cto cbe cbilled cby cthe cmedical coffice cfor cpayment.
cthe cextra cstep.
Which cof cthe cfollowing cdocuments cdoes cthe cprovider cor cfacility cneed cto csubmit cin corder cto cre
cinsurance ccompany? c- cCORRECT cANS✔✔CMS-1500
Rationale
The cCMS-1500 cis cthe cform cto cbe cused cto cenable cthe cprovider cor cmedical cfacility cto creceive c
cpatient's cinsurance ccompany.
Which cof cthe cfollowing cforms cis cused cby cthe cmedical coffice cto censure cthat cinsurance cpaymen
cphysician? c- cCORRECT cANS✔✔assignment cof cbenefits
Rationale
If ca cpatient's chealth cinsurance ccontract callows cfor cassignment cof cbenefits, cthe cpatient cfirst cfills
, camount c(insurance cadjustment) cas cpayment cin cfull cfrom cthe cinsurance ccompany. cAn cadjustme
cdiscount cin caccordance cwith ca ccontract cbetween cthe chealth ccare cprovider cand cinsurance ccom
cNon-Participating c(NON-PAR) cproviders cchoose cwhether cto cparticipate cin cthe cMedicare cprogra
caccept cassignment con cMedicare cclaims.
A clist cof call caccount cbalances cand cthe camounts cowed cto cthe cmedical cpractice cat cthe cend cof c
cCORRECT cANS✔✔accounts creceivable creport.
Rationale
A crecord cof caccount cbalances cand camounts cowed cthe cmedical cpractice cis ccall can caccounts cre
cpayable cis cthat cwhich cis cowed cto cvendors cor csuppliers cof cthe cmedical cpractice. cAn caging crep
coutstanding cbalances cdue. cAn cinsurance caging creport cprovided can caged csummary cof cthe cme
ccharges cbroken cdown cby cinsurance cprovider.
When cfollowing cup con ca cdenied cclaim, ca cmedical coffice cassistant cshould chave cwhich cof cthe cf
cwhen cspeaking cwith cthe cinsurance ccompany? c(Select cthe cthree c(3) ccorrect canswers). c- cCORR
cnumber, cphysician's cNPI, cpatient's cinsurance cID cnumber
Rationale
Before ccalling can cinsurance ccompany cto cfind cout cwhy ca cclaim cwas cdenied, cthe cmedical coffice
cthe cphysician's cNPI c(national cprovider cidentifier), cthe cpatient's cclaim cnumber cand cinsurance cID
cprovider cwill calready chave cthe cclaim cdenied cdate cand ctheir ccustomers cmailing caddress cwith cc
A cmedical coffice cassistant's cknowledge cof ca cstatute cof climitations cfor ccollecting can coverdue cac
cmanaging cthe ccollections cprocess cwhile ccomplying cwith c- cCORRECT cANS✔✔state cand cfeder
Rationale
State cand cfederal cguidelines cexist cfor cthe ccollecting cof cany cover cdue caccounts. cThe clength cof
crequest cpayment cvaries cfrom cstate cto cstate. cEven cwith ca cstatue cof climitations, cthat cdoes cnot
cattempt cto ccollect con cpayment cfor cservices. cOffice cpolicy cand ccircumstances cwill cdetermine cw
cefficient cto ccontinue cto ccollect csuch caccounts. cHIPAA ccovers cthe cnational cstandard cfor cprivac
crecords cand cthe cAMA cis ca cgroup cthat caims cto cpromote cthe cart cand cscience cof cmedicine cand
A cpatient chas crefused cto cpay cfor ca cmedical cprocedure cthat cwas cperformed csix cmonths cago. cT
cnot clisted cunder cthe cpatient's cschedule cof cbenefits, cand cshe cis cnow cfully cresponsible cfor call cc
cbeen cturned cover cto ca ccollection cagency. cThis cscenario cis cmost clikely can cexample cof cfailure
cto cproperly c- cCORRECT cANS✔✔explain cthe cnon-coverage cbilling cpolicies.
Rationale
Making csure cthat cthe coffice chas ca cpolicy cin cplace cto clet cyour cpatients cknow cwhat cyou cexpect
cexpect cof cyou. cA cwell-crafted cpolicy cwill cprevent cpatients cfrom cbeing csurprised cabout ctheir cfin
creceive cbilling cfor cyour cservices. cIt cwill calso cgive cyour cpractice csome clegal cprotection cshould
care centitled cto ccollect. cThe cpolicy cshould cbe ctailored cto cthe cmedical coffice cpolicy cand cpractic
cpatients cprevents cfuture cerror cor cmisunderstandings.
The cmedical coffice cassistant creceives cpayments cin cfull cfrom cboth ca cprimary cprivate cinsurance
cpatient. cAt cthe cend cof cthe cday cshe crealizes cthere cwas can coverpayment con cthe cpatient's cacco
cshould cthe coverpayment cbe crefunded cto? c- cCORRECT cANS✔✔The cpatient
Rationale
If cthe cmedical coffice cassistant creceived ca cfull cpayment cfrom cthe cinsurance ccompany, cthe cmed
crefund cthe cpatient cfor cany coverpayment cfor cservices cprovided.
The cprocess cof cfinding cout cif ca cservice cor cprocedure cis ccovered cunder ca cpatient's cinsurance c
cANS✔✔precertification.
CORRECT ANSWERS
The cmain cpurpose cfor cverifying ca cpatient's cinsurance ccoverage cat cevery cvisit cis cto c- cCORREC
crejection cdue cto cineligibility cor cnon-active cstatus.
Rationale
This calso censures cthe ccorrect cinsurer cis cbilled cand cfacilitates ctimely creimbursement cfor cthe cpr
cshould cscan cinto cthe cEHR cor cmake ca ccopy cof cboth csides cof cthe cpatient's ccurrent cinsurance c
Which cof cthe cfollowing cmust cbe cfilled cout cby cthe cpatient cin corder cto cforward cpayment cto cthe c
cCORRECT cANS✔✔assignment cof cbenefits
Rationale
If ca cpatient's chealth cinsurance ccontract callows cfor cassignment cof cbenefits, cthe cpatient cfirst cfills
cthat cany callowable cbenefit cpayment cbe csent cto cthe cmedical cprovider. cWithout cthe cAOB, cany c
cissued cto cthe cpatient, cthen cthey cwould chave cto cbe cbilled cby cthe cmedical coffice cfor cpayment.
cthe cextra cstep.
Which cof cthe cfollowing cdocuments cdoes cthe cprovider cor cfacility cneed cto csubmit cin corder cto cre
cinsurance ccompany? c- cCORRECT cANS✔✔CMS-1500
Rationale
The cCMS-1500 cis cthe cform cto cbe cused cto cenable cthe cprovider cor cmedical cfacility cto creceive c
cpatient's cinsurance ccompany.
Which cof cthe cfollowing cforms cis cused cby cthe cmedical coffice cto censure cthat cinsurance cpaymen
cphysician? c- cCORRECT cANS✔✔assignment cof cbenefits
Rationale
If ca cpatient's chealth cinsurance ccontract callows cfor cassignment cof cbenefits, cthe cpatient cfirst cfills
, camount c(insurance cadjustment) cas cpayment cin cfull cfrom cthe cinsurance ccompany. cAn cadjustme
cdiscount cin caccordance cwith ca ccontract cbetween cthe chealth ccare cprovider cand cinsurance ccom
cNon-Participating c(NON-PAR) cproviders cchoose cwhether cto cparticipate cin cthe cMedicare cprogra
caccept cassignment con cMedicare cclaims.
A clist cof call caccount cbalances cand cthe camounts cowed cto cthe cmedical cpractice cat cthe cend cof c
cCORRECT cANS✔✔accounts creceivable creport.
Rationale
A crecord cof caccount cbalances cand camounts cowed cthe cmedical cpractice cis ccall can caccounts cre
cpayable cis cthat cwhich cis cowed cto cvendors cor csuppliers cof cthe cmedical cpractice. cAn caging crep
coutstanding cbalances cdue. cAn cinsurance caging creport cprovided can caged csummary cof cthe cme
ccharges cbroken cdown cby cinsurance cprovider.
When cfollowing cup con ca cdenied cclaim, ca cmedical coffice cassistant cshould chave cwhich cof cthe cf
cwhen cspeaking cwith cthe cinsurance ccompany? c(Select cthe cthree c(3) ccorrect canswers). c- cCORR
cnumber, cphysician's cNPI, cpatient's cinsurance cID cnumber
Rationale
Before ccalling can cinsurance ccompany cto cfind cout cwhy ca cclaim cwas cdenied, cthe cmedical coffice
cthe cphysician's cNPI c(national cprovider cidentifier), cthe cpatient's cclaim cnumber cand cinsurance cID
cprovider cwill calready chave cthe cclaim cdenied cdate cand ctheir ccustomers cmailing caddress cwith cc
A cmedical coffice cassistant's cknowledge cof ca cstatute cof climitations cfor ccollecting can coverdue cac
cmanaging cthe ccollections cprocess cwhile ccomplying cwith c- cCORRECT cANS✔✔state cand cfeder
Rationale
State cand cfederal cguidelines cexist cfor cthe ccollecting cof cany cover cdue caccounts. cThe clength cof
crequest cpayment cvaries cfrom cstate cto cstate. cEven cwith ca cstatue cof climitations, cthat cdoes cnot
cattempt cto ccollect con cpayment cfor cservices. cOffice cpolicy cand ccircumstances cwill cdetermine cw
cefficient cto ccontinue cto ccollect csuch caccounts. cHIPAA ccovers cthe cnational cstandard cfor cprivac
crecords cand cthe cAMA cis ca cgroup cthat caims cto cpromote cthe cart cand cscience cof cmedicine cand
A cpatient chas crefused cto cpay cfor ca cmedical cprocedure cthat cwas cperformed csix cmonths cago. cT
cnot clisted cunder cthe cpatient's cschedule cof cbenefits, cand cshe cis cnow cfully cresponsible cfor call cc
cbeen cturned cover cto ca ccollection cagency. cThis cscenario cis cmost clikely can cexample cof cfailure
cto cproperly c- cCORRECT cANS✔✔explain cthe cnon-coverage cbilling cpolicies.
Rationale
Making csure cthat cthe coffice chas ca cpolicy cin cplace cto clet cyour cpatients cknow cwhat cyou cexpect
cexpect cof cyou. cA cwell-crafted cpolicy cwill cprevent cpatients cfrom cbeing csurprised cabout ctheir cfin
creceive cbilling cfor cyour cservices. cIt cwill calso cgive cyour cpractice csome clegal cprotection cshould
care centitled cto ccollect. cThe cpolicy cshould cbe ctailored cto cthe cmedical coffice cpolicy cand cpractic
cpatients cprevents cfuture cerror cor cmisunderstandings.
The cmedical coffice cassistant creceives cpayments cin cfull cfrom cboth ca cprimary cprivate cinsurance
cpatient. cAt cthe cend cof cthe cday cshe crealizes cthere cwas can coverpayment con cthe cpatient's cacco
cshould cthe coverpayment cbe crefunded cto? c- cCORRECT cANS✔✔The cpatient
Rationale
If cthe cmedical coffice cassistant creceived ca cfull cpayment cfrom cthe cinsurance ccompany, cthe cmed
crefund cthe cpatient cfor cany coverpayment cfor cservices cprovided.
The cprocess cof cfinding cout cif ca cservice cor cprocedure cis ccovered cunder ca cpatient's cinsurance c
cANS✔✔precertification.
