NHA CBCS Exam Questions With Correct
Answers
adjudication
the process where the insurance company receives a claim and makes a
| | | | | | | | | | | |
determination on payment or denial | | | |
allowed amount |
the maximum amount an insurance company will pay for the service,
| | | | | | | | | | |
procedure and supply | |
auditing process
|
the act of reviewing and comparing the patient medical records and
| | | | | | | | | | |
claims to assess for coding appropriateness and completeness of the
| | | | | | | | | |
medical documentation
|
coding compliance
|
,the conformity and adherence to established coding guidelines and
| | | | | | | | |
regulations
current procedural terminology (cpt)
| | |
descriptive definitions used to explain procedures and services provided
| | | | | | | | |
to the patient.
| |
dented claim |
a claim returned from a third-party payer because of technical errors or
| | | | | | | | | | | |
patient coverage errors | |
explanation of benefits (EOB) | | |
document that explains how the payer processed the claim for services
| | | | | | | | | | |
rendered, can also be referred to as remittance advice (RA)
| | | | | | | | |
fee for service
| |
cost or fee that is charged for each service
| | | | | | | |
, Health and Human Services (HHS)
| | | |
government department that oversees the health of the community and
| | | | | | | | | |
provides crucial services to
| | |
codes used to report and classify diseases, conditions and other reasons
| | | | | | | | | | |
for healthcare encounters
| |
international classification of diseases, tenth revision, clinical
| | | | | | |
modification (ICD-10-CM) |
noncompliance
the act of disregarding rules and guidelines outlined by state and federal
| | | | | | | | | | | |
government agencies and third-party payers
| | | |
office of inspector general (OIG)
| | | |
government agency that investigates fraud and abuse
| | | | | |
place of service (pos) code
| | | |
Answers
adjudication
the process where the insurance company receives a claim and makes a
| | | | | | | | | | | |
determination on payment or denial | | | |
allowed amount |
the maximum amount an insurance company will pay for the service,
| | | | | | | | | | |
procedure and supply | |
auditing process
|
the act of reviewing and comparing the patient medical records and
| | | | | | | | | | |
claims to assess for coding appropriateness and completeness of the
| | | | | | | | | |
medical documentation
|
coding compliance
|
,the conformity and adherence to established coding guidelines and
| | | | | | | | |
regulations
current procedural terminology (cpt)
| | |
descriptive definitions used to explain procedures and services provided
| | | | | | | | |
to the patient.
| |
dented claim |
a claim returned from a third-party payer because of technical errors or
| | | | | | | | | | | |
patient coverage errors | |
explanation of benefits (EOB) | | |
document that explains how the payer processed the claim for services
| | | | | | | | | | |
rendered, can also be referred to as remittance advice (RA)
| | | | | | | | |
fee for service
| |
cost or fee that is charged for each service
| | | | | | | |
, Health and Human Services (HHS)
| | | |
government department that oversees the health of the community and
| | | | | | | | | |
provides crucial services to
| | |
codes used to report and classify diseases, conditions and other reasons
| | | | | | | | | | |
for healthcare encounters
| |
international classification of diseases, tenth revision, clinical
| | | | | | |
modification (ICD-10-CM) |
noncompliance
the act of disregarding rules and guidelines outlined by state and federal
| | | | | | | | | | | |
government agencies and third-party payers
| | | |
office of inspector general (OIG)
| | | |
government agency that investigates fraud and abuse
| | | | | |
place of service (pos) code
| | | |
