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Mimi

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Which of the following are included in surgery service codes? Postoperative complications Exacerbations Implants and devices Preoperative history and physical
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HCPCS codes are used in which of the following health care settings? Hospital inpatient services Skilled nursing facilities Physician clinics Psychiatric facility
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A billing and coding specialist is reviewing a remittance advice from Medicare and notices that the amount paid for a procedure is less than the contracted amount. Which of the following is a potential reason for the red...
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Which of the following actions by a billing and coding specialist ensures a patient's health information is protected? Confirming test results with the patient over the phone at the reception area Asking patients the rea...
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Which of the following statements is true regarding the release of patient records? Verbal requests for records from life insurance companies are appropriate. Identification is not required when requesting access to pati...
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A patient who recently received care from an endocrinologist is being referred to an infectious disease specialist. Which of the following types of referral does the patient need from the endocrinologist? Formal referral...
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Which of the following is an example of a violation of an adult patient's confidentiality? While reviewing a claim, a billing and coding specialist reads the diagnosis before realizing that the patient is a neighbor. A b...
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A billing and coding specialist is filing a CMS-1500 claim form for a patient who has private insurance. The specialist should recognize that a signature approving assignment of benefits indicates which of the following?...
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FLAG A billing and coding specialist observes a colleague perform an unethical act. Which of the following actions should the specialist take? File a complaint with the provider. Confront the employee. Report the inciden...
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Which of the following is a ICD-10-CM category code? A 3-character code A 5-character code A 7-character code A 6-character code
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FLAG A billing and coding specialist should add a modifier in which of the following scenarios? A bilateral procedure was performed. The procedure was cancelled. The service was an initial service. An unspecified code is...
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A billing and coding specialist discovers that one private payer has not reimbursed the provider for any claims submitted in the past year. Clean claims have been submitted to the payer and have been acknowledged. Which...
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HIPAA transaction standards apply to which of the following entities? Employers who provide workers' compensation plans Automobile insurance providers Health care clearinghouses Educational facilities
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Which of the following information is required on a patient account record? Name and address of guarantor Procedures performed Family history of the guarantor Diagnosis
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Medigap coverage is offered to Medicare beneficiaries by which of the following? Medicaid Federal health plans Managed care plans Private third-party payers
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On a remittance advice form, which of the following is responsible for writing off the difference between the amount billed and the amount allowed by the agreement? Provider Guarantor Patient Third-party payer
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Which of the following qualifies a patient for eligibility under Medicare as the primary third-party payer? Individuals who have worked 9 years in Medicare-covered employment Individuals who are below the federal poverty...
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Which of the following provisions ensures that an insured patient's benefits from third-party payers do not exceed 100% of allowable medical expenses? Source document Assignment of benefits Coinsurance Coordination of be...
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A billing and coding specialist is reviewing a report from the clearinghouse after submitting electronic claims and notices that one claim was rejected due to missing demographic information. Which of the following actio...
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Which of the following is the purpose of running an insurance aging report each month? To determine the balances the patients owe the provider To determine which patients have upcoming or missed appointments To determine...
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A patient presents to a primary care provider for a closed right index finger fracture. The provider is a non-participating provider for a private payer and does not accept assignment of benefits. The provider's charge f...
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In ICD-10-CM, Z codes are used to identify which of the following? Behavior disorders Digestive diseases Infectious diseases Immunizations
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A billing and coding specialist is preparing a claim for a provider. The operative note indicates the surgeon performed a CABG. The specialist should identify that CABG stands for which of the following? Coronary artery...
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Which of the following actions should a billing and coding specialist take to assign a diagnosis code to the highest level of specificity? Apply only the three-character code to a claim. Check for exclusion or inclusion...
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respond to post Medical office staff play an important role in understanding insurance types, patient eligibility, and payment incentive programs because these factors directly affect reimbursement and patient satisfacti...
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