Denials Study guides, Class notes & Summaries

B. If documentation supports the service, have the staff contact the carrier to reprocess the claims. Code 33010 was valid for the date of service billed. Rationale: The effective dates of codes are date of service driven. New CPT® codes become effective January 1st of every year. When auditing, verify codes based on the codes that were valid during the date of service. - correct answer In February 2020, an auditor is asked to review 10 records for date of service 12/1/2019 to make sure the ...

What are the 3 things to advise person of constitutional rights? 1) Reading rights to person 2) Asking person if he/she understands rights 3) Explaining rights to person What are the steps to interview of a suspect? - Establish rapport - Listen - Take notes and clarify details - Evaluates body language - Process info to utilize in the interrogation approach and/or theme How to conduct interrogation of a suspect? - Using interrogation techniques - Controls di...

AHIMA Revenue Cycle Management Best Practices – Quiz with Complete Solutions In the revenue cycle, what is the role of Administration? - Strategic goals - Operational efficiency and effectiveness In the revenue cycle, what is the role of Finance? Cash flow In the revenue cycle, what is the role of Managed Care/ Payer Services? - Contract management - Material breach issues affecting reimbursement (claims projects) In the revenue cycle, what is the role of Patient Access? -...

What are some ways to avoid missing/invalid code denials on submitted claims? I. QA coding staff II. Code the same way all the time III. Offer education to coding staff IV. Use current year coding books I, II, III I, IV I, III, IV I, III 1 of 27 Term Which regulations require a health insurer offering group or individual coverage to implementan effective appeals process for appeals of coverage determinations and claims? Health Insurance Portability and Accountability Act False Claim...

AAPC CPB Chapter 13 ReviewWhich denial occurs when the claim is a liability case and was submitted to the health insurance? a. Coordination of Benefits b. Request for medical records c. Claim not covered by insurer d. Claim covered by other insurer - correct answer d. Claim covered by other insurer Similar to a coordination of benefits denial, a claim covered by other insurer denial occurs when the claim is a liability case such as auto or work-related accident. What is a rejected cl...

AAPC CPB - Chapter 13 Review On 05/02/19, a claim for a fine needle aspiration biopsy with ultrasound guidance was reported with CPT code 10022, ICD-10-CM code D49.2 for DOS 05/01/2019. Why would the claim be denied? a. Not medically necessary b. Invalid CPT code for DOS c. Invalid ICD-10-CM code for DOS d. Timely filing - correct answer b. Invalid CPT code for DOS Response Feedback: Rationale: CPT™ code 10022 was deleted in 2019. CPT® codes should only be reported for dates of s...

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 ...

CRCR Exam Questions and Answers All Correct What do Case Managers do? - Answer-Monitor high resource cases to ensure effective utilization What is HIM responsible for? - Answer-all pt medical records: transcribe, coding, release to biling, answer requests for documentation What is utilization management responsible for? - Answer-manage cases: services correct, on time What are the three types of utilization review? - Answer-Prospective, Concurrent, Retrospective Where can home heal...

CPPM 2023 Exam Questions and Answers All Correct What percentage of communication occurs through body language ? - Answer-55 The physician who owns the practice approaches you to discuss an increased frequency of denials . Which of the following would give the physician the impression that you have low interest in what he is saying ? - Answer-Fidgeting or little eye contact Which of the following is NOT a typical duty of a practice manager ? - Answer-Preparation of the patient for the ...

Domain 4 CDIP notes Part 1 of 6 Questions and Answers 100% Pass Why hire Medicare Contractor Reviewers? For Protection of Medicare Trust Fund. Who is 1st of 6 Medicare Contract Reviewers? (MACs) Medicare Administrative Contractors Whos is 2nd of 6 Medicare Contract Reviewers? (RACs) Recovery Auditor Contractors Who's 3rd of 6 Medicare Contractor Reviewers? (CERTs) Comprehensive Error Rate Testing Contractors Who's 4th of 6 Medicare Contract Reviewers? (SMRCs) Supplemental Medical Review Co...