NHA CBCS #4 Questions with Complete Rationales

NHA CBCS #4 Questions with Complete Rationales CAP - ANS: Claims assistance Professional AHIMA - ANS: American Health Information Management Association In locating a diagnosis, look up the main term, which is the - ANS: Disease or condition Reasons for documentation are - ANS: Defense of a professional liability claim. Insurance carriers require accurate documentation that supports procedure and diagnostic codes. SOAP is - ANS: Subjective, objective, assessment, plan A diseased condition or state is known as - ANS: Morbidity. According to birth law, if both parents have the same bday - ANS: The hour of birth determines who pays first. What is the correct term to determine if a procedure is covered and medically necessary. - ANS: Pre-authorization Obtaining and recording patient data before the person's first visit is known as - ANS: Pre-registration Discovering the maximum $ amount that the carrier will pay for a procedure is called - ANS: Predetermination Criteria used by insurance companies when making decisions to limit or deny payment of medical services or procedures must be justified by the patient's symptoms and diagnosis are called - ANS: Medical necessity If husband & wife both have insurance through their employers, and each has added the spouse to their primary insurance plans for coverage. If the wife is seen for treatment then her plan is considered - ANS: Primary The health insurance claim form, also known as universal claim form is often called - ANS: CMS-1500 If a professional liability claim is filed by a patient, good helps establish a strong defense. - ANS: Documentation Insurance claim submitted on paper - ANS: Paper claim Insurance claim held in suspense due to review or other reason. - ANS: Pending claim Insurance claim that is submitted via a dial-up modem or direct data entry - ANS: electronic claim Cost pressures on health care providers are forcing employers to reduce personnel costs by hiring - ANS: Multi skilled health care practitioners Claims Assistance Professional (CAP) - ANS: Works for the consumer, helps patients file insurance claims In medical practice what is cash flow - ANS: Actual money available to a medical practice Front office medical duties have become increasingly important because - ANS: Diagnostic and procedural coding must be review for its correctness and completeness What level of education is genrallly required for one who seeks employment as an insurance coder? - ANS: Completion of an accredited program for coding certification What organized published diagnostic and procedure coding cometencies for outpatient services and diagnostic coding and reporting requiremnt for physician billing. - ANS: AHIMA - AMerican Health Information Management Association Amount of money an insurance billing specialist earns is dependent on what - ANS: Knowledhge Experience Size of employing institution Billing specialist is entrusted with - ANS: holding patients' medical information in confidence, collecting money, and being a reliable resource for co-workers Confidentiality between the physician and the patient is automatically waived when the patient is being treated in a workers' compensation case. - ANS: True A patient has the right to obtain a copy of his/her confidential health information. - ANS: True Non-privileged Information about a patient consists of the patient's - ANS: City of residence Confidentiality is automatically waived in cases of - ANS: Gunshot wound, child abuse, extremely contagious disease To bill medicare beneficiaries at a higher rate that the other patients is considered - ANS: Abuse Electronic Media refers to - ANS: Leased phone or dialup phone lines the internet transmissions that are physically moved from one location to another.