NHA - Certified Billing and Coding Specialist (CBCS) Study Guide

NHA - Certified Billing and Coding Specialist (CBCS) Study Guide The symbol "O" in the Current Procedural Terminology reference is used to indicate what? - ANS - Reinstated or recycled code In the anesthesia section ...

NHA - Certified Billing and Coding Specialist (CBCS) Study Guide The symbol "O" in the Current Procedural Terminology reference is used to indicate what? - ANS - Reinstated or recycled code In the anesthesia section of the CPT manual, what are considered qualifying circumstances? - ANS - Add-on codes As of April 1, 2014 what is the maximum number of diagnoses that can be reported on the CMS1500 claim form before a further claim is required? - ANS - 12 What is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - ANS - Operative report What action should be taken first when reviewing a delinquent claim? - ANS - Verify the age of the account A claim can be denied or rejected for which of the following reasons? - ANS - Block 24D contains the diagnosis code A coroner's autopsy is comprised of what examinations? - ANS - Gross Examination Medigap coverage is offered to Medicare beneficiaries by whom? - ANS - Private third-party payers What part of Medicare covers prescriptions? - ANS - Part C What plane divides the body into left and right? - ANS - Sagittal Where can unlisted codes be found in the CPT manual? - ANS - Guidelines prior to each section Ambulatory surgery centers, home health care, and hospice organizations use which form to submit claims? - ANS - UB-04 Claim Form What color format is acceptable on the CMS-1500 claim form? - ANS - Red Who is responsible to pay the deductible? - ANS - Patient A patient's health plan is referred to as the "payer of last resort." What is the name of that health plan? - ANS - Medicaid Informed Consent - ANS - Providers explain medical or diagnostic procedures, surgical interventions, and the benefits and risks involved, giving patients an opportunity to ask questions before medical intervention is provided. Implied Consent - ANS - A patient presents for treatment, such as extending an arm to allow a venipuncture to be performed. Clearinghouse - ANS - Agency that converts claims into standardized electronic format, looks for errors, and formats them according to HIPAA and insurance standards. Individually Identifiable - ANS - Documents that identify the person or provide enough information so that the person can be identified. De-identified Information - ANS - Information that does not identify an individual because unique and personal characteristics have been removed. Consent - ANS - A patient's permission evidenced by signature. Authorizations - ANS - Permission granted by the patient or the patient's representative to release information for reasons other than treatment, payment, or health care operations. Reimbursement - ANS - Payment for services rendered from a third-party payer. Auditing - ANS - Review of claims for accuracy and completeness. Fraud - ANS - Making false statements of representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist. Upcoding - ANS - Assigning a diagnosis or procedure code at a higher level than the documentation supports, such as coding bronchitis as pneumonia. Unbundling - ANS - Using multiple codes that describe different components of a treatment instead of using a single code that describes all steps of the procedure. Abuse - ANS - Practices that directly or indirectly result in unnecessary costs to the Medicare program. Business Associate (BA) - ANS - Individuals, groups, or organizations who are not members of a covered entity's workforce that perform functions or activities on behalf of or for a covered entity. What is the main job of the Office of the Inspector General (OIG)? - ANS - The OIG protects Medicare and other HHS programs from fraud and abuse by conducting audits, investigations , and inspections. Medicare - ANS - Federally funded health insurance provided to people age 65 or older, and people 65 and younger with certain disabilities. Medicaid - ANS - A government-based health insurance option that pays for medical assistance for individuals who have low incomes and limited financial resources. Timely Filing Requirements - ANS - Within 1 calendar year of a claim's date of service. Electronic Data Interchange (EDI) - ANS - The transfer of electronic information in a standard form. Coordination of Benefits Rules - ANS - Determines which insurance plan is primary and which is secondary. Conditional Payment - ANS - Medicare payment that is recovered after primary insurance pays. Crossover Claim - ANS - Claim submitted by people covered by a primary and secondary insurance plan. Assignment of Benefits - ANS - Contract in which the provider directly bills the payer and accepts the allowable charge. Allowable Charge - ANS - The amount an insurer will accept as full payment, minus applicable cost sharing. Clean Claim - ANS - Claim that is accurate and complete. They have all the information needed for processing, which is done in a timely fashion. Dirty Claim - ANS - Claim that is inaccurate, incomplete, or contains other errors. Medicare Administrative Contractor (MAC) -