CHAPTER 2 Verified Solutions

CHAPTER 2 Verified Solutions Coding and Billing What code set is used to report procedure codes by a facility? Options: a. ICD-10-CM; b. ICD-10-PCS Answer: b. ICD-10-PCS Which service is covered by Medicare Part B? Options: a. Hospital services; b. Physician surgical fees Answer: b. Physician surgical fees What is not a reason to append a modifier to a CPT or HCPCS Level II code? Options: a. Medical necessity; b. Unusual or extraordinary circumstance Answer: a. Medical necessity Insurance and Reimbursement What is not required to process the online application on the CMS website for a NPI (National Provider Identification)? Options: a. DEA number; b. Taxpayer Identification Number Answer: a. DEA number Which option is a common reason for denials? Options: a. Service not medically necessary; b. Service not billed correctly Answer: a. Service not medically necessary Provider and Patient Information Who is the primary insurance in this case if a Medicare patient is seen in an urgent care clinic following a minor automobile accident and has Medicare Part A, B, and C as well as no-fault through auto insurance? Options: a. Medicare Part A, B, and C; b. Auto insurance Answer: b. Auto insurance Credentialing and Compliance When should credentialing of a provider be performed? Options: a. When it is determined the physician will be hired; b. When the provider requests participation in a health insurance network Answer: a. When it is determined the physician will be hired WHICH HEALTH PLANS BELOW ARE CONSIDERED PUBLIC HEALTH PLANS? ️MEDICARE , MEDICAID , PREFERED PROVIDER ORGANIZATION(PPO) YOU WORK FOR A PEDIATRIC OFFICE AND THE PARENTS OF A PATIENT INFORM YOU THEY CAN NO LONGER AFFORD HEALTH INSURANCE. THEY DO NOT QUALIFY FOR MEDICAID AS THEIR INCOME IS TOO HIGH. WHAT WOULD YOU RECOMMEND? ️APPLY FOR CHIP COVERAGE ABN ️ADVANCE BENIFICIARY NOTICE WHICH VOLUME CODE OF THE ICD-9 IS USED TO IDENTIFY DIAGNOSES? SELECT ALL THAT APPLY ️VOLUME 1 / VOLUME 2 PAYMENTS FOR PHYSICIAN SERVICES IS BASED ON THE ----- CODE . SELECT ALL THAT APPLY. ️CPT HCPCS LEVEL II AN ABN FOR IS USED TO : ️NOTIFICATION TO PATIENTS THAT MEDICARE MAY NOT COVER A CERTAIN PROCEDURE OR SERVICE. WHICH OF THE FOLLOWING SERVICES IS COVERED BY MEDICARE PART B? ️PHYSICIAN SURGICAL FEES WHAT IS THE BEST WAY TO PREVENT DENIALS FOR INVALID CODES? ️UPDATE THE PRACTICE MANAGEMENT SYSTEM WHEN NEW DELETED AND REVISED CODES ARE RELEASED MBI ️MEDICARE BENEFICIARY IDENTIFIER POSTING PAYMENT AND COLLECTION POLICIES IN A PROMINENT PLACE IN YOUR OFFICE HAS WHAT BENEFIT? ️PREPARES THE PATIENT TO MAKE PROPER PAYMENTS AT THE TIME OF SERVIE WHAT ARE EXAMPLES OF PRIVATE HEALTH INSURANCE ️MCO , PPO , HMO, CDHC, HAS WHAT IS A CHRONOLOGIAL DESCRIPTION OF THE DEVELOPEMENT OF THE PATIENT'S COMPLAINTS? ️HISTORY OF PRESENT ILLNESS WHIS OF THE FOLLOWING OPTIONS IS MOST LIKELY TO NEGATIVELY IMPACT COLLECTIONS? ️INCREASE IN NUMBER OF PATIENTS WITH HIGH DEDUCTIBLE INSURANCE PLAN OF THE SERVICES LISTED BELOW , WHICH ARE CPT EVALUATION AND MANAGEMENT SERVICES? ️CHEST X-RAY , OFFICE CONSULTATION, NEW PATIENT PREVENTIVE MEDICINE EXAM WHAT CODE SET REPRESENTS HEALTHCARE EQUIPMENT, DRUGS AND SUPPLIES? ️HCPCS LEVEL II A CLAIM FORM THAT IS COMPLETE AND ACCURATE AND INCLUDES ALL PROVIDER INFORMATION, MEMBER INFORMATION AND OTHER ADDITIONAL INFORMATION NEEDED TO PROCESS FOR PAYMENT IS CALLED: ️CLEAN PROCEDURE CODES ARE REPORTED BY THE PROVIDER USING WHICH CODE SET? ️CPT WHICH OF THE FOLLOWING IS AN EXAMPLE OF PRIVATE HEALTH PLAN ️MCO