NHA Practice Test Billing and Coding Latest Updates

NHA Practice Test Billing and Coding Medicare Part C (Medicare Advantage) - Which of the following parts of the Medicare insurance program is managed by private, third party insurance providers that have been approved by Medicare? coordination of benefits - a group health insurance provision that specifies how the insurers will share the cost when more than one policy covers a claim, Do not exceed 100% of allowable medical expenses Procedure Descriptions - "" Used to indicate new and revised text other than which of the following? Which of the following sections of the SOAP note indicates a patients level of pain to a provider? - Subjective SOAP - subjective, objective, assessment, plan Subjective - Chief complaint to the provider Objective - results of the physical examination of the patient Assessment - provider diagnoses for patient Plan - providers plan of treatment Crossover - when an insurance company transfers data to allow coordination of benefits of a claim. (Medicare uses the term to describe payers electronically data.) Which of the following is a HIPAA compliance guideline affecting electronic health records? - The electronic transmission and code set standards require every provider to use healthcare transaction, code sets, and identifiers. Which of the following is a deadline for Medicare Claim submission? - 1 year What symbols is a Add-on - +plus "" - Revised Bulls Eye - moderate sedation Bullet - new code A lighting Bolt - pending FDA approval Which of the following standardized formats are used in the electronic filling or claims? - HIPAA standard transaction Which of the following describes an insurance carrier that pays the provider who rendered services to a patient? - Third-party payer In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? - Add-on codes Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - Operative Report A Medicare non-participating (non-par) provider approved payment amount is $200 for a labectomy and the deductible has been met. Which of the following amount is the limiting charge for this procedure? - $230 %15 over Urine moves from the kidney to the bladder through which of the following parts of the body? - Ureters Which of the following does a patient sign to allow payment of claims directly to the provider? - Assignment of Benefits the billing and coding specialist should follow the guidelines in the CPT manual for which of the following reasons? - The guidelines define items that are necessary to accurately code. Which of the following causes a claim to be suspended? - Services require additional information which of the following actions by a billing and coding specialist would be considered fraud? - billing for services not provided Remittance adivce (RA) - is a notice of payment and adjustments Medicare contractors send to providers, billers and suppliers after the process a claim. Coordination of Benefits (COB) - exchange of information between payers when a patient has more than one health plan. Which of the following best describes medical ethics? - medical standard of conduct which of the following documentation is valid authorization to release medical information to the judicial system? - Subpoena duces tecum Which of the following considered fraud? - The billing and coding specialist unbundles a code to receive higher reimbursement. which of the following explains why Medicare will deny a particular service or procedure? - Advance Beneficiary Notice (ABN)