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25 Cards in this Set
- Front
- Back
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A beneficiary of Medicare/Medicaid crossover claim submitted by a participating provider is responsible for which of the following |
0% |
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A biller will electronically submit a claim to the carrier via which of the following? |
Direct data entry |
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A Billing and coding Specialist can ensure appropriate insurance coverage for an outpatient procedure by first using which of the following processes? |
Precertification |
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A billing and coding specialist has four past–due charges: $400 that is 10 weeks past due; $800 that is 6 weeks past due; $1,000 that is 4 weeks past due; and $2,000 that is 8 weeks past due. Which of the following charges should be sent to collection first? |
$2,000 |
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A billing and coding specialist is preparing a claim form for a provider from a group practice. The billing and coding specialist should enter the rendering provider's national provider identifier (NPT) into which of the following blocks on the CMS–1500 claim form? |
Block 24J |
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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 |
the provider receives payment directly from the payer |
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A billing and coding specialist needs to know how much Medicare paid on a claim before billing the secondary insurance. To which of the following should the specialist refer? |
Remittance advice |
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A billing and coding specialist should add modifier –50 to codes when reporting which of the following? |
A bilateral procedure |
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A billing and coding specialist should enter the prior authorization number on the CMS–1500 claim form in which of the following blocks? |
Block 23 |
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A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? |
Aging report |
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A billing and coding specialist should understand that the financial record source is generated by a provider's office is called a |
Patient ledger account |
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A billing and coding specialists submitted a claim to Medicare electronically. No errors were found by the billing software or clearinghouse. Which of the following describes this claim? |
Clean Claim |
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A claim can be denied or rejected for which of the following reasons |
Block 24D contains the diagnosis code |
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A claim is denied because the service was the service was not covered by the insurance company. Upon confirmation of no errors on the claim, which of the following describes the process that will follow denial? |
The claim will not be resubmitted and the patient will sent a bill |
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A claim is denied due to termination of coverage. Which of the following actions should the billing and coding specialist take next? |
Follow up with the patient to determine current name, address, and insurance carrier for resubmission |
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A claim is submitted with a transposed insurance member ID number and returned to the provider. Which of the following describes the status that should be assigned to the claim by the carrier |
Invalid |
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A coroner's autopsy is comprised of when of the following examinations? |
Gross examination |
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A deductible of $100 is applied to patient's remittance advice. The provider requests the accounts personnel write off. Which of the following terms describes this scenario? |
Fraud |
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A dependent child whose parents both have insurance coverage comes to the clinic. The billing and coding specialist uses the birthday rule to determine which insurance policy is primary. Which of the following describes the birthday rule? |
The parent whose birthdate comes first in the calendar year |
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A difference between Medicare and Medicaid? |
Medicare is funded by the federal government, but Medicaid is funded by both state and federal government. |
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A document that contains dates of service, list of detailed charges, co–payments, and deductibles paid, date insurance was filed, and account balances is? |
An itemized statement |
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A form that contains charges, DOS, CPT codes, fees, and copayment information is called which of the following? |
Encounter form |
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A fracture of the epiphyseal place in children |
Salter–Harris |
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A Husband and wife each have group insurance through their employers. The wife has an appointment with her provider. Which insurance should be used as primary for the appointment? |
The wife's insurance |
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A MAA creates an invoice for the remaining percentage of an encounter fee after receiving a copayment. This portion is considered to be the what? |
Coinsurance |
