Medical Billing and Coding: Q&A for Healthcare Professionals, Exams of Health sciences

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BREACH OF CONFIDENTIAL COMMUNICATION - Correct answer- unauthorized release of information under HIPAA Generate an accounts receivable aging report - Correct answer-What action should be taken to determine whether an account is delinquent? The risks and expected outcomes of a procedure - Correct answer-As part of the consent discussion when obtaining informed consent, the provider should explain this. the global period - Correct answer-Under CPT guidelines, the number of days surrounding a surgical procedure during which all services relating to the procedure- preoperative, during the surgery, and postoperative-are considered part of the surgical package and are not additionally reimbursed. $0 - Correct answer-A patient's charge for an office visit was $40.25. The insurance company paid the network contracted fee of $32.25. An adjustment of $8.00 has been applied. How much does the patient owe to the participating provider? ($8 - Discount according to insurance plan) add-on code - Correct answer-Procedures that are performed and reported only in addition to a primary procedure; indicated in CPT by a plus sign (+) next to the code. MEDICARE TO MEDICAID - Correct answer-An example of a Medigap

OCR (Office for Civil Rights) - Correct answer-Organization that conducts investigations and audits on questions regarding the privacy law. The Department of Health and Human Servises (HSS) Office of Inspector General - Correct answer-Contracts with Medicare to recoup money from inappropriately paid claims. Accounts RECEIVABLE - Correct answer-The amount of unpaid balances owed by patients and third-party payers to a facility. CPT (Current Procedural Terminology) - Correct answer-Needed to complete the procedure section of a CMS-1500 form FALSIFYING CERTIFICATES OF MEDICAL NECESSITY - Correct answer-Example of fraud. FEDERALLY FUNDED - Correct answer-Medicaid, Medicare, and TRICARE are examples of which of the following types of health insurance? STANDARD, EXTRA, AND PRIME - Correct answer-The three types of plans covered under TRICARE programs are. NPI OF THE PROVIDER WHO PROVIDED THE SERVICE - Correct answer-The is the billing provider NPI. (NPI - The National Provider Identifier) FRAUD - Correct answer-When a service or procedure that is not done, is billed to the insurance company. remark codes - Correct answer-an area on the EOB where the payer indicates conditions under which the claim was paid or denied MMDDYYYY - Correct answer-The format of a date in the CMS-1500 form MM DD YYYY (with spaces) - Correct answer-The format used in the CMS- form for a patient's birthday. ( block #3, mm/dd/yyyy is known as .) INSURANCE CARD - Correct answer-Collected from a patient during an initial office visit. You always need a copy of this to complete the insurance claim form POISONING - Correct answer-Overdose of a drug that causes damage to multiple body systems and has the potential for fatal reactions.

(Which ICD-10 Section is used to identify the code for a patient's swollen lips after taking his medication?)

Compensation Claims

12 MONTHS FROM THE DATE OF SERVICE - Correct answer-Medicare claims should be submitted within. UPPERCASE LETTERS - Correct answer-Used When entering information in an Intelligent Character Scanning (ICR) form. ACCOUNTS RECEIVABLE REPORT - Correct answer-A list of all account balances and the amounts owed to the medical practice at the end of the day is called an. (Used to monitor the revenue cycle and improve cash flow in a medical office.) HIPAA (Health Insurance Portability and Accountability Act of 1996). - Correct answer- Mandates the retention of patient records and insurance claims for 6 years cross-reference term - Correct answer-Meaning of "see also" in CPT-4 coding ALTERING CLAIMS TO INCREASE REIMBURSEMENT - Correct answer-Example of Abuse. CPT (Current Procedural Terminology) - Correct answer-Needed for the Procedure Section of the CMS-1500 form CLEAN CLAIM - Correct answer-health insurance claim form that has been completed correctly without any errors or omissions. (Where is further review not necessary before submitting payment? ) OUTSTANDING AMOUNTS OWED TO THE PRACTICE - Correct answer-Balances shown on Insurance Aging Report. ASTHMA - Correct answer-A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing. ( For which a nebulizer is used.) PAYMENT MATCHES THE BILLED AMOUNT LESS COPAYMENT (PAYMENT = THE BILLED AMOUNT - COPAYMENT) - Correct answer-What should an EOB show? ASSIGNING WRONG DIAGNOSIS CODES TO INCREASE REIMBURSEMENT - Correct answer-Example of a False Claim. LAMINECTOMY - Correct answer-A type of spinal surgery. The surgical removal of a lamina, or posterior portion, of a vertebra

3 (Three) - Correct answer-No. of key components considered when assigning E/M codes for an office visit CROSSOVER - Correct answer-When insurance companies electronically transfer data to facilitate coordination of benefits. CARDIOMYOPATHY - Correct answer-A primary disease of the heart muscle. The term used to describe all diseases of the heart muscle. RESUBMIT A CORRECTED CLAIM - Correct answer-A paper claim is rejected due to missing information. Which of the following actions should the billing and coding specialist take once the claim is corrected? This has to be done when a Medicare claim has incomplete information and is not paid. TO ALLOW FOR HEALTH CARE ACCESS, PORTABILITY, AND RENEWABILITY - Correct answer-Primary purpose of HIPAA Title I. NOT VALID - Correct answer-A signed Release of Information form that does not have a date Release of Information form - Correct answer-Legal form signed by a patient that indicates who can see the patient's health records FEDERAL REGISTER - Correct answer-Contains proposed and final rules of federal standards of compliance. An official document, published every weekday, that lists the new and proposed regulations of executive departments and regulatory agencies. TRENDS OF NONPAYMENT BY THE INSURANCE COMPANY - Correct answer- Contained in the aging report which shows more than just the immediate claims pending. OPEN CLAIMS - Correct answer-Claims already submitted to the insurance company, and is waiting processing. DERMATOSIS - Correct answer-An abnormal condition of the skin APPEAL THE CLAIM - Correct answer-Action to take when a reimbursement request for an EMERGENCY appendectomy was denied because of the absence of a preauthorization. AGING REPORT - Correct answer-Used to review and track balances of an insurance company by date of service.

Used to determine if claims are delinquent. A report that lists the amount of money owed to the practice, organized by the amount of time the money has been owed.

10. Inflammation of the bronchial tubes. COORDINATION OF BENEFITS (COB) - Correct answer-To keep multiple insurers from paying benefits covered by other policies.

Explains how an insurance policy will pay if more than one policy applies PURPOSE OF PREAUTHORIZATION - Correct answer-Prior approval from a payer for services to be provided FEDERAL ANTI-KICKBACK LAW - Correct answer-Passed in 1972 to protect patients from fraud and abuse by reducing the influence of money on health care. Prohibits knowingly and willfully receiving or paying anything of value to influence the referral of federal health care program business. ADD THE MISSING INFORMATION AND RESUBMIT - Correct answer-Action that should be taken if the clearinghouse rejects a claim that is missing the patient's DOB. SEQUELA - Correct answer-Term used to mean Late Effects of a previous medical condition. An bnormal condition or complication that is caused by the original disease and remains after the original disease has resolved ANSI ASC X 12 837 - Correct answer-Example of an Electronic Claim Format. Stands for American National Standards Institute X DN - Correct answer-The qualifier used for a referring provider when filling in Block 17 of the CMS-1500 form CLAIMS SUBMISSION - Correct answer-the transmission of claims data (electronically or manually) to payers or clearinghouses for processing. OFFICE FOR CIVIL RIGHTS - Correct answer-The division of the federal government that conducts investigations and audits regarding privacy law violations. DIAGNOSIS CODE ENTRY - Correct answer-An example of an omission in the CMS- 1500 form that prevents a clean claim submission to an insurance company. RESUBMIT A CLAIM USING A DIFFERENT CODE - Correct answer-Action that should be taken if in an eClaim with multiple procedures, one procedure is denied. UNITS OF SERVICE - Correct answer-Example of data missing that could delay claims processing. A measure of the work being produced by the organization, such as patient

AT THE TIME THE APPOINTMENT IS MADE - Correct answer-The physician- patient impled contract begins. BLOCK 24G - Correct answer-This is where it is indicated that the same procedure or service was performed more than once in a day. This block is the number of days or units. PAYMENT DETERMINATION FOR A CLAIM - Correct answer-Contained in a Remittance Advice (RA). Covered services must meet all of the following Payment Determination Criteria. The treatment, service or supply must be:

• For the purpose of treating a medical condition
• The most appropriate delivery or level of service, considering potential benefits and harms to the patient
• Known to be effective in improving health outcomes
• Cost-effective for the medical condition being treated compared to alternative health interventions CREDIT COLUMN - Correct answer-Where an insurance payment to an account is posted. The right-hand amount column of a standard two-column ledger account form. EXCISION OF A FIBROSARCOMA - Correct answer-An example of cancer removal MEDICARE PART D - Correct answer-Medicare prescription drug reimbursement plans MEMBER CONTRACT - Correct answer-After the CMS-1500 form, the next most important source of financial information about a patient is the . RECORDS RELEASE AUTHORIZATION - Correct answer-Required document for any release of patient information. $8.05 - Correct answer-What is the patient's responsibility for a charge of $40.25, after the insurance pays 80%? CPT CODING MANUAL - Correct answer-The code 99214 is an example of one found in this manual $100 - Correct answer-What is the required adjustment amount necessary for the following Medicare Part B scenario? Charge is $200 with allowed amount of $100. Patient still owes deductible of

$60. Patient coinsurance is 20%. SUPERIOR - Correct answer-above; toward the head. Terminology when coding a directional area.

or an injury

COLLECTING INSURANCE INFORMATION - Correct answer-The first step in the life cycle of a claim is. $54.40 - Correct answer-The amount an insurance company pays for a charge of $120 given the following: The patient has a remaining balance of $52 in his deductible. The plan pays 80%. HMO (Health Maintenance Organization) - Correct answer-An insurance plan that requires a referral for a specialist appointment BASAL CELL CARCINOMA - Correct answer-most common type of skin cancer The code for this is found in the Neoplasm Table of ICD- RESUBMIT THE REVISED CLAIM - Correct answer-Action taken if a claim is denied because of a wrong Place of Service (POS) code. TRACER - Correct answer-A form submitted to the insurance company to determine the status of a claim ADVANCE BENEFICIARY NOTICE (ABN) - Correct answer-Medicare form used to inform a patient that a service to be provided is not likely to be reimbursed by the program. WRITE-OFF - Correct answer-a balance that has been removed from a patient's account A type of bad debt where the patient's payment is considered uncollectible THE PROCESS OF COORDINATION OF BENEFITS - Correct answer-Coordinating the primary and secondary payers for patients who have two insurances. ASSIGNMENT OF BENEFITS (BLOCK #13 ) - Correct answer-In the CMS-1500 form, this has to be signed in order for the provider to be paid directly by the insurance company. PATIENT'S DEDUCTIBLE - Correct answer-Always included in an electronic Remittance Advice (RA) LAPAROSCOPY - Correct answer-A procedure whose code is found in the Fee Schedule and in CPT-4. Visual examination of the abdominal cavity using an endoscope CROSSOVER CLAIM - Correct answer-A claim where both Medicare and Medicaid are