NCCT: Interactive Review: Medical Insura
Questions And Correct Answers
Eligibility cfor cMedicaid cmay cchange cas cquickly cas c- cCORRECT cANS✔✔monthly.
Which cof cthe cfollowing cprocesses crequires cchecking cand cconfirming cthat cthe cpatient cis ca cmem
cand cthat cthe cmember cidentification cnumber cis ccorrect? c- cCORRECT cANS✔✔verification
The cpatient cis ca c3-year-old. cBoth cparents chave cprivate cinsurance ccoverage con cthe cpatient, can
cHealthcare cSavings cAccount. cThe cprimary cinsurance cbelongs cto cthe cparent c- cCORRECT cANS
cin cthe cyear.
A cchild cwas cseen cby cher cpediatrician. cThe cchild cis ccovered cunder cboth cher cfather's cand cmoth
cthe c"Birthday cRule," cthe cmother's cinsurance cis cprimary. cWhy? c- cCORRECT cANS✔✔The cmoth
cthe ccalendar cyear.
Which cof cthe cfollowing cstatements cis ctrue cconcerning ca ccourt corder cabout cchildren's chealth cco
cCORRECT cANS✔✔Divorce crulings coverride cthe cbirthday crule.
If ca cmarried ccouple cis ccovered cunder cboth cspouses' chealth cinsurance cand cthe chusband cis cpic
chimself, che cshould c- cCORRECT cANS✔✔use cboth cof cinsurance cbenefits cas cthey capply cto cthi
A cpatient chas cjust cleft cthe cdoctor's coffice cwith ca cnew cprescription cafter ca cscheduled cfollow cup
cinsurance ccovers cthe cbill ccompletely, cher csecondary cinsurance cpolicy c- cCORRECT cANS✔✔w
The cMedicare cSecondary cPayer cQuestionnaire cis ca cform cthat c- cCORRECT cANS✔✔patients cfi
cother cinsurance cdesignated cas cthe cprimary cinsurance.
Which cof cthe cfollowing cshould cthe cinsurance cand ccoding cspecialist ccheck cin corder cto cdetermin
cbilled cas cprimary cor csecondary? c- cCORRECT cANS✔✔COB: cCOB cstands cfor cCoordination cof
corder cin cwhich cthe cinsurance cspecialist cshould cbill cthe cpayers.
Which cof cthe cfollowing cstatements cis ctrue cfor can cemployee con cMedicare cif che cchooses ccover
cgroup cplan? c- cCORRECT cANS✔✔The cgroup cplan cwill cbe cprimary cand cMedicare cwill cbe cseco
, The cpatient cwas cinjured cat cwork cso cWorker's cCompensation cis cthe cprimary cinsurance ccarrier.
cthrough cWorker's cCompensation, cit cwould cfollow cthe cstandard cof cthe cpatient's chealth cinsuranc
cpatient cis cworking cand ccovered cunder cthe cemployers' cpolicy, cthe cclaim cshould cbe cfiled cwith cB
csubmission cand cthe cclaim cwould cbe cfiled cwith cMedicare clast.
Place cthe coptions cbelow cin corder cof cclaim csubmission, cwhere call cinsurances care crelevant. c(Cl
cthe cleft ccolumn cto ctheir ccorrect cposition cin cthe cright ccolumn.): cMedicare, cMedicaid, cHumana, c
cANS✔✔ABC cAuto, cHumana, cMedicare, cMedicaid:
It cis chighly cunlikely cthat ca cpatient cwould chave call cfour cof cthese cinsurances. cHowever, cif cthey c
cclaims care csubmitted cis crelevant. cIt cis cassumed cthat csince cthere cis cauto cinsurance cinvolved, c
can cautomobile caccident. cThe cauto cinsurance cshould cbe cfiled cfirst. cHumana, ca cprivate cpayer, c
cGovernment cinsurance, csuch cas cMedicare cand cMedicaid, cshould calways cbe csubmitted clast. cW
cMedicaid care cvalid, cMedicaid cshould cbe cbilled clast.
After ca cpatient cis cseen cfor ca cfollow cup cvisit, cthe cphysician corders cadditional cdiagnostic ctesting
cthe cinsurance cand ccoding cspecialist cneed cto cobtain? c- cCORRECT cANS✔✔pre-authorization:
A cbilling cand ccoding cspecialist cmust cobtain ca cpre-authorization cfor cthe cdiagnostic ctesting. cA cp
cfrom cthe cinsurance ccompany cfor cthe ctesting cto cbe cdone. cAn callowed camount cis cnot cobtained
cexplanation cof cbenefits, cafter cthe cservice cis ccompleted. cA creferral cis cneeded cto csee ca cspecia
cprovided cby cthe cprimary ccare cphysician. cAn cadvanced cbeneficiary cnotice cis ca cstatement cthat
cwhen cit cis cknown cthat cthe cinsurance ccompany cwill cnot cpay cfor cthe cservice cand cthe cpatient cis
canyway. cIt cis ca cpromise cthat cthe cpatient cwill cpay cfor cthe cservices cin cfull.
A cpatient cis creferred cto ca cspecialist cby cthe cprimary ccare cprovider. cPre-certification cis crequired
cvisit. cWhich cof cthe cfollowing cactions cis crequired cby cthe cinsurance cand ccoding cspecialist cto cob
cCORRECT cANS✔✔Contact cthe cpatient's cinsurance cprovider:
An cinsurance cand ccoding cspecialist cmust cobtain can cauthorization cfor ca cpatient cto csee cthe cspe
cobtained cby ccontacting cthe cpatient's cinsurance cprovider cfor cauthorization cbefore cthe cpatient cc
When csubmitting ca crequest cfor ca cpre-authorization, cthe cbilling cand ccoding cspecialist cshould c- c
ccodes cfor cany cscenario cthat cmay carise cduring cthe cprocedure:
When csubmitting cfor ca cpre-authorization, cthe cbilling cand ccoding cspecialist cshould cuse ccodes cf
cservice cthat cmay cbe cprovided. cFor cexample, cif ca cphysician cexpects cto cdo ca cstab cphlebectom
cperson cwho cis ccompleting cthe cpre-authorization cshould csubmit ccode c37766 c(stab cphlebectom
cinstead cof ccode c37765 c(stab cphlebectomy, c10-20 cincisions), cin ccase cthe cprocedure cis cslightly
cexpected. cPre-authorizations care ctypically cvalid cfor c6 cmonths. cIt cis ca cgood cidea cto cacquire cth
cas cpossible cprior cto cthe cprocedure cdate cwithin cthe c6-month cwindow, cin ccase cthe csurgery cis c
Which cof cthe cfollowing cis clikely cto cbe ca ccause cfor cdelay cin creceiving cprior capproval cfor ca cpro
cinsurance ccompany? c- cCORRECT cANS✔✔The cprocedure csubmitted cis cnot cincluded con cthe cp
The cprocedure csubmitted cnot con cthe cpolicy cwould cbe cconsidered cto cbe can cexclusion cto cthe cp
cconsideration cof cmedical cnecessity cwith cthe cinsurance ccompany. cA cresident cis cnot crequired ct
cemployees cof cthe cfacility. cA cprocedure ctaking clonger cthan cusual, crequires ca cmodifier, cnot cprio
Which cof cthe cfollowing cstatements cis ctrue cabout cpreauthorization? c- cCORRECT cANS✔✔It conl
cnecessity cand cis cnot ca cguarantee cof cpayment:
Preauthorization conly cpertains cto cmedical cnecessity cand cdoes cnot cguarantee cpayment. cIt cstate
cplausible, cdue cto cthe cproper cdiagnosis, cproper ctime cframe, cand cother crequirements cfor ca cser
cmedical cnecessity cfor cthat cservice. cAn cexample cis can cangiogram. cAccording cto cmedical cnece
Questions And Correct Answers
Eligibility cfor cMedicaid cmay cchange cas cquickly cas c- cCORRECT cANS✔✔monthly.
Which cof cthe cfollowing cprocesses crequires cchecking cand cconfirming cthat cthe cpatient cis ca cmem
cand cthat cthe cmember cidentification cnumber cis ccorrect? c- cCORRECT cANS✔✔verification
The cpatient cis ca c3-year-old. cBoth cparents chave cprivate cinsurance ccoverage con cthe cpatient, can
cHealthcare cSavings cAccount. cThe cprimary cinsurance cbelongs cto cthe cparent c- cCORRECT cANS
cin cthe cyear.
A cchild cwas cseen cby cher cpediatrician. cThe cchild cis ccovered cunder cboth cher cfather's cand cmoth
cthe c"Birthday cRule," cthe cmother's cinsurance cis cprimary. cWhy? c- cCORRECT cANS✔✔The cmoth
cthe ccalendar cyear.
Which cof cthe cfollowing cstatements cis ctrue cconcerning ca ccourt corder cabout cchildren's chealth cco
cCORRECT cANS✔✔Divorce crulings coverride cthe cbirthday crule.
If ca cmarried ccouple cis ccovered cunder cboth cspouses' chealth cinsurance cand cthe chusband cis cpic
chimself, che cshould c- cCORRECT cANS✔✔use cboth cof cinsurance cbenefits cas cthey capply cto cthi
A cpatient chas cjust cleft cthe cdoctor's coffice cwith ca cnew cprescription cafter ca cscheduled cfollow cup
cinsurance ccovers cthe cbill ccompletely, cher csecondary cinsurance cpolicy c- cCORRECT cANS✔✔w
The cMedicare cSecondary cPayer cQuestionnaire cis ca cform cthat c- cCORRECT cANS✔✔patients cfi
cother cinsurance cdesignated cas cthe cprimary cinsurance.
Which cof cthe cfollowing cshould cthe cinsurance cand ccoding cspecialist ccheck cin corder cto cdetermin
cbilled cas cprimary cor csecondary? c- cCORRECT cANS✔✔COB: cCOB cstands cfor cCoordination cof
corder cin cwhich cthe cinsurance cspecialist cshould cbill cthe cpayers.
Which cof cthe cfollowing cstatements cis ctrue cfor can cemployee con cMedicare cif che cchooses ccover
cgroup cplan? c- cCORRECT cANS✔✔The cgroup cplan cwill cbe cprimary cand cMedicare cwill cbe cseco
, The cpatient cwas cinjured cat cwork cso cWorker's cCompensation cis cthe cprimary cinsurance ccarrier.
cthrough cWorker's cCompensation, cit cwould cfollow cthe cstandard cof cthe cpatient's chealth cinsuranc
cpatient cis cworking cand ccovered cunder cthe cemployers' cpolicy, cthe cclaim cshould cbe cfiled cwith cB
csubmission cand cthe cclaim cwould cbe cfiled cwith cMedicare clast.
Place cthe coptions cbelow cin corder cof cclaim csubmission, cwhere call cinsurances care crelevant. c(Cl
cthe cleft ccolumn cto ctheir ccorrect cposition cin cthe cright ccolumn.): cMedicare, cMedicaid, cHumana, c
cANS✔✔ABC cAuto, cHumana, cMedicare, cMedicaid:
It cis chighly cunlikely cthat ca cpatient cwould chave call cfour cof cthese cinsurances. cHowever, cif cthey c
cclaims care csubmitted cis crelevant. cIt cis cassumed cthat csince cthere cis cauto cinsurance cinvolved, c
can cautomobile caccident. cThe cauto cinsurance cshould cbe cfiled cfirst. cHumana, ca cprivate cpayer, c
cGovernment cinsurance, csuch cas cMedicare cand cMedicaid, cshould calways cbe csubmitted clast. cW
cMedicaid care cvalid, cMedicaid cshould cbe cbilled clast.
After ca cpatient cis cseen cfor ca cfollow cup cvisit, cthe cphysician corders cadditional cdiagnostic ctesting
cthe cinsurance cand ccoding cspecialist cneed cto cobtain? c- cCORRECT cANS✔✔pre-authorization:
A cbilling cand ccoding cspecialist cmust cobtain ca cpre-authorization cfor cthe cdiagnostic ctesting. cA cp
cfrom cthe cinsurance ccompany cfor cthe ctesting cto cbe cdone. cAn callowed camount cis cnot cobtained
cexplanation cof cbenefits, cafter cthe cservice cis ccompleted. cA creferral cis cneeded cto csee ca cspecia
cprovided cby cthe cprimary ccare cphysician. cAn cadvanced cbeneficiary cnotice cis ca cstatement cthat
cwhen cit cis cknown cthat cthe cinsurance ccompany cwill cnot cpay cfor cthe cservice cand cthe cpatient cis
canyway. cIt cis ca cpromise cthat cthe cpatient cwill cpay cfor cthe cservices cin cfull.
A cpatient cis creferred cto ca cspecialist cby cthe cprimary ccare cprovider. cPre-certification cis crequired
cvisit. cWhich cof cthe cfollowing cactions cis crequired cby cthe cinsurance cand ccoding cspecialist cto cob
cCORRECT cANS✔✔Contact cthe cpatient's cinsurance cprovider:
An cinsurance cand ccoding cspecialist cmust cobtain can cauthorization cfor ca cpatient cto csee cthe cspe
cobtained cby ccontacting cthe cpatient's cinsurance cprovider cfor cauthorization cbefore cthe cpatient cc
When csubmitting ca crequest cfor ca cpre-authorization, cthe cbilling cand ccoding cspecialist cshould c- c
ccodes cfor cany cscenario cthat cmay carise cduring cthe cprocedure:
When csubmitting cfor ca cpre-authorization, cthe cbilling cand ccoding cspecialist cshould cuse ccodes cf
cservice cthat cmay cbe cprovided. cFor cexample, cif ca cphysician cexpects cto cdo ca cstab cphlebectom
cperson cwho cis ccompleting cthe cpre-authorization cshould csubmit ccode c37766 c(stab cphlebectom
cinstead cof ccode c37765 c(stab cphlebectomy, c10-20 cincisions), cin ccase cthe cprocedure cis cslightly
cexpected. cPre-authorizations care ctypically cvalid cfor c6 cmonths. cIt cis ca cgood cidea cto cacquire cth
cas cpossible cprior cto cthe cprocedure cdate cwithin cthe c6-month cwindow, cin ccase cthe csurgery cis c
Which cof cthe cfollowing cis clikely cto cbe ca ccause cfor cdelay cin creceiving cprior capproval cfor ca cpro
cinsurance ccompany? c- cCORRECT cANS✔✔The cprocedure csubmitted cis cnot cincluded con cthe cp
The cprocedure csubmitted cnot con cthe cpolicy cwould cbe cconsidered cto cbe can cexclusion cto cthe cp
cconsideration cof cmedical cnecessity cwith cthe cinsurance ccompany. cA cresident cis cnot crequired ct
cemployees cof cthe cfacility. cA cprocedure ctaking clonger cthan cusual, crequires ca cmodifier, cnot cprio
Which cof cthe cfollowing cstatements cis ctrue cabout cpreauthorization? c- cCORRECT cANS✔✔It conl
cnecessity cand cis cnot ca cguarantee cof cpayment:
Preauthorization conly cpertains cto cmedical cnecessity cand cdoes cnot cguarantee cpayment. cIt cstate
cplausible, cdue cto cthe cproper cdiagnosis, cproper ctime cframe, cand cother crequirements cfor ca cser
cmedical cnecessity cfor cthat cservice. cAn cexample cis can cangiogram. cAccording cto cmedical cnece
