Prep Exam items
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| what form used to post payments? | show 🗑
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| the authorization number for a service approved before service was rendered is indicated in which block on cms-1500 claim form? | show 🗑
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| show | block 25
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| show | block 21
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| show | block 18
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| show | HIPPA standard transactions
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| show | block 27
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| show | patients condition and provider's information
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| the EOB states the amount billed was $80. the amount allowed is $60, and the patient is required to pay a $20 copayment. what insurance check amount should be posted? | show 🗑
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| show | claim attachment
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| show | National Coverage Determination (NCD)
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| show | contractual allowance
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| show | UB-04
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| show | follow up with the patient to determine the current name, address, and carrier for resubmission
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| what NPI # is required in block 33a of cms-1500 claim form? | show 🗑
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| show | incorrectly linked codes
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| show | ensure the proper payment has been made
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| what term is used to describe the location of the stomach, spleen, part of pancreas, part of liver, and part of the small & large intestines? | show 🗑
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| show | 18%
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| which statement is true regarding Medicaid eligibility? | show 🗑
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| which of the following describes a key component of E/M service? | show 🗑
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| show | a billing and coding specialist unbundles a code to receive higher reimbursement
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| which of the following is an example of medicare abuse? | show 🗑
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| show | OIG - Office of the Inspector General
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| show | hospital services
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| show | provides insurance for outpatient and physician services
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| show | managed by private, third-party insurance providers approved by medicare
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| medicare part D | show 🗑
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| what part of medicare insurance program is managed by private, third-party insurance providers approved by medicare? | show 🗑
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| show | denied
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| show | block 24d
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| what describes an insurance carrier that pays the provider who rendered services to a patient? | show 🗑
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| show | 837
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| show | OIG
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| show | services required additional information
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| a medicare non-participating (non-PAR) provider's approved payment amount is $200 for a lobectomy and deductible has been met. what amount is the limiting charge for this procedure? | show 🗑
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| for non-crossover claims, the billing and coding specialist should prepare a copy of what form? | show 🗑
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| a billing and coding specialist can ensure insurance coverage for an outpatient procedure by using what process? | show 🗑
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| when a third-party payer requests copies of patient information related to claim, billing and coding specialist must include what document from patient's file? | show 🗑
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| show | add-on codes
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| what describes the term "crossover" relating to medicare? | show 🗑
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| show | arthroscopy
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| a billing and coding specialist has 4 past-due charges: $400 - 10 weeks past due; $800 - 6 weeks past due; $1,000 - weeks past due; and $2,000 - 8 weeks past due. what charge should be sent to collections first? | show 🗑
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| the EOB states the amount billed was $170. The allowed amount is $150. The patient has an unmet deductible of $50 and a copayment of $20. what dollar amount is the patient responsible for? | show 🗑
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| show | adjustment
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| show | procedure descriptors
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| show | electronic transmission & code set standards require every provider to use healthcare transactions, code sets, & identifiers
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| what describes a code that would be denied? | show 🗑
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| what section of SOAP note indicates a patient's level of pain to a provider? | show 🗑
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| what HMO managed care services requires a referral? | show 🗑
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| show | ABN - advance beneficiary notice
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| which block of cms-1500 form should a billing & coding speacialist enter the referring provider's NPI# ? | show 🗑
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| show | vertical plane divides body into front & back
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| show | horizontal plan divides the body into top & bottom sections
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| show | vertical plane divides body into right and left sides
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| anterior, ventral | show 🗑
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| posterior, dorsal | show 🗑
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| superior | show 🗑
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| proximal | show 🗑
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| show | far / away form origin
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| inferior | show 🗑
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| show | side
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| show | both sides
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| show | middle of body
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| what action should billing & coding specialist take when submitting a claim to medicaid for a patient that has primary & secondary insurance coverage? | show 🗑
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| show | claim adjustment codes
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| show | 57305-62
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| show | National Correct Code Initiative (NCCI)
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| what plane divides the body into left & right? | show 🗑
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| show | 24j
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| on a remittance advice form, who is responsible for writing off difference between amount billed and the amount allowed by agreement? | show 🗑
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| show | prevent multiple insurers from paying benefits covered by other policies
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| which block of cms-1500 claims form is the report modifiers section? | show 🗑
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| show | 12
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| show | medical standard of conduct
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| show | block 9
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