NCCT REVIEW - CLAIMS PROCESS EXAM QUESTIONS AND ANSWERS

NCCT REVIEW - CLAIMS PROCESS EXAM QUESTIONS AND ANSWERS Which of the following requires a patient's signature for the medical facility/provider to be paid by the carrier? A. SOF B. ABN C. NPP D. RA - Answer-SOF ( Singature on FIle) The Assignment of Benefits form is used to allow the insurance company to A. pay the provider directly. B. pay the beneficiary directly. C. pay for the services provided. D. bill other insurance companies. - Answer-Pay the provider directly —rational—— when a patient sees a new physician, one form that is filled out as part of the new patient paperwork is in Assignment of Benefits form. This form states that the patient is allowing the insurance company to pay the provider directly. An Advance Beneficiary Notice must be signed A. before a series of covered services. B. prior to the start of any surgical procedure. C. before a service which is not covered is provided D. prior to a procedure when the risk of death is high. - Answer-before a service which is not covered is provided —rational— An ABN is used to let the patient know that a service that is going to be provided to the patient might not be paid or processed by Medicare. This must be filled in completely and explained to the patient that he/she may be responsible for the charges in the event the services are not covered. This is always done prior to any of the services being performed. A patient presents for a procedure that Medicare will not pay for. Which of the following should the billing and coding specialist do? - Answer-Have the patient sign an advanced beneficiary notice. (An advanced Beneficiary Notice, or ABN, is a form that Medicare requires all healthcare providers to use when Medicare does not pay for a service or procedure. Patients must sign the form to acknowledge that they understand they have a choice about their healthcare procedure or service in the event that Medicare does not pay. Choosing to proceed with the service or procedure holds the patient financially responsible for payment in full.) Which of the following signed documents should the insurance and coding specialist obtain from all new patients? (Select the three (3) correct answers.) A. insurance eligibility B. HIPAA acknowledgement C. financial responsibility D. advance beneficiary notice E. assignment of benefits - Answer--HIPAA acknowledgement -financial responsibility -assignment of benefits —-Rationale—— Every new patient should receive a copy of HIPAA guidelines and sign an acknowledgement of it. A financial responsibility form should be signed by the patient/guardian acknowledging financial responsibility. Assignment of benefits needs to be signed giving the office authority to bill on his/her behalf. A claim that is not missing information is called A. dirty. B. pending. C. clean. D. scrubbed - Answer-clean. —————————- A claim that is not missing any pertinent information is called a clean claim. A claim that is missing information is a dirty claim. A scrubbed claim has been reviewed by a third party, such as a clearinghouse, and the errors or missing information have been corrected. A pending claim is being reviewed by the insurance carrier. To verify that multiple CPT® codes may be billed together without being considered unbundled, the insurance and coding specialist should query the A. CPT® coding nomenclature. B. private payer's policy guidelines. C. NCCI edits. D. clearinghouse. - Answer-NCCI edits. ———Rationale——— NCCI edits are published by Medicare as guidelines to their coding practices. NCCI edits contain services that are bundled together and should not be billed separately. Please note that not every code is mentioned in the NCCI edits, but should always be reviewed for information. Even though these edits are published for Medicare patients, may other insurances also use these guidelines. Which of the following are common reasons for a claim to be rejected by a primary payer? (Select the three (3) correct answers.) A. On the CMS 1500 form, Block 29, Amount Paid, is blank. B. Insurance ID number is incorrect. C. Tertiary insurance information is missing. D. Dates of service do not match charges. E. Diagnosis codes are not linked to procedures. - Answer-Insurance ID number is incorrect., Dates of service do not match charges., Diagnosis codes are not linked to procedures. ——————-Rationale————— A claim can be rejected for many reasons. Some examples of claim rejection by the insurance carrier are: the insurance ID number is incorrect, the dates of service are incorrect, the diagnosis codes are not linked to the procedures, the physician information is missing, or the secondary insurance information is missing. It is allowable for the "Amount Paid" space to be left blank. There is no space on a CMS-1500 form for a tertiary (3rd) payer. The Patient Information section of an encounter form contains A. diagnosis codes. B. date of service. C. physician's signature. D. treatment codes. - Answer-date of service. ——-Rationale—— The patient information section of an encounter form includes the patient's name, date of birth, and date of service. Which of the following is required information from the encounter form necessary for insurance reimbursement? (Select the three (3) correct answers.) A. date of service B. procedure codes C. physician's signature D. HCPCS codes E. authorization number - Answer-date of service procedure codes, HCPCS codes —Rationale——- An encounter form is used for each patient visit. It is usually made specifically for that practice and includes common codes that the providers use. The providers then check off the codes as the patient's visit progresses. A date of service is used on this form, since it is expected that a patient will have many of these in his chart (from previous dates of service). A medical biller or coder will use the data from the encounter form to fill out portions of the claim form. A physician's signature is not required on an encounter form. An authorization number is also not included on an encounter form, as it should usually be prepared prior to a visit. Which of the following should the insurance and coding specialist verify upon receiving an encounter form? (Select the three (3) correct answers.) A. doctor assessment B. date of service C. authorization number D. provided service E. patient balance - Answer-doctor assessment, date of service, provided service —Rationale— An insurance and coding specialist should verify the following information upon receiving an encounter form: The physician's assessment, the date of service, the services provided, the patient's name, and any additional diagnoses. Authorization numbers and patient balances are not found on encounter forms. This information can usually be found on claim forms and ledger cards. The multipurpose billing forms should be reviewed and updated to include new or revised codes A. quarterly. B. annually. C. bi-monthly. D. monthly. - Answer-annually.