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MOP110 Study Guide

CLO#1

QuestionAnswer
The insurance and coding specialist calls a carrier to verify a patient's insurance and the representative states that the patient's insurance was cancelled months ago. Which of the following should the insurance and coding specialists do first? Ask the patient for another form of insurance coverage
Which of the following must be verified to process a credit card transaction? Credit card number Account number Security code
When the patient calls to inquire about an account, which of the following does the insurance and coding specialist need to ask before discussing the account? Patient's insurance ID number Patient's name Patient's DOB
The provider is a non-PAR with the patient's insurance and the patient's insurance company states that they will cover 60% of allowed charges. The charge for the office visit is $100. The patient's co-pay is $10.00. The patient is required to pay: $50.00
A Medicare patient had 80/20 plan. The charges amount was $300.00. The amount was $100.00. How much is the patient's coinsurance? $20.00
When should a provider have a patient sign an ABN? When the items may be denied and prior to performing the service
The most effective method to manage patient statements and other financial invoices as well as avoid payment delays is to.... Collect fees at the time of service
When following up on a denied claim, an insurance & coding specialist should have which of the following info available when speaking with the insurance company? Patient's insurance ID number Date the claim was denied Date of service
Which of the following is most likely cause of the deposits not agreeing with credits on the day sheet of the patient ledgers? Payment is misplaced
Which of the following financial reports produces a quarterly review of any dollar amount a patient still owes after all insurance carriers claim payments have been received? Aging
An insurance & coding specialist is reviewing Appendix M in the CPT book. Which of the following tasks is she most likely performing? Checking for renumbered code
A patient had called to schedule an apt for an office visit to see the doctor tomorrow for an earache. It is discovered during the scheduling that the insurance policy on file had been cancelled. What should the specialist do next? Advise the patient to bring current insurance information to the appt.
Which of the following is an appropriate way to open the discussion when explaining practice fees to a patient? "Do you have any questions about the cost of today's visit?"
Which of the following info is necessary to post payments from the RA/EOB? Patient's name Date of service Billed CPT codes
When there is a professional courtesy awarded to a patient's account the insurance and coding specialist should post the amount under the... Adjustment column
Which of the following must a patient sign prior to an insurance claim being processed? An Authorization to Release Information
Which of the following are necessary to complete a CMS-1500 form? Demographic info Physician info Diagnosis and CPT codes
Which of the following processes makes a final determination for payment in an appeal board? Adjudication
When patients sign Block 13 of the CMS-1500 claim to instruct the payer to directly reimburse the provider, it is known as .... Assignment of benefits
Which of the following defines the maximum time that a debt can be collected from the time it was incurred of became due? Statute of Limitations
A patient present for a right-sided hip injection. The provider used palpation for guidance. Which of the following is the appropriate CPT code? 20610
Created by: Cristinacholi
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