NHA - CERTIFIED BILLING AND CODING SPECIALIST (CBCS) STUDY GUIDE|UPDATED&VERIFIED|100% SOLVED|GUARANTEED SUCCESS

The symbol "O" in the Current Procedural Terminology reference is used to indicate what? - correct answer Reinstated or recycled code In the anesthesia section of the CPT manual, what are considered qualifying circumstances? - correct answer Add-on codes As of April 1, 2014 what is the maximum number of diagnoses that can be reported on the CMS-1500 claim form before a further claim is required? - correct answer 12 What is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - correct answer Operative report What action should be taken first when reviewing a delinquent claim? - correct answer Verify the age of the account A claim can be denied or rejected for which of the following reasons? - correct answer Block 24D contains the diagnosis code A coroner's autopsy is comprised of what examinations? - correct answer Gross Examination Medigap coverage is offered to Medicare beneficiaries by whom? - correct answer Private third-party payers What part of Medicare covers prescriptions? - correct answer Part C What plane divides the body into left and right? - correct answer Sagittal Where can unlisted codes be found in the CPT manual? - correct answer Guidelines prior to each section Ambulatory surgery centers, home health care, and hospice organizations use which form to submit claims? - correct answer UB-04 Claim Form What color format is acceptable on the CMS-1500 claim form? - correct answer Red Who is responsible to pay the deductible? - correct answer Patient A patient's health plan is referred to as the "payer of last resort." What is the name of that health plan? - correct answer Medicaid Informed Consent - correct answer Providers explain medical or diagnostic procedures, surgical interventions, and the benefits and risks involved, giving patients an opportunity to ask questions before medical intervention is provided. Implied Consent - correct answer A patient presents for treatment, such as extending an arm to allow a venipuncture to be performed. Clearinghouse - correct answer Agency that converts claims into standardized electronic format, looks for errors, and formats them according to HIPAA and insurance standards. Individually Identifiable - correct answer Documents that identify the person or provide enough information so that the person can be identified. De-identified Information - correct answer Information that does not identify an individual because unique and personal characteristics have been removed. Consent - correct answer A patient's permission evidenced by signature. Authorizations - correct answer Permission granted by the patient or the patient's representative to release information for reasons other than treatment, payment, or health care operations. Reimbursement - correct answer Payment for services rendered from a third-party payer. Auditing - correct answer Review of claims for accuracy and completeness. Fraud - correct answer Making false statements of representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist. Upcoding - correct answer Assigning a diagnosis or procedure code at a higher level than the documentation supports, such as coding bronchitis as pneumonia. Unbundling - correct answer Using multiple codes that describe different components of a treatment instead of using a single code that describes all steps of the procedure. Abuse - correct answer Practices that directly or indirectly result