CMM FINAL STUDY GUIDE (medical office management) practice test exam Questions and Answers 100% Already Graded A+ Excel

CMM FINAL STUDY GUIDE (medical office management) practice test exam Questions and Answers 100% Already Graded A+ Excel Steps of Revenue Cycle - CORRECT ANSWER-Patient Registration & Check in/ Clinical encounter/ Accurate Coding and Billing/ Claims Generation and Transmittal/ Processing Payments/ Preparation and Transmittal of Patient Statements/ Collections and Finalizing Payments/ Denials, Appeals & Refunds Coding analysis - CORRECT ANSWER-involves analyzing the financial impact of proper vs. improper coding procedures in practice What type of codes reflect the accurate level of medical necessity that justfies each CPT and HCPC level II code? - CORRECT ANSWER-ICD-10 Why is it important to have accurate coding - CORRECT ANSWER-minimizes denials and rejections while ensuring the practice is reimbursed the full amount All electronic opportunities to verfy active patient insurance and benefits should be utilized ___-_____ hours before visit - CORRECT ANSWER-24-48 hours If the patient does not have insurance, has a lapse in coverage, or cannot pay service, protect the practice by having the patient sign a _____ _____ Notice or Notice of Non-coverage prior to being seen - CORRECT ANSWER-Advance Beneficiary Notice Electronic Medical Record and Practice Management Systems that are certified by CMS and the Office of the National Coordinator for Health Information Technology (ONC) require to have built in _________ Verification Systems. - CORRECT ANSWER-Insurance Verification Systems (IVS). NOTE: Once activated they will automatically ping the insurance company IVS will come back to the Practice management system (PMS) will highlight the appointment as Green, Yellow, or Red. What does each color mean? - CORRECT ANSWER-Green - Verified and Approved Yellow - There may be a problem with this insurance Red - Insurance is not active or out of network and do not participate Most PMS systems have the ability to capture the IVS information in an electronic footprint that occurs in the system. The information is held as a ______ ______ - CORRECT ANSWER-Virtual Envelope Even if the practice does not use EHR or EHR is not interfaced with the PMS, do they still have the ability to access IVS system? - CORRECT ANSWER-Yes Most insurance denials are due to what three reasons? - CORRECT ANSWER-Incorrect patient demographics invalid insurance information ICD-10 code that is missing a seventh character required for that condition The claims process is streamlined and clean claims are paid electronically within ____ - ____ days - CORRECT ANSWER-14-21 Examples of what a CMM should do to achieve optimum reimbursement and compliance - CORRECT ANSWER-Send staff to coding seminars or webinars regular due to frequent and signifcant changes Hire certified coders and billing specialists Ensure coding and billing staff are knowledgeable and familiar with reimbursement schedules of insurance plans (pages 8-9 for more information) NCCI - CORRECT ANSWER-National Correct Coding Initiative Four parts of Medicare - CORRECT ANSWER-Part A Part B Part C Part D What does Medicare Part A Cover? - CORRECT ANSWER-Inpatient care in a hospital Skilled nursing facility care Nursing home care (inpatient care in a skilled nursing facility that's not custodial or long-term care) Hospice care Home health care What does Medicare Part B Cover? - CORRECT ANSWER-Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best. What is Medicare Part C? - CORRECT ANSWER-A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. What is Medicare Part D? - CORRECT ANSWER-Medicare Drug Plan A plan's list of covered drugs is called a "formulary," and each plan has its own formulary. Medicare drug coverage typically places drugs into different levels, called "tiers," on their formularies. Drugs in each tier have a different cost. Medicare Part B RBRV - CORRECT ANSWER-Resource Based Relative Scale RBRV is based on the product of what three numbers? - CORRECT ANSWER-Relative Value Units (RVUs) Geographic Practice Cost Indices (GPCI) The national Conversion Factor (CF) RSUs are the sum what three components? - CORRECT ANSWER-Physician's work Practice expense and overhead Malpractice Medicare Managed Care Plans - CORRECT ANSWER-these are health care choices such as HMO's. Part C of the medicare program or premiums for supplemental insurance paid by the state through a Medicaid managed care option Medicare Write-Offs for Assigned Claims - What to Always write off? - CORRECT ANSWER-Always write off: -The difference between your actual charge and Medicare's allowed amount -Covered services that have been denied if the patient's Waiver of Liability has not been obtained (you cannot bill patient) -Your appeals rights have been exhausted/choose not to appeal Medicare Write-offs for Assigned Claims - What NOT to write off? - CORRECT ANSWER-The patients 20 percent co-insurance, yearly deductible, non-covered services, and denied services if waiver of liability was not obtained Medicare Write-offs for Non-assigned Claims - What to ALWAYS write off? - CORRECT ANSWER-Covered services that have been denied if: The patient's waiver of liability has not been obtained Your appeal rights have been exhausted or you choose not to appeal Medicare Write-offs for Non-assigned Claims - What NOT to write off? - CORRECT ANSWER-Patients 20 percent co-insurance Patients yearly deductible Covered services that have been denied if the patient Waiver of Liability has been obtained The difference between your actual charge and the payment received from Medicare