If a person eligible for Medicaid has other insurance coverage, Medicaid is always the
secondary carrier
Medicare is a federal health insurance program for the following categories of people EXCEPT
preschool children
...
If a person eligible for Medicaid has other insurance coverage, Medicaid is always the
secondary carrier
Medicare is a federal health insurance program for the following categories of people EXCEPT
preschool children
For Medicare inpatient services, a benefit period begins the
day the patient enters the hospital
A patient might submit his own Medicare claim when
purchasing medical equipment
When an illiterate patient cannot sign a Medicare form,
a witness should sign the form
To be eligible for Medicare, an alien resident must have lived in the U.S. for
5 consecutive years
Which of these are an advantage of electronic claims submission
- Online error-edit process identifies errors quickly
- Helps to increase cash to the practice
- Saves time for the sender and the receiver
A physician must make a decision to accept or refuse to treat a Medicaid patient based on the
entire Medicaid program
Which of the following spurred the development of DRG?
advances in technology
DRGs are a type of
hospital inpatient reimbursement
These hospital records will contain not only information about the patient's condition (including diagnosis & treatment) and a final prognosis.
discharge summary
Which chapters of the ICD-10-CM code book includes certain infectious and parasitic diseases
Chapter 16
What does the bullet (•) in CPT codebooks stand for
new code
Which of the following is an example of unethical or illegal coding?
Dividing services provided into separate codes when a single code is available
The transformation of verbal descriptions of diseases, injuries, and procedures into numbers is called
coding
Two coding systems are used by physicians' offices. One is for diagnoses and the other is for
Services and procedures
Physicians' Current Procedural Terminology (CPT) is revised
Annually
Basic CPT codes use
5 digits
Add-on modifier -26 indicates the
professional component
Codes 99281 through 99285 refer to
emergency department services
In some billing cases it is necessary to add a 2 digit modifier in order to
give a more accurate description
CPT codes, descriptions and two digit modifiers are copyrighted by the
American Medical Association (AMA)
When transferring codes to claim forms be careful to
keep from transposing numbers
Unbundling, exploding, or a la carte coding are
fraudulent
if multiple lacerations are repaired under the same classification and in the same group of anatomic parts a billing and coding specialist should
add the sum of lengths of report one code
When the patient calls to inquire about an account which of the following does the insurance and coding specialist need to ask for before discussing the account?
patient's name, patient's date of birth, patient's insurance ID number
A Medicare patient has an 80/20 plan. The charged amount was $300.00. The amount allowed was $100.00. What is the patient's coinsurance?
$20
A claim submitted with all the necessary and accurate information so that it can be processed and paid is called a
clean claim
If the insurance and coding specialist suspects Medicare fraud she should contact the
OIG - office of inspector general
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