NHA - Certified Billing and Coding Specialist (CBCS) Study Guide latest updated
The symbol "O" in the Current Procedural Terminology reference is used to indicate what? - Answer- Reinstated or recycled code
In the anesthesia section of the CPT manual, what are considered qualifying circumstances? - 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? - Answer- 12
What is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - Answer- Operative report
What action should be taken first when reviewing a delinquent claim? - Answer- Verify the age of the account
A claim can be denied or rejected for which of the following reasons? - Answer- Block 24D contains the diagnosis code
A coroner's autopsy is comprised of what examinations? - Answer- Gross Examination
Medigap coverage is offered to Medicare beneficiaries by whom? - Answer- Private third-party payers
What part of Medicare covers prescriptions? - Answer- Part C
What plane divides the body into left and right? - Answer- Sagittal
Where can unlisted codes be found in the CPT manual? - Answer- Guidelines prior to each section
Ambulatory surgery centers, home health care, and hospice organizations use which form to submit claims? - Answer- UB-04 Claim Form
What color format is acceptable on the CMS-1500 claim form? - Answer- Red
Who is responsible to pay the deductible? - Answer- Patient A patient's health plan is referred to as the "payer of last resort." What is the name of that health plan? - Answer- Medicaid
Informed Consent - Answer- Providers explain medical or diagnostic procedures, surgical interventions, and the benefits and risks involved, giving patients an opportunity
to ask questions before medical intervention is provided.
Implied Consent - Answer- A patient presents for treatment, such as extending an arm to allow a venipuncture to be performed.
Clearinghouse - Answer- Agency that converts claims into standardized electronic format, looks for errors, and formats them according to HIPAA and insurance standards.
Individually Identifiable - Answer- Documents that identify the person or provide enough information so that the person can be identified.
De-identified Information - Answer- Information that does not identify an individual because unique and personal characteristics have been removed.
Consent - Answer- A patient's permission evidenced by signature.
Authorizations - Answer- Permission granted by the patient or the patient's representative to release information for reasons other than treatment, payment, or health care operations.
Reimbursement - Answer- Payment for services rendered from a third-party payer.
Auditing - Answer- Review of claims for accuracy and completeness.
Fraud - Answer- Making false statements of representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist.
Upcoding - Answer- Assigning a diagnosis or procedure code at a higher level than the documentation supports, such as coding bronchitis as pneumonia.
Unbundling - Answer- Using multiple codes that describe different components of a treatment instead of using a single code that describes all steps of the procedure.
Abuse - Answer- Practices that directly or indirectly result in unnecessary costs to the Medicare program.
Business Associate (BA) - Answer- Individuals, groups, or organizations who are not members of a covered entity's workforce that perform functions or activities on behalf of or for a covered entity.
The symbol "O" in the Current Procedural Terminology reference is used to indicate what? - Answer- Reinstated or recycled code
In the anesthesia section of the CPT manual, what are considered qualifying circumstances? - 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? - Answer- 12
What is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - Answer- Operative report
What action should be taken first when reviewing a delinquent claim? - Answer- Verify the age of the account
A claim can be denied or rejected for which of the following reasons? - Answer- Block 24D contains the diagnosis code
A coroner's autopsy is comprised of what examinations? - Answer- Gross Examination
Medigap coverage is offered to Medicare beneficiaries by whom? - Answer- Private third-party payers
What part of Medicare covers prescriptions? - Answer- Part C
What plane divides the body into left and right? - Answer- Sagittal
Where can unlisted codes be found in the CPT manual? - Answer- Guidelines prior to each section
Ambulatory surgery centers, home health care, and hospice organizations use which form to submit claims? - Answer- UB-04 Claim Form
What color format is acceptable on the CMS-1500 claim form? - Answer- Red
Who is responsible to pay the deductible? - Answer- Patient A patient's health plan is referred to as the "payer of last resort." What is the name of that health plan? - Answer- Medicaid
Informed Consent - Answer- Providers explain medical or diagnostic procedures, surgical interventions, and the benefits and risks involved, giving patients an opportunity
to ask questions before medical intervention is provided.
Implied Consent - Answer- A patient presents for treatment, such as extending an arm to allow a venipuncture to be performed.
Clearinghouse - Answer- Agency that converts claims into standardized electronic format, looks for errors, and formats them according to HIPAA and insurance standards.
Individually Identifiable - Answer- Documents that identify the person or provide enough information so that the person can be identified.
De-identified Information - Answer- Information that does not identify an individual because unique and personal characteristics have been removed.
Consent - Answer- A patient's permission evidenced by signature.
Authorizations - Answer- Permission granted by the patient or the patient's representative to release information for reasons other than treatment, payment, or health care operations.
Reimbursement - Answer- Payment for services rendered from a third-party payer.
Auditing - Answer- Review of claims for accuracy and completeness.
Fraud - Answer- Making false statements of representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist.
Upcoding - Answer- Assigning a diagnosis or procedure code at a higher level than the documentation supports, such as coding bronchitis as pneumonia.
Unbundling - Answer- Using multiple codes that describe different components of a treatment instead of using a single code that describes all steps of the procedure.
Abuse - Answer- Practices that directly or indirectly result in unnecessary costs to the Medicare program.
Business Associate (BA) - Answer- Individuals, groups, or organizations who are not members of a covered entity's workforce that perform functions or activities on behalf of or for a covered entity.
