NHA CBCS || QUESTIONS WITH COMPLETE
SOLUTIONS!!
Assignment of benefits correct answers contract in which the provider directly bills the payer
and accepts allowable charge
Medicare Summary Notice (MSN) correct answers A summary sent to the patient from
Medicare that summarizes all services provided over a period of time with an explanation of
benefits provided
Remittance Advice correct answers notice sent by the insurance company that contains
payment information about a claim; the report sent from the third-party payer to the provider
that reflects any changes made to the original billing
Coordination of Benefits (COB) correct answers the provision of an insurance contract that
limits benefits to 100% of the cost
COB Rules correct answers determines which insurance plans are primary and which are
secondary
Third-party payer correct answers Organization other than a patient who pays for services,
such as insurance companies, Medicare, and Medicaid.
explanation of benefits correct answers describes the services rendered, payment covered,
and benefit limits and denials
crossover claim correct answers Claim submitted by people covered by a primary and
secondary insurance plan.
Medicare Part A correct answers Provides hospitalization insurance to eligible individuals.
Medicare Part B correct answers outpatient and office visits
voluntary supplemental medical insurance to help pay for physicians' and other medical
professionals' services, medical services, and medical-surgical supplies not covered by part A
Medicare Part C correct answers Medicare Advantage Plans; combined package of benefits
under Medicare Parts A and B that may offer extra coverage for services such as vision,
hearing, dental, health and wellness
Medicare Part D correct answers Prescription drug coverage
medigap correct answers a private health insurance that pays for most of the charges not
covered by A and B
State Children's Health Insurance Program (SCHIP) correct answers a public health insurance
program, jointly funded by the federal and state governments, that provides health insurance
coverage for children whose families meet income eligibility standards
, Time-Specific(Stream) Scheduling correct answers an appointment scheduling method in
which each patient is given a different, specific appointment time
aka fixed appointment scheduling, single booking
Wave scheduling correct answers A method of scheduling appointments in which several
patients are given the same appointment time and are seen in the order in which they arrive.
Modified wave scheduling correct answers An appointment system that has some fixed
appointments and some appointment times during which patients are seen in order of arrival.
Double booking correct answers scheduling two patients at the same time
open booking (tidal wave scheduling) correct answers not scheduled for a specific time, seen
in the order which they arrive
Claim adjudication correct answers refers to the determination of the insurer's payment or
financial responsibility after the member's insurance benefits are applied to a medical claim.
modifier -50 correct answers Bilateral procedure
O in Current Procedure Terminology correct answers reinstated or recycled code
Block 13 is left blank correct answers the third-party payer reimburses the patient, and the pt
is responsible for reimbursing the provider
The first listed diagnoses code is correct answers principal diagnoses
A claimed is denied bc the insurance company does not cover the service and there were no
errors on the claim form what is the process following the denial correct answers claim will
not be resubmitted and the pt will be sent the bill
Z codes correct answers immunizations
What modifier should be used to indicate a professional service has been discontinued prior
to completion? correct answers -53
Adjudication correct answers considered the final determination of the issues involving
settlement of an insurance claim
time period the billing and coding specialist should track unpaid claims before taking action
is correct answers 30 days
patient account record correct answers forms used as a financial report of all services
provided to patients
lymphatic system correct answers regulates immunity
stages/ life cycle of insurance claim correct answers claim submission
claim processing
claim adjudication
SOLUTIONS!!
Assignment of benefits correct answers contract in which the provider directly bills the payer
and accepts allowable charge
Medicare Summary Notice (MSN) correct answers A summary sent to the patient from
Medicare that summarizes all services provided over a period of time with an explanation of
benefits provided
Remittance Advice correct answers notice sent by the insurance company that contains
payment information about a claim; the report sent from the third-party payer to the provider
that reflects any changes made to the original billing
Coordination of Benefits (COB) correct answers the provision of an insurance contract that
limits benefits to 100% of the cost
COB Rules correct answers determines which insurance plans are primary and which are
secondary
Third-party payer correct answers Organization other than a patient who pays for services,
such as insurance companies, Medicare, and Medicaid.
explanation of benefits correct answers describes the services rendered, payment covered,
and benefit limits and denials
crossover claim correct answers Claim submitted by people covered by a primary and
secondary insurance plan.
Medicare Part A correct answers Provides hospitalization insurance to eligible individuals.
Medicare Part B correct answers outpatient and office visits
voluntary supplemental medical insurance to help pay for physicians' and other medical
professionals' services, medical services, and medical-surgical supplies not covered by part A
Medicare Part C correct answers Medicare Advantage Plans; combined package of benefits
under Medicare Parts A and B that may offer extra coverage for services such as vision,
hearing, dental, health and wellness
Medicare Part D correct answers Prescription drug coverage
medigap correct answers a private health insurance that pays for most of the charges not
covered by A and B
State Children's Health Insurance Program (SCHIP) correct answers a public health insurance
program, jointly funded by the federal and state governments, that provides health insurance
coverage for children whose families meet income eligibility standards
, Time-Specific(Stream) Scheduling correct answers an appointment scheduling method in
which each patient is given a different, specific appointment time
aka fixed appointment scheduling, single booking
Wave scheduling correct answers A method of scheduling appointments in which several
patients are given the same appointment time and are seen in the order in which they arrive.
Modified wave scheduling correct answers An appointment system that has some fixed
appointments and some appointment times during which patients are seen in order of arrival.
Double booking correct answers scheduling two patients at the same time
open booking (tidal wave scheduling) correct answers not scheduled for a specific time, seen
in the order which they arrive
Claim adjudication correct answers refers to the determination of the insurer's payment or
financial responsibility after the member's insurance benefits are applied to a medical claim.
modifier -50 correct answers Bilateral procedure
O in Current Procedure Terminology correct answers reinstated or recycled code
Block 13 is left blank correct answers the third-party payer reimburses the patient, and the pt
is responsible for reimbursing the provider
The first listed diagnoses code is correct answers principal diagnoses
A claimed is denied bc the insurance company does not cover the service and there were no
errors on the claim form what is the process following the denial correct answers claim will
not be resubmitted and the pt will be sent the bill
Z codes correct answers immunizations
What modifier should be used to indicate a professional service has been discontinued prior
to completion? correct answers -53
Adjudication correct answers considered the final determination of the issues involving
settlement of an insurance claim
time period the billing and coding specialist should track unpaid claims before taking action
is correct answers 30 days
patient account record correct answers forms used as a financial report of all services
provided to patients
lymphatic system correct answers regulates immunity
stages/ life cycle of insurance claim correct answers claim submission
claim processing
claim adjudication
