NCCT REVIEW | COLLECTIONS WITH COMPLETE
The cpayer cprovided cthe cfollowing cinformation con ca cpatient's caccount: c
Charge c- c$189.00
Discounted cAmount c- c$74.59
Patient cResponsibility c- c$30.00
Amount cPaid cto cProvider c- c$84.41
Which cof cthe cfollowing cis cthe cpayer callowed camount cfor cthis cclaim?
A. c$84.41 c
B. c$114.41
C. c$74.59
D. c$159.00 c- cB. c$114.41
Which cof cthe cfollowing cmanaged ccare cpayer cdenials cindicates cfront cend cuser cerror?
A. ca cdiagnosis cinconsistent cwith cthe cprocedure
B. cincorrect cinsurance cinformation
C. ca cprocedure cdeemed cnot cmedically cnecessary
D. cpassed ctimely cfiling cdate c- cB. cincorrect cinsurance cinformation
Front cend cuser cerror crefers cto cerrors cmade cin cthe cclaim cprocess cprior cto ctransmitting cthe cclai
cinconsistent cwith cthe cprocedure", c"a cprocedure cdeemed cnot cmedically cnecessary" cand c"passe
crefer cto cincorrect cinformation csupplied cthat crequires ccorrecting cso c"incorrect cinsurance cinforma
ccorrect cchoice.
When cdealing cwith ca cMedicare cdenied cclaim, cit cis cappropriate cto cwrite coff cthe camount cdenied
csubmitted
A. cwith cthe cwrong cdate cof cbirth.
B. cfor cexperimental cprocedures.
C. cwith cno crendering cprovider clisted.
D. cfor cnon-covered cprocedures. c- cB. cfor cexperimental cprocedures.
Experimental cservices care cnot ccovered cby cMedicare cand cwould cnot cbe cthe cpatient cresponsibil
can cABN cunderstanding cto cbe cfinancially cresponsible. cAny cdenial cwith cthe cwrong cdate cof cbirth
cor cnon-covered cprocedures ccan cbe cresubmitted cwith cappropriate cinformation cor crecords.
, B. crejected.
C. cpending.
D. cbypassed. c- cB. crejected.
Which cof cthe cfollowing cis cthe ccorrect cterm cfor can cinsurance cclaim csubmitted cwith cerrors?
A. cpending
B. cdirty
C. cinvalid
D. cincomplete c- cB. cdirty
A cdirty cclaim cis ca cclaim cthat cis csubmitted cwith cerrors, csuch cas cmissing cinformation cor cinforma
cfields. cA cpending cclaim cis ca cclaim cthat cis cbeing cchecked cby ca ccarrier cand cis cawaiting cpayme
cincomplete cclaim cis cmissing cinformation.
Which cof cthe cfollowing care ctypical creasons cfor ca cclaim cto cbe crejected cby ca cclearinghouse? c(S
canswers.)
A. cinvalid cinsurance cpolicy
B. cinvalid cICD ccode(s)
C. cinvalid creferral cnumber
D. cinvalid cCLIA cnumber
E. cinvalid cfinal cdate cof ctreatment c- cA. cinvalid cICD ccode(s)
D. cinvalid cCLIA cnumber
A cclearinghouse cbundles cclaims ctogether cto csend cto cthe cinsurance ccarrier. cThey cwill calso csen
cfor cbasic, cnon-patient cspecific cerrors cfor cwhich ca cclaim ccan cbe cdenied. cClaims cwith cinvalid cIC
cCLIA cnumbers, cwill cbe crejected cby cthe cclearinghouse. cCLIA crequires cthat cclinical claboratories
cstate. cClaims cwith cinvalid cinsurance cpolicies, cinvalid creferral cnumbers, cand cinvalid cfinal cdates
crejected cand cwill cbe csent cto cthe cinsurance ccompany. cThese csituations care cspecific cto ctreatme
cthe cclearinghouse's cresponsibility.
A cMedicare cpatient creceived cservice con cJanuary c10th. cThe cclaim cwas crejected cfor creason: cPa
cfor csubmitted cdates. cWhich cof cthe cfollowing cshould cthe cinsurance cand ccoding cspecialist cdo cfi
A. cContact cthe cpatient cfor cpayment.
B. cVerify cthat cthe cpatient's cemployer cdid cnot cchange cinsurance cJanuary c1.
C. cResubmit cthe cclaim cwith ccorrected cdates.
D. cReview cthe cclaim cagainst cregistration cmaterials cfor caccuracy. c- cD. cReview cthe cclaim cagain
caccuracy.
When ca cMedicare cbeneficiary creceives cservices cthat cmay cnot cbe cpayable, cthe cInsurance cBillin
ccheck cto csee cif cthere cis can cAdvance cBeneficiary cNotice c(of cNoncoverage) con cfile cand csigned
cservices crendered. c"Resubmit cthe cclaim cwith ca cdifferent cprocedure ccode, cresubmit cthe cclaim c
cresubmit cclaim cusing ca cHCPCS ccode care call cincorrect cactions.
The crejected cclaim creport cidentified ctwo cerrors cwhich crequire cimmediate cattention. cWhich cof cth
cbilling cand ccoding cspecialist cexpect cto cfind con cthis creport? c(Select cthe ctwo c(2) ccorrect canswe
A. cThe cbeneficiary's cname cis cincomplete cor cmissing.
B. cThe cpatient's cdeductible chas cnot cbeen cmet.
C. cThe cpatient chas cnot cbeen cto cthe coffice cin cover cthree cyears.
D. cAn cincorrect cpatient ccopayment cwas creceived cat cthe ctime cof cvisit.
E. cThe cinsurance cidentification cnumber cis cinvalid c- cA. cThe cbeneficiary's cname cis cincomplete co
E. cThe cinsurance cidentification cnumber cis cinvalid
A crejection creport cidentifies cclaims cthat chave cnot cbeen cprocessed. cThese cclaims crequire ccorre
cpatient's cdeductible chas cnot cbeen cmet, cthe cpatient chas cnot cbeen cto cthe coffice cin cover cthree c
ccopayment cwas creceived cat cthe ctime cof cvisit cwould cnot caffect cthe cadjudication c(processing) co
cbeneficiary's cname cis cincomplete cor cmissing cand cthe cinsurance cidentification cnumber cis cinvali
ccorrection.
Which cof cthe cfollowing care clegitimate creasons cfor ca cclaim cto cbe crejected? c(Select cthe cthree c(
The cpayer cprovided cthe cfollowing cinformation con ca cpatient's caccount: c
Charge c- c$189.00
Discounted cAmount c- c$74.59
Patient cResponsibility c- c$30.00
Amount cPaid cto cProvider c- c$84.41
Which cof cthe cfollowing cis cthe cpayer callowed camount cfor cthis cclaim?
A. c$84.41 c
B. c$114.41
C. c$74.59
D. c$159.00 c- cB. c$114.41
Which cof cthe cfollowing cmanaged ccare cpayer cdenials cindicates cfront cend cuser cerror?
A. ca cdiagnosis cinconsistent cwith cthe cprocedure
B. cincorrect cinsurance cinformation
C. ca cprocedure cdeemed cnot cmedically cnecessary
D. cpassed ctimely cfiling cdate c- cB. cincorrect cinsurance cinformation
Front cend cuser cerror crefers cto cerrors cmade cin cthe cclaim cprocess cprior cto ctransmitting cthe cclai
cinconsistent cwith cthe cprocedure", c"a cprocedure cdeemed cnot cmedically cnecessary" cand c"passe
crefer cto cincorrect cinformation csupplied cthat crequires ccorrecting cso c"incorrect cinsurance cinforma
ccorrect cchoice.
When cdealing cwith ca cMedicare cdenied cclaim, cit cis cappropriate cto cwrite coff cthe camount cdenied
csubmitted
A. cwith cthe cwrong cdate cof cbirth.
B. cfor cexperimental cprocedures.
C. cwith cno crendering cprovider clisted.
D. cfor cnon-covered cprocedures. c- cB. cfor cexperimental cprocedures.
Experimental cservices care cnot ccovered cby cMedicare cand cwould cnot cbe cthe cpatient cresponsibil
can cABN cunderstanding cto cbe cfinancially cresponsible. cAny cdenial cwith cthe cwrong cdate cof cbirth
cor cnon-covered cprocedures ccan cbe cresubmitted cwith cappropriate cinformation cor crecords.
, B. crejected.
C. cpending.
D. cbypassed. c- cB. crejected.
Which cof cthe cfollowing cis cthe ccorrect cterm cfor can cinsurance cclaim csubmitted cwith cerrors?
A. cpending
B. cdirty
C. cinvalid
D. cincomplete c- cB. cdirty
A cdirty cclaim cis ca cclaim cthat cis csubmitted cwith cerrors, csuch cas cmissing cinformation cor cinforma
cfields. cA cpending cclaim cis ca cclaim cthat cis cbeing cchecked cby ca ccarrier cand cis cawaiting cpayme
cincomplete cclaim cis cmissing cinformation.
Which cof cthe cfollowing care ctypical creasons cfor ca cclaim cto cbe crejected cby ca cclearinghouse? c(S
canswers.)
A. cinvalid cinsurance cpolicy
B. cinvalid cICD ccode(s)
C. cinvalid creferral cnumber
D. cinvalid cCLIA cnumber
E. cinvalid cfinal cdate cof ctreatment c- cA. cinvalid cICD ccode(s)
D. cinvalid cCLIA cnumber
A cclearinghouse cbundles cclaims ctogether cto csend cto cthe cinsurance ccarrier. cThey cwill calso csen
cfor cbasic, cnon-patient cspecific cerrors cfor cwhich ca cclaim ccan cbe cdenied. cClaims cwith cinvalid cIC
cCLIA cnumbers, cwill cbe crejected cby cthe cclearinghouse. cCLIA crequires cthat cclinical claboratories
cstate. cClaims cwith cinvalid cinsurance cpolicies, cinvalid creferral cnumbers, cand cinvalid cfinal cdates
crejected cand cwill cbe csent cto cthe cinsurance ccompany. cThese csituations care cspecific cto ctreatme
cthe cclearinghouse's cresponsibility.
A cMedicare cpatient creceived cservice con cJanuary c10th. cThe cclaim cwas crejected cfor creason: cPa
cfor csubmitted cdates. cWhich cof cthe cfollowing cshould cthe cinsurance cand ccoding cspecialist cdo cfi
A. cContact cthe cpatient cfor cpayment.
B. cVerify cthat cthe cpatient's cemployer cdid cnot cchange cinsurance cJanuary c1.
C. cResubmit cthe cclaim cwith ccorrected cdates.
D. cReview cthe cclaim cagainst cregistration cmaterials cfor caccuracy. c- cD. cReview cthe cclaim cagain
caccuracy.
When ca cMedicare cbeneficiary creceives cservices cthat cmay cnot cbe cpayable, cthe cInsurance cBillin
ccheck cto csee cif cthere cis can cAdvance cBeneficiary cNotice c(of cNoncoverage) con cfile cand csigned
cservices crendered. c"Resubmit cthe cclaim cwith ca cdifferent cprocedure ccode, cresubmit cthe cclaim c
cresubmit cclaim cusing ca cHCPCS ccode care call cincorrect cactions.
The crejected cclaim creport cidentified ctwo cerrors cwhich crequire cimmediate cattention. cWhich cof cth
cbilling cand ccoding cspecialist cexpect cto cfind con cthis creport? c(Select cthe ctwo c(2) ccorrect canswe
A. cThe cbeneficiary's cname cis cincomplete cor cmissing.
B. cThe cpatient's cdeductible chas cnot cbeen cmet.
C. cThe cpatient chas cnot cbeen cto cthe coffice cin cover cthree cyears.
D. cAn cincorrect cpatient ccopayment cwas creceived cat cthe ctime cof cvisit.
E. cThe cinsurance cidentification cnumber cis cinvalid c- cA. cThe cbeneficiary's cname cis cincomplete co
E. cThe cinsurance cidentification cnumber cis cinvalid
A crejection creport cidentifies cclaims cthat chave cnot cbeen cprocessed. cThese cclaims crequire ccorre
cpatient's cdeductible chas cnot cbeen cmet, cthe cpatient chas cnot cbeen cto cthe coffice cin cover cthree c
ccopayment cwas creceived cat cthe ctime cof cvisit cwould cnot caffect cthe cadjudication c(processing) co
cbeneficiary's cname cis cincomplete cor cmissing cand cthe cinsurance cidentification cnumber cis cinvali
ccorrection.
Which cof cthe cfollowing care clegitimate creasons cfor ca cclaim cto cbe crejected? c(Select cthe cthree c(
