NCCT Insurance & Coding Practice Test COMPLETE SOLUTION 2022/23

NCCT Insurance & Coding Practice Test COMPLETE SOLUTION 2022/23 An insurance and coding specialist is reviewing a patient's encounter form that is documented in the medical record prior to competing a CMS-1500 form. S ...

NCCT Insurance & Coding Practice Test COMPLETE SOLUTION 2022/23 An insurance and coding specialist is reviewing a patient's encounter form that is documented in the medical record prior to competing a CMS-1500 form. She notices that the physician upcoded the encounter form. The specialist has the ethical obligation to first - ✔✔query the physician A patient had surgery two weeks ago to repair a dislocated ankle, and returns today to have a flexor tendon in the hand repaired. Which of the following modifiers should be reported for today's service? - ✔✔-79 A patient has called to schedule an appointment for an office visit to see the doctor tomorrow for an earache. It is discovered during the scheduling process that the insurance policy on file has been cancelled. Which of the following should the insurance and coding specialist do next? - ✔✔Advise the patient to bring current insurance information to the appointment. An established patient is being seen by the physician today. The patient owes $25.00 for the visit. The amount collected for the office visit is called the - ✔✔copayment Applying the birthday rule, a minor child comes in. Both parents have remarried and the child is listed on the mother's, father's, and both step-parents' policies. The mother's birthday is April 16, stepfather's birthday March 19, father's birthday is February 19th, and the stepmother's birthday is January 20th. Which of the following is correct? - ✔✔Father's plan is primary, mother's plan is secondary. A provider performed a right sided facet joint injection using fluoroscopic guidance. The billed codes were 64493 and 77003. An EOB was returned denying the charge of 77003. Why was this charge denied? - ✔✔Imaging guidance is an inclusive component of 64493. A patient was seen in the office. Charges were recorded and submitted to the patient's insurance, and an EOB was received by the office with a payment of $70.89. These transactions should be recorded in the - ✔✔patient ledger.A new HIM director was recently hired at a hospital. She was advised her health insurance benefits become available in 90 days. Which of the following is correct regarding her health insurance? - ✔✔She will be able to keep her current medical insurance from her previous job through COBRA. A claim submitted with all the necessary and accurate information so that it can be processed and paid is called a - ✔✔clean claim. A patient has two health insurance policies-a group insurance plan through her full-time employer and another group insurance plan through her husband's employer. Which of the following policies should be billed as primary? - ✔✔her policy. An insurance and coding specialist is reviewing Appendix M in the CPT book. Which of the following is she most likely performing? - ✔✔checking for renumbered codes A Medicare patient has an 80/20 plan. The charged amount was $300.00. The amount allowed was $100.00. Which of the following is the patient's coinsurance? - ✔✔$20 The Fair Debt Collection Practices Act restricts debt collectors from engaging in conduct that includes - ✔✔calling before 8:00 AM or after 9:00 PM, unless permission is given. A third party payer made an error while adjudicating a claim. Which of the following should the insurance and coding specialist do? - ✔✔Resubmit the claim with an attachment explaining the error. A Medicare patient presents to an outpatient hospital facility for a scheduled hysterectomy. To which Medicare plan should the facility submit the claim? - ✔✔Part B A physician performed a bilateral L4/L5 Laminectomy on a patient in an ambulatory surgical center. Which of the following place of service codes should be used on the CMS 1500? - ✔✔24 A 72-year-old patient is undergoing a corneal transplant. An anesthesiologist is personally performing monitored anesthesia care. Which of the following modifiers should be reported for the anesthesia? - ✔✔-AA-QSBased on the CMS manual system, when updating or maintaining the billing code database, which of the following does the "R" denote? - ✔✔Revised Collecting statistics on the frequency of copay collection at time of service is a step in the process of - ✔✔managing A/R. Claims are often rejected because a provider needs to obtain - ✔✔pre-authorizations. Collection agencies are regulated by the - ✔✔Fair Debt Collections Practice Act. Developing an insurance claim begins - ✔✔when the patient calls to schedule an appointment. Encounter forms should be audited to ensure the - ✔✔payer's address and phone are current. HIPAA allows a health care provider to communicate with a patient's family, friends, or other persons who are involved in the patient's care regarding their mental health status providing - ✔✔the patient does not object. How often should the encounter form CPT codes be updated? - ✔✔annually If the insurance and coding specialist suspects Medicare fraud she should contact the - ✔✔OIG. In order to have claims paid as quickly as possible, the insurance specialist must be familiar with which of the following? - ✔✔payer's claim processing procedures If the insurance carrier's rate of benefits is 80%, the remaining 20% is known as - ✔✔coinsurance