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A provider removes a skin lesion in an ASC and receives a denial from the insurance carrier that states "Lower level of care could have been provided." What steps should the biller take? a. Write-off the charge. b. Check with the provider and write an appeal to the insurance carrier explaining why the service was provided in the ASC. c. Check with the provider and write an appeal to the insurance carrier explaining why the service was not an inpatient service. d. Submit the CMS-1500 cla...

Which of the following TRICARE options is/are available to active duty service members? - AnswerTRICARE Prime A claim for CPT® codes 58260 and 58720 was filed to the patient's insurance. The claim was returned with 58260 paid and 58720 denied as inclusive. How should the claim be handled? - Answer-A corrected claim should be filed with CPT® code 58262 A dermatologist performed an excision of a squamous cell carcinoma from the patients forehead with a 1.2 cm excised diameter. The excision...

An internist sees a 20-year-old patient for an office visit. The patient needs to see an endocrinologist for a consultation regarding her diabetes. The internist is a participating provider in her plan. She can choose any provider she wishes for her consultations, but she will save money if she sees a specialist that is in her network. She does not require a referral for her consultation. What type of insurance does the patient have? a. HMO b. Indemnity insurance c. Medicare Advantage d....

A family has health insurance coverage from both the father and mother. The father's birthday is May 29, 1989 and the mother's birthday is May 26, 1990. Which insurance would be primary for their three children? A. The father's insurance would be primary because he was born before the mother. B. The mother's insurance would be secondary because she was born after the father. C. The mother's insurance would be primary based on the month and day of her birthday. D. The father's insuran...

Medicare Supplement Insurance policies or Medigap is sold by: a. Medicare b. Medicaid c. Private insurance companies d. Healthcare providers - Answer-c. Private insurance companies Albert has purchased a Medigap policy to supplement his Medicare benefits. To which entity will Albert pay his monthly premium for this policy? a. Medicare b. MAC c. Medicaid d. Medigap insurance company - Answer-d. Medigap insurance company Andrew has selected TRICARE Prime as his health plan. Who will be ...

What does no-fault insurance mean? a. The insurance will pay only if no one was found to be at fault. b. The insurance will pay regardless of who was at fault. c. Both insurances pay evenly when no one is found to be at fault. d. No payments or benefits are paid. - Answer-b. The insurance will pay regardless of who was at fault. Which entity(ies) require employers to maintain workers' compensation coverage? a. Federal b. State c. Federal and State d. None of the above - Answer-c. Feder...

Patient presents with difficulty speaking, facial droop, and she is unable to close her left eye. She has no other complaints. She is diagnosed with Bell's palsy. She is prescribed Corticosteroids. She will return in 3 days for follow-up. What ICD-10-CM code(s) is/are reported? a. G51.0, R29.810, R47.81 b. P11.3 c. G51.0 d. R29.810, R47.81 - Answer-c. G51.0 After testing a newborn in the NICU, the newborn is found to have hypothyroidism due to congenital absence of a thyroid gland. How ...

A patient is scheduled in your office for Botox injections in her face for her smile lines. She has not met her deductible and states that she is going to use money from her Healthcare Reimbursement Account to pay for it. Is this possible? a. Yes, as long as she has enough money in the account, she may use it for any medical expense she chooses. b. No, cosmetic procedures are ineligible expenses. c. Yes, but only a portion since it is a cosmetic procedure. d. No, because a Healthcare ...

A 3 year-old is seen for ear infections in both of his ears. The provider's assessment indicates that the infection is worse in the child's right ear. What ICD-10-CM code(s) should be assigned? a. H66.92, H66.91 b. H66.90 c. H66.91, H66.92 d. H66.93 - Answer-d. H66.93 A patient complains of a severe sore throat, a fever and headache. Based on the results of a rapid strep test the provider determines the patient has strep throat. What ICD-10-CM code(s) is/are reported? a. J02.0 b. J02....

A 40-year-old patient has severe pain in his lower back. After multiple surgeries, physical therapy, and various medications without relief, the provider performed percutaneous epidural lysis of adhesions. An epidural catheter is placed and an epidurography is performed. A series of injections are performed over a span of 3 days. The catheter is removed. Utilize the NCCI edits and MUE edits above. Which of the following is the correct way to report this procedure? :a. 62264 b. 62264 x 2 c...

Case 7 - Clearinghouse Rejection Report Status: 7/6/20XX Contents: REJ - untimely filing; UTF Patient Name: Smith, Hattie Patient Number: MRN7862 Payer: AAPC Health Plan Submission Date: 7/5/X2 Date of Service: 12/23/X1 Charge: $1200.00 Provider: Dailey, David According to this clearinghouse rejection report, what actions should be taken on the claim for Hattie Smith, Date of Service 12/23/20X1?I. Review claim and ensure DOS is correct. If DOS is incorrect, correct claim and resubmit....

12 National Priority Purposes (instances that don't require the individual's authorization to be released) - 1. Required by Law - Includes by statute, regulation, or court orders. 2. Public Health Activities - Release to public health authorities who are legally authorized to receive reports to prevent and control disease, injury, or disability. 3. Victims of Abuse, Neglect or Domestic Violence 4. Health Oversight Activities - Authorized health oversight activities include audits and i...

If add-on procedure code 11101 is performed twice during an office visit, how is it indicated on the CMS- 1500 claim form? a) code 11101 is reported with a modifier 50 b) code 11101 is reported twice c) code 11101 is reported once with the number 2 in box 24G d) code 11101 is reported twice with the number 2 in box 24G - Answer-Code 11101 is reported once with the number 2 in box 24G 60-year-old woman is seeking help to quit smoking. She makes an appointment to see Dr. Lung for an initia...

________ is when the provider has limited access to payer and patient data elements on their patients only. - Extranet An extranet is a private computer network allowing controlled access to the payer's system. The provider has limited access to payer and patient data elements on their patients only. 1992 US federal government implemented a standardized physician payment schedule utilizing resourcebased relative value scale - RBRVS A batch of claims is submitted to the clearinghouse for pr...

Nursing 105 Bundled Exams 2024/2025 with complete solution

0.5 Grams - 500 Miligrams 0.5 Liters - 500 Mililiters 1 Gram - 1000 Miligrams 1 Kilogram - 2.2 Pounds 1 Liter - 1000 Mililiters 15 mililiters - 1 Tablespoon 30 mililiters - 1 Ounce 5 Mililiters - 1 teaspoon A 12-year-old patient, dying of heart failure, wants to have his organs removed for transplantation after his death. What action by the nurse is correct? A) Prepare the organ donation form for the patient to sign while he is still oriented. B) Instruct the patient to talk with his ...

A 12-year-old patient, dying of heart failure, wants to have his organs removed for transplantation after his death. What action by the nurse is correct? - Instruct the patient to talk with his parents about his desire to donate his organs. A female patient from an unfamiliar culture is in the emergency department and needs an emergency operation. She wishes to wait for a tribal elder to arrive before making a decision about the operation. The best action by the nurse is to: - Wait for the ...

A 2-year-old patient is being admitted for an outpatient tonsillectomy surgery. Which will provide the best source of information regarding what comforts the patient when stressed? - Parents A patient has a problem of muscular weakness. The outcome is to walk in the hospital hallway to the nurse's station and back to bed 3 times a day. The patient has not walked at all today. What should the nurse do first? - Reassess the patient A patient is ready to be discharged from the hospital to go ...

18 months - the age in which the fontonelle has fully closed 20th century influences on nursing - first nursing philosophy; movement towards scientific, research based practices; nursing assume expanded roles 21st century influences on nursing - curriculum changes advances in technology new programs assess current health concerns leadership roles in developing standards and policies. 6 Caring Behaviors - 1. Presence 2. Touch 3. Listening 4. Knowing the patient: continuity of care 5. S...

-ation - an action or process Differentiation: The action of discovering a difference. Discontinuation: The process of stopping something Experimentation: The process of performing a scientific experiment -ectomy - surgical removal of something tonsillectomy - removal of tonsils appendectomy - removal of appendix -ismus - indicates a spasm or contraction strabismus - contraction of eye phlebismus -itis - inflammation of cellulitis dermatitis arthritis -lysis - Decomposition, destruc...