Third party payer Study guides, Class notes & Summaries

NHA CBCS exam review 2024/2025 (questions and answers verified) Which of the following Medicare policies determines if a particular item or service is covered by Medicare? - C ORRECT ANSWER-National Coverage Determination (NCD) A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer? - C ORRECT ANSWER-Denied A billing and coding specialist should routinely analyze which of the following to ...

The nurse is speaking to students about changes in maternal-newborn care. One change is that self-care has gained wide acceptance with clients and the healthcare community due to research findings that suggest that it has which effect? A) Shortens newborn length of stay B) Decreases use of home health agencies C) Decreases healthcare costs D) Decreases the number of emergency department visits Answer: C Explanation: A) Length of stay is often determined by third-party payer (insurance c...

Advance Beneficiary Notice (ABN) A form provided to the patient when the provider believes Medicare will probably not pay for services received Allowed Amount The maximum amount a third-party payer will pay for a particular procedure or service Copayment a small fixed fee paid by the patient at the time of an office visit Coinsurance a provision under which both the insured and the insurer share the covered losses, typically 80:20 deductible specific amount of money a patient must pay out...

A person who represents either party of an insurance claim is the: A. doctor B. adjuster C. provider D. subscriber - adjuster A request for payment under an insurance contractor bond is called a(n): A. insurance application B. claim C. dual choice request D. total disability - claim Payment made periodically to keep an insurance policy in force is called: A. time limit B. premium C. coinsurance D. fee for service - premium A person or institution that gives medical care is a(n): ...

HFMA CRCR Exam with 100% Correct Answers 2023 CORRECT AND VERIFIED ANSWERS)|ALREADY GRADED A+ Through what document does a hospital establish compliance standards? - Correctanswer-code of conduct what is a recurring or series registration? - Correct answer-One registration record iscreated for multiple days of service What are nonemergency patients who come for service without prior notification to theprovider called? - Correct answer-Unscheduled patients Which of the following st...

Which of the following Medicare policies determines if a particular item or service is covered by Medicare? -Answer - National Coverage Determination (NCD) A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer? -Answer - Denied A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? -Answer - Aging report

Knowing which of the following can best assist a technician in the prevention of data entry errors? A. Names of medications B. Insurance co-payments C. Pharmacokinetics D. Physician contact information - A. Names of medications Which of the following injectable drugs would be stored in refrigerator? A. Clindamycin B. Ciprofloxacin C. Cyanocobalamin D. Calcitonin-salmon - D. Calcitonin-salmon The requirement that a non-formulary medication be covered only if approved by the third-party...

CMAA EXAM STUDY GUIDE QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS 100% VERIFIED when should an MA assistant schedule a return appointment for a pt when pt checks out proper protocol when following up on nonpayment and of claims from third party payers notify the pt of the claim; contact third party payer

Which of the following Medicare policies determines if a particular item or service is covered by Medicare? - National Coverage Determination (NCD) A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer? - Denied A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? - Aging report Which of the following should a billing an...

CBCS Practice Test Questions And Answers Which of the following sections of the medical record is used to determine the correct evaluation and management code used for billing and coding? - ANS history and physical A billing and coding specialist is reviewing a CMS-1500 claim form. The "assignment of benefits" box has been checked "yes." The checked box indicates which of the following? - ANS The provider receives payment directly from the payer Which of the following do physic...