medical billing and coding final Flashcards

4353980430	which of the following should a bc use to sort aging reports	type of payer	0
4353981852	in order to ensure that claims are submitted and received a bc should document all claims processed	on an insurance claims register	1
4353983837	a patient who has a bluish discoloration of the skin which is the condition	low blood oxygen level	2
4354022071	what should a bc collect form a patient during a initial visit	insurance card	3
4354031122	if a bc practice management software cannot transmit claims directly to the third party payer which of the following must a specialist use to transmit/to catch errors by providers	clearinghouse	4
4354031831	a patient authorization form is good for	90 days	5
4354032403	which institution works with cos to prevent overpayments	quality improvement organization	6
4354092783	which of the following is the process a payer follows to determine if a claim should be paid	payer adjudication	7
4354095754	a sinus procedure with a health maintenance organization requires which of the following	preauthorization	8
4354097206	a bc is allowed to make which of the following id within HIPAA guidelines	call patients by name	9
4354101100	a medicare provider billed medicare for 360.00 the allowed amount is 200 .for which of the following amount is the patient responsible	40.00	10
4354131320	once a bc begins working on an aging report within the payer area which of the following criteria should she sort by next	date of service	11
4354133425	the process of selecting the correct icd code ends with the final code being chosen form which of the following	tabular list of diseases	12
4354135736	which of the following is the primary purpose of the HIPAA Act Title I	to allow for health care access ,portability ,and renewability	13
4354139832	exchange of personal health information via a standardized format through computer systems is an example of which of the following technologies	EHR	14
4354200871	billing a patient who is covered by medicare using a higher fee schedule than a patient who is not covered by medicare is an example of	abuse	15
4354201501	which of the following is an electronic claim for format	ANSI ASC X12 837	16
4354203724	under CPT guidelines all services related to a surgical procedure are not additionally reimbursed during which of the following periods	global period	17
4354207577	a patient payment is considered uncollectible .a billing and coding specialist should record an entry on the patients ledger as which of the following types of bad debt	write off	18
4354209344	which of the following govt agencies has launched a website to help consumers identify sources of public and private coverage and initiated by icd 9	DHHS: department of health and human services	19
4354211042	which of the following is the priority action a billing and coding specialist should take to identify the areas of risk associated with billing compliance	perform internal audits to monitor billing process	20
4354213554	which of the following forms is required for a medicare non covered procedure	ABN Advance Beneficiary Notice	21
4354215665	which of the following should result from a provider committing abuse	administrative fines	22
4354218348	a billing and coding specialist is filling out the cos 1500 claim form for a satellite office .which of the following blocks should the specialist use for the providers name and address	billing provider information and phone number	23
4354222001	secondary to the cos 1500 claim form, which of the following forms is the next most significant piece of paperwork for obtaining patient financial information	medical record	24
4354224306	which of the following are the three types of plans covered under Tricare programs	standard ,extra,and prime	25
4354226389	which of the following is an example of why claims can be denied for reasons other than a processing error	not medically necessary	26
4354229312	a patient is scheduled to have an endoscopy ,which of the following providers should perform the procedure	Gastroenterologist	27
4354230858	which of the following speciality providers should perform an orchiopexy	urologist	28
4354233553	which of the following actions should a B&C specialist take after receiving an EOB	apply the payment	29
4354236081	the field "insured ID Number" on the Cms 1500 claim form is used to report which of the following pieces of the information	policy number	30
4354240743	a patient who has a right tibia fracture receives a cast . upon X-ray ,the patient also received a diagnosis of a tumor on his right patella and is admitted to the facility for further treatment . Which should the B&C specialist code second	Right patella tumor	31
4354243573	which of the following should treat a patient who is scheduled to undergo a surgical procedure and return home the same day	ambulatory care center	32
4354245712	a B&C specialist should take which of the following proactive actions to prevent fraud and abuse	use the most up to date coding manuals	33
4354253468	a patient is injured while working as a subcontractor .this claim should be filed with which of the following ?	the patients private insurance	34
4354256368	when posting a payment to an account, in which of the following column should a B&C specialist record an insurance payment	credit column	35
4354258903	which of the following describes how a B&C specialist should code a claim for a patient who falls in his yard at home and breaks his arms	E code on accident due to natural and environmental factors	36
4354261358	which of the following forms must be signed to release documents to a 3rd party payer	release of information	37
4354265066	a new patient who has a PPO presents to the office reporting stomach pains .For which of the following reasons does the patient have to pay out of pocket for this office visit	the patient has not met the deductible	38
4354268212	a provider accepts pre-established payments for providing services to a patient enrolled for 1 year .which of the following plans does this describe	EPO	39
4354271382	Which of the following actions should a B&C take when submitting a hard copy of the CMS 1500 claim form	complete the claim form on the computer	40
4354273117	which of the following data elements delays claim processing if missing	secondary insurance or units of service	41
4354278722	in which of the following locations should a B&C specialist find the contact info to appeal a claim	insurance company file	42
4354283532	a b&c specialist determines that several patient have outstanding balances of greater than 90 days . Which of the following is used to determine outstanding balances	aging report	43
4354287188	which of the following steps should a billing and coding specialist take when a patient is ineligible and a denied claim is retired to the provider	submit a new claim to the correct insurance carrier	44
4354289197	which of the following is included in the release of information	expiration date	45
4354291848	when a modifier -GA is used on a patients claim form . Which of the following forms should the patients sign	ABN	46
4354292999	the cos 1500 claim form is used for which of the following types of claims	office outpatient	47
4354297224	when interpreting an EOB it is necessary for billing and coding specialist to know which of the following	the EOB can include multiple patients on one form	48
4354300096	a b&c specialist received payments for dates of service found on	an RA	49
4354304308	99214 cpt manual	established office visit	50
4354305047	Nasal deformity	rhinoplasty	51
4354305894	life cycle of a claim 1st step	collecting insurance info	52
4354307531	allowed amount	amount of reimbursement an insurance payer agrees and patient agrees to ay a provider	53
4354312700	what is excision	removal	54
4354323570	what is an emancipated minor	a person younger than 18 years who lives independently who processes decision making rights	55
4354367696	Date format	MMDDYYYY	56
4354370087	information associated with aging report informs the B&C specialist about more than just the immediate claims pending	trend of non payment of the insurance payer	57
4354370706	what is the OIG	investigates fraud and abuse	58
4354373267	if a pre-auth is expired	claim will come back to provider as denied	59
4354375266	how to verify copay prior to appointment	contact insurance carrier	60
4354376144	medical necessity	charge capture process	61
4354376774	clean claim	completed insurance claim form submitted with the program time limits that contains all the necessary information/doesn't need account number for submission	62
4354377562	workers care	state mandated 3rd party payer	63
4354383127	what is a deductible	specific amount of money must be paid each year before the policy benefit begins.should be collected first	64
4354393698	fraud	filing for services not provided	65
4354395248	switch of policies and now covered under partner	policy number needed	66
4354395930	billing provider NPI	person who provided service	67
4354400592	what is COB (coordinations of benefits )	statements is included in most policies and contracts with providers	68
4354821827	block 241 on cms 1500 form	leave blank	69
4354828090	what is aging report	document that reports the status of insurance claims to the provider	70
4354833046	how many volumes does the icd 9 use for outpatient services	Two :vol II to vol I	71
4354834971	electronic claim submitted ,one service denied	retransmit claim with required info	72
4354836886	which are federally funded	medicaid ,medicare,tricare	73
4354838014	directional terminology	superior	74
4354839864	if there is a diagnosis missing on a claim form	it prevents submission	75
4354841770	supporting document needed for electronic claim	email an electronic file format of the supporting document	76
4354857778	what is an insurance claim register	checking batch reports and scrubber reports on a schedule basis	77
4354859447	cholelithiasis	stones in gallbladder	78
4354860574	injury and poisoning supplemental codes begins with	E000	79
4354860917	ss# for medicare	no dashes with letter A	80
4354861697	homeostasis	normal balance and function	81
4354866738	what does electronic remittance advice include	referring provider	82
4354867249	v-code	supplemental diagnosis code ,exposure to tuberculosis	83
4354868221	patient paid in advance ,insurance co paid more	b&c specialist should refund the patient	84
4354868981	capitation	A system of payment used by managed care plans in which physicians and hospitals are paid a fixed per capita mount for each patient enrolled over a stated period of time	85
4354882466	Who implemented the NCCI in 1996 and initiated ICD9	WHO	86
4354883449	Guarantor	an individual who promise to pay the medical bill by signing a form agreeing to pay or who accepts treatment which constitutes an expressed promised	87
4354890963	add on code	can be listed as the primary code	88
4354897532	audit performed after payments os sent to 3rd party payer	prospective adult	89
4354899569	Tricare prime (elgibility )	active duty personnel	90
4354900437	appendicitis	right lower quad	91
4354903214	MDM-medical decision making	health care management process done after performing a history and physical examination on a patient that results in a plan of treatment	92
4358987107	Part b	provider services	93
4358989647	private insurance standards	NCCI	94
4359226553	what type of physician would deal with thyroid issue and exposure to tuberculosis	Endocrinologist	95
4359002380	Implied contract	at time appointment is made	96
4359063050	Nephrolithiasis	kidney stones	97
4359065568	if minor has no insurance who is responsible for the bill	guarantor	98
4359068676	when you have a diagnosis and a manifestation diagnosis	combination code	99
4359070780	when looking for an evaluation and management code where should you look first	place of service	100
4359074089	when a procedure is pending FDA approval what symbol is next to the code	Flash symbol	101
4359075563	what is the first section in the CPT manual	the evaluation and management section	102
4359082121	if a procedure was done and a preauthorization has expired what is the next step to get the claim paid	file an appeal	103
4359083432	what is Assignment of benefits	when a participating provider accepts what the insurance company is allowing for patient and in return the checks goes to the physician	104
4359086981	balance due on the aging represents what	outstanding money owed to the practice	105
4359090337	which tricare fee for service policy has the most flexibility when it comes to choosing a physician	tricare standard	106
4359091582	HCPCS level II codes are used for	Ambulance Services	107
4359093331	three key components of an evaluation and management	history,physical and medical decision making	108
4359096129	in ICD 10 (tabular list)	parenthesis are used in the tabular list to enclose supplementary words that may be present or absent in the statement of disease or condition	109
4359100485	Predetermination	the actual dollar amount the insurance company will pay	110
4359101759	protected health information	includes body mass	111
4359102593	federal register	resources for changes ,notices and proposals for centers for medicare/medicaid services	112
4359105702	Medicare part b	covers emergency services	113
4359109756	Primigravda	one pregnancy	114
4359113425	what is the purpose of OIG (office of inspector general)	is to safeguard the health and welfare of the beneficiaries of dh's programs and to protect the integrity of dh's programs (fraud and abuse)	115
4359126795	filing for services not provided is a fraudulent act	true	116
4359312049	a billing and coding specialist is filling out the cos 1500 claim for for a satellite office . which of the following blocks should the specialist use for the providers name and address	Block 31 and 33	117
4359316391	what two codes do you need to process a medical claim	CPT and ICD	118