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A ypatient's yhealth yplan yis yreferred yto yas ythe ypayer yof ylast yresort. yThe ypatient yis ycovered yby ywhich yof ythe yfollowing yhealth yplans? Medicaid CHAMPA Medicare TRICARE y- ycorrect yanswers y-Medicaid A yprovider ycharged y$500 yto ya yclaim ythat yhad yan yallowable yamount yof y$400. yIn ywhich yof ythe yfollowing ycolumns yshould ythe yCBCS yapply ythe ynon yallowed ycharge? -Reference ycolumn y(For ynotations) -Description ycolumn -Payment ycolumn -Adjustment ycolumn yof ythe ycredits y- ycorrect yanswers y-Adjustment ycolumn yof ythe ycredits Which yof ythe yfollowing ystatements yis ycorrect yregarding ya ydeductible? -Coinsurance yis ya ytype yof ydeductible -The yphysician yshould ywrite yoff ythe ydeductible -The yinsurance ycompany ypays yfor ythe ydeductible
-The ydeductible yis ythe ypatient's yresponsibility y- ycorrect yanswers y-The ydeductible yis ythe ypatient's yresponsibility Which yof ythe yfollowing ycolor yformats yallows yoptical yscanning yof ythe yCMS- yclaim yform? -Red -Blue -Green -black y- ycorrect yanswers y-red Ambulatory ysurgery ycenters, yhome yhealth yand yhospice yorganizations yuse ythe y______. -CMS-1500 yclaim yform -UB-04 yclaim yform -Advance yBeneficiary ynotice -First yreport yof yinjury yform y- ycorrect yanswers y-UB- Claims ythat yare ysubmitted ywithout yan yNPI ynumber ywill ydelay ypayment yto ythe yprovider ybecause y______. -The ynumber yis ythe ypatient' yid ynumber -The ynumber yis yneeded yto yidentify ythe yprovider -Is yis yused yas ya yclaim ynumber -It yis yused yas ya ypre yauthorization ynumber y- ycorrect yanswers y-The ynumber yis yneeded yto yidentify ythe yprovider Which yof ythe yfollowing yterms ydescribes ywhen ya yplan ypays y70% yof ythe yallowed yamount yand ythe ypatient ypays y30%? -Coinsurance -Deductible -Premium -copayment y- ycorrect yanswers y-coinsurance Which yof ythe yfollowing yindicates ya yclaim yshould ybe ysubmitted yon ypaper yinstead yof yelectronically? -The ysoftware yclaims yreview yprocess yindicates ythe yclaim yis ynot ycomplete -The yclaim yneeds yauthorization -The yclaim yrequires yan yattachment -The ypractice ymanagement ysoftware yis ynon yfunctional. y- ycorrect yanswers y-the yclaim yrequires yan yattachment On ya yremittance yadvice yform, ywhich yof ythe yfollowing yis yresponsible yfor ywriting yoff ythe ydifference ybetween ythe yamount ybilled yand ythe yamount yallowed yby ythe yagreement? -Provider -Insurance ycompany -Patient
Behavior yplays yan yimportant ypart yof ybeing ya yteam yplayer yin ya ymedical ypractice. yWhich yof ythe yfollowing yis yan yappropriate yaction yfor ythe yCBCS yto ytake? -Reprimanding yanother ystaff ymember yduring ya yteam ymeeting yfor ydisplaying ya ybad yattitude ytoward ya ypatient -Looking yin ythe ymedical yrecord yof ya yfriend ywho yreceives yservices yat ythe yoffice -Communicating ywith ythe yfront ydesk ystaff yduring ya yteam ymeeting yabout ymissing yinformation yin ypatient yfiles -Questioning ythe ynurse yabout ythe yprovider ydocumentation yin ythe ymedical yrecord y- ycorrect yanswers y-Communicating ywith ythe yfront ydesk ystaff yduring ya yteam ymeeting yabout ymissing yinformation yin ypatient yfiles Which yof ythe yfollowing yacts yapplies yto ythe yadministrative ysimplification yguideline? -HIPAA -Deficit yreduction yact yof y 2005 -The ypatient yprotection yand yaffordable ycare yact y 2009 -National ycorrect ycoding yinitiative yof y 1995 y- ycorrect yanswers y-HIPAA Which yof ythe yfollowing yis yan yexample yof ya yviolation yof yan yadult ypatient's yconfidentiality? -While yreviewing ya yclaim, ythe yCBCS yreads ythe ydiagnosis ybefore yrealizing ythat ythe ypatient yis ya yneighbor -A yCBCS yqueries ythe yphysician yabout ya ydiagnosis yin ya ypatient's ymedical yrecord -The yphysician yuses yhis yhome yphone yto ydiscuss ypatient ycare ywith ythe ynursing ystaff -Patient yinformation ywas ydisclosed yto ythe ypatient's yparents ywithout yconsent y- ycorrect yanswers y-Patient yinformation ywas ydisclosed yto ythe ypatient's yparents ywithout yconsent Which yof ythe yfollowing yis ythe ypurpose yof yrunning yan yaging yreport yeach ymonth? -If yindicates ythe ybalances ythe ypatients yowe ythe yprovider -It yindicates ywhich ypatients yhave yupcoming yor ymissed yappointment -It yindicates ywhich yclaims yare youtstanding -It yindicates ywhat ythe yinsurance ycompany yhas ypaid yfor ythe yprovider's yservices yto ya ypatient. y- ycorrect yanswers y-It yindicates ywhich yclaims yare youtstanding Which yof ythe yfollowing ydescribes ythe ystatus yof ya yclaim ythat ydoes ynot yinclude ythe yrequired ypreauthorization yfor ya yservice? -Delinquent y(overdue) -Denied -Suspended -Adjudicated y(claim ystill ybeing yprocessed) y- ycorrect yanswers y-Denied
-Delinquent y(overdue) -Adjudicated y(claim ystill ybeing yprocessed) Which yof ythe yfollowing yactions yshould ythe yCBCS ytake yto yprevent yfraud yand yabuse yin ythe ymedical yoffice? -Serviced yprocedure ypreauthorization -Internal ymonitoring yand yauditing -Utilization yreview -Correct ycoding yinitiative y- ycorrect yanswers y-Internal ymonitoring yand yauditing In yan youtpatient ysetting, ywhich yof ythe yfollowing yforms yis yused yas ya yfinancial yreport yof yall yservices yprovided yto ypatients? -Encounter yform -Patient yaccount yrecord y -CMS-1500 yclaim yform -Accounts yreceivable yjournal y- ycorrect yanswers y-Patient yaccount yrecord y(patient yledger, yall ytransactions ybetween ypatient yand ythe ypractice) -Accounts yreceivable yjournal y(Day ysheet y= ychronological ysummary yof yall ytransaction yon ya yspecific yday) Patient ycharges ythat yhave ynot ybeen ypaid ywill yappear yin ywhich yof ythe yfollowing? -Accounts yreceivable -Accounts ypayable -Tracer -Rejected yclaim y- ycorrect yanswers y-Accounts yreceivable Which yof ythe yfollowing yis yconsidered ythe yfinal ydetermination yof ythe yissues yinvolving ysettlement yof yan yinsurance yclaim? -Processing y -Translation y -Adjudication y -Transmission y- ycorrect yanswers y-Adjudication y(process yof yputting ya yclaim ythrough ya yseries yof yedits yfor yfinal ydetermination) -Processing y( yhandling ya yclaim yfrom ythe yfirst yencounter yto yclaim ysubmission) -Translation y(claim yis ysend yfrom ythe yhost ysystem yto ythe yclearing yhouse) -Transmission y(how ythe yclaim ywas ysent) Which yof ythe yfollowing yinformation yshould ythe yCBCS yinput yinto yblock y33a yon ythe yCMS-1500 yclaim yform -Provider ysocial ysecurity ynumber y(no ySocial ysecurity ynumber yon yCMS1500) -Federal ytax yid ynumber y(entered yin yblock y25) -Patient yid ynumber y(on yblock y1a) -National yprovider yidentification ynumber y- ycorrect yanswers y-National yprovider yidentification ynumber
Which yof ythe yfollowing ysections yof ythe ymedical yrecord yis yused yto ydetermine ythe ycorrect yevaluation yand ymanagement ycode yto yuse yfor ybilling yand ycoding? -Codes yused yduring yprior ypatient yvisits -Patient's yinsurance yplan -Plan yof ycare -History yand yphysical y- ycorrect yanswers y-History yand yphysical A ypatient yhas ymet ya yMedicare ydeductible yof y$150. yThe ypatient's ycoinsurance yis y20%, yand ythe yallowed yamount yis y$600. yWhich yof ythe yfollowing yis ythe ypatient's yout yof ypocket yexpense? -$ -$ -$ -$150 y- ycorrect yanswers y-$ Which yof ythe yfollowing yis yallowed ywhen ybilling yprocedure ycodes? -Unbundling ycodes yto yensure ythat yall ymedical yservices ywere yreceived yand ybilled yfor -Billing yusing ytwo ydigit yCPT ymodifiers yto yindicate ya yprocedure yas yperformed ydiffers yfrom yits yusual yfive ydigit ycode -Billing yfor ya ysurgical ypackage ywith yitemized ycodes -Referring yto ythe yICD ybook yfor ythe yaccurate ydescription yof ythe yprocedural ycode. y- ycorrect yanswers y-Billing yusing ytwo ydigit yCPT ymodifiers yto yindicate ya yprocedure yas yperformed ydiffers yfrom yits yusual yfive ydigit ycode Which yof ythe yfollowing ydescribes ythe ycontent yof ya ymedical ypractice yaging yreport? -An yoverview yof ythe ypractice's ynet yworth -An yoverview yof ythe ypractice ydeposits. -An yoverview yof ythe ypractice's ydebts -An yoverview yof ythe ypractice's youtstanding yclaims y- ycorrect yanswers y-An yoverview yof ythe ypractice's youtstanding yclaims Which yof ythe yfollowing yis ythe ycorrect yterm yfor yan yamount ythat yhas ybeen ydetermined yto ybe yuncollectible? -Discounted yfee -Bad ydebt -Financial yhardship -Professional ycourtesy y- ycorrect yanswers y-bad ydebt Which yof ythe yfollowing yis ythe yfunction yof ythe yrespiratory ysystem? -Deoxygenating yblood ycells -Oxygenating yblood ycells -Generating yred yblood ycells -Generating ywhite yblood ycells y- ycorrect yanswers y-Oxygenating yblood ycells
A yCBCS yneeds yto yknow yhow ymuch yMedicare ypaid yon ya yclaim ybefore ybilling ythe ysecondary yinsurance. yTo ywhich yof ythe yfollowing yshould ythe yspecialist yrefer? -Assignment yof ybenefits -Medicare ysummary ynotice y(how ymuch ythe yprovider ywas ybilled yand yhow ymuch ythe ypatient yhas yto ypay) -Remittance yadvice -Coordination yof ybenefits y- ycorrect yanswers y-remittance yadvice The ystandard ymedical yabbreviation y"ECG" yrefers yto ya ytest yused yto yassess ywhich yof ythe yfollowing ybody ysystems? -Endocrine ysystem -Cardiovascular ysystem -Male yreproductive ysystem -Respiratory ysystem y- ycorrect yanswers y-Cardiovascular ysystem Which yof ythe yfollowing yblocks yon ythe yCMS-1500 yclaim yform yis yused yto ybill yICD ycodes? -24D
-17a -21 y- ycorrect yanswers y- -24D y(CPT yor yHCPCS ycodes) -22 y(resubmitting yto yMedicare) -17a ynot yrequired Which yof ythe yfollowing yis ythe yinitial ystep yin yperceiving ya yworker's ycompensation yclaim? -First yreport yof yinjury -Notice yof ycontest y(carrier's ydenial yof ythe yemployers' yliability yfor yan yincomplete yclaim) -Disability yclaim -Progress ynotes y- ycorrect yanswers y-First yreport yof yinjury A yparticipating yblue ycross/blue yshield yprovider yreceives yan yexplanation yof ybenefits yfor ya ypatient yaccount. yThe ycharged yamount ywas y$100. yBlue yshield yallowed y$80 yand yapplied y$40 yto ythe ypatient's yannual ydeduction. yBlue yshield ypaid ythe ybalance yat y80%. yHow ymuch yshould ythe ypatient yexpect yto ypay? -$ -$ -$ -$48 y- ycorrect yanswers y-$ A ybiller ywill yelectronically ysubmit ya yclaim yto ythe ycarrier yvia ywhich yof ythe yfollowing? -Electronic yremittance yadvice y(response yfrom yinsurance)
-The yprocedures yperformed y- ycorrect yanswers y-The ypatient's ydemographics -The yprovider's yinformation y(on yblocks y25-33) -The ypatient's ydiagnosis y(block y21) -The yprocedures yperformed y(block y24) Which yof ythe yfollowing yis ya ytype yof yclaim ythat ywill ybe ydenied yby ythe ythird yparty ypayer?
- yRejected yclaim -Pending yclaim
- ySecondary yclaim
- yIncomplete yclaim y- ycorrect yanswers y-incomplete yclaim Which yof ythe yfollowing yis ythe yappropriate ydiagnosis yfor ya ypatient ywho yhas yan yabnormal yaccumulation yof yfluids yin yher ylower yleg ythat yhas yresulted yin yswelling? -Ptosis y(drooping) -Emesis y(vomiting) -Edema -Dilation y(widening) y- ycorrect yanswers y-edema -Ptosis y(drooping) -Emesis y(vomiting) -Dilation y(widening) Which yof ythe yfollowing yis yan yexample yof yelectronic yclaim ysubmission? -Claim ysubmitted yvia ya ysecure ynetwork -Claims ysubmitted yvia yfax -Claims ythat yare ycomputer ygenerated ypaper yclaims -Claims ythat yare ycompleted yusing ythe yCMS-1500 yclaim yform y- ycorrect yanswers y-claim ysubmitted yvia ya ysecure ynetwork Which yof ythe yfollowing ysecurity yfeatures yis yrequired yduring ytransmission yof yprotected yhealth yinformation yand ymedical yclaims yto ythird yparty ypayers? -Unique yused yIDs yand ypasswords -Role ybased yaccess ycontrols -Electronic ydata yinterchange -Encryption y- ycorrect yanswers y-encryption Which yof ythe yfollowing yactions yshould ythe yCBCS ytake yto yeffectively ymanage yaccounts yreceivable? -Collect ypayment yfrom ythe ypatient yat ythe ytime yof yservice -Have ythe ypatient ypat ythe ybalance yup yfront yand ywait yfor yreimbursement -Delay ysubmission yuntil ythe ypatient ypays ythe ydeductible -Ask ythe ypatient yto ypay yhalf ynow yand ybill ythe yinsurance yfor ythe ybalance y- ycorrect yanswers y-Collect ypayment yfrom ythe ypatient yat ythe ytime yof yservice
Which yof ythe yfollowing yinsurance ycarriers yis yconsidered ythe ypayer yof ylast yresort? -Medicaid -Medicare -TRICARE -Blue ycross/shield y- ycorrect yanswers y-Medicaid Which yof ythe yfollowing yblocks yon ythe yCMS-1500 yclaim yform yis yrequired yto yindicate ya yworker's ycompensation yclaim? 11a 21 10a 22 y- ycorrect yanswers y-10a -11a yprimary yinjured ydate yof ybirth yand ygender -21 ydiagnosis ycode y -22 yMedicaid yresubmission ynumber The yprovision yof yhealth yinsurance ypolicies ythat yspecifies ywhich ycoverage yis yconsidered yprimary yor ysecondary yis ycalled? -Eligibility yverification -Explanation yof ybenefits -Assignment yof ybenefits -Coordination yof ybenefits y- ycorrect yanswers y-coordination yof ybenefits A yprovider yreceives ya yreimbursement yfrom ya ythird yparty ypayer yaccompanied yby ywith ydocument? -Monthly ystatement -Explanation yof ybenefits -Age yanalysis -Benefit ysummary ysheet y(guideline yfor ybilling) y- ycorrect yanswers y-Explanation yof ybenefits When ysubmitting yclaims, ywhich yof ythe yfollowing yis ythe youtcome yif yblock y 13 yis yleft yblank? -The yprovider yaccepts yassignment yand ypayment yas ypayment yin yfull -The yprovider ycannot ycollect ydeductible, ycopayment, yand ycoinsurance yamounts -This yhas yno yeffect yon ythe yclaim yprocessing yand yreimbursement -The ythird yparty ypayer yreimburses ythe ypatient, yand ythe ypatient yis yresponsible yfor yreimbursing ythe yprovider y- ycorrect yanswers y-The ythird yparty ypayer yreimburses ythe ypatient, yand ythe ypatient yis yresponsible yfor yreimbursing ythe yprovider Which yof ythe yfollowing ysituations yconstitutes ya yconsultation?
- yServices yrendered yby ya yphysician ywhose yopinion yor yadvice yis yrequired yby yanother yphysician yor yagency.
Which yof ythe yfollowing yorganizations yidentifies yimproper ypayments ymade yon yCMS yclaims?
- yOffice yof yinspector ygeneral y(OIG) y
- yQuality yimprovement yorganization y(QIOs)
- yRecovery yaudit ycontractor y(RAC)
- yMedicare yadministrative yContractors y(MACs) y- ycorrect yanswers y-Recovery yaudit ycontractor y(RAC)
- yOffice yof yinspector ygeneral y(OIG) y(protect ythe yintegrity yof ythe ydepartment yof yHealth yand yHuman yservices yprograms)
- yQuality yimprovement yorganization y(QIOs) y(perform yutilization yand yquality ycontrol yreview yof yhealthcare yfurnished yto yMedicare ybeneficiaries
- yMedicare yadministrative yContractors y(MACs) If ythe ypatient yhas yosteomyelitis, yhe yhas yproblems ywith ywhich yof ythe yfollowing?
- yBones yand ymuscles
- yBones yand ybone ymarrow
- yBones yand yskin
- yBones yand ytendons y- ycorrect yanswers y-bone yand ybone ymarrow When ycoding yon ythe yUB-04 yform, ythe yCBCS ymust ysequence ythe ydiagnosis ycodes yaccording yto yICD yguidelines. yWhich yof ythe yfollowing yis ythe yfirst ylisted ydiagnosis ycode?
- yPrimary ydiagnosis
- yChief ycomplaint
- yEtiology y(underlying ycause yof ythe ydisease)
- yPrincipal ydiagnosis y- ycorrect yanswers y-Principal ydiagnosis A yprovider yperforms yan yexamination yof ya ypatient's ysore ythroat. yWhich yof ythe yfollowing ydescribes ythe ylevel yof ythe yexamination?
- yExpanded yproblem yfocused yexamination y
- yDetailed yexamination y
- yProblem yfocused yexamination
- yComprehensive yexamination y- ycorrect yanswers y-Problem yfocused yexamination
- yExpanded yproblem yfocused yexamination y( yspecific yexamination yof yan yaffected yorgan ysystem yand yrelated yorgan ysystems)
- yDetailed yexamination y(extended yexamination yof yan yaffected yorgan ysystem, yand yother yrelated yorgan ysystems
- yComprehensive yexamination y(general ymulti ysystem yexamination) Which yof ythe yfollowing ycoding ymanuals yis yused yto yidentify yproducts, ysupplies yand yservices?
- yICD-10 ymanual y(diagnosis ycodes)
- yHCPCS ylevel yII ymanual
- yICD-10-PCS ymanual y(inpatient yfacilities yto yassign yprocedures)
- yCPT ymanual y(outpatient yprofessional yservice yand yprocedure ycodes yin yan y- ycorrect yanswers y-HCPCS ylevel yII ymanual
- yICD-10 ymanual y(diagnosis ycodes)
- yICD-10-PCS ymanual y(inpatient yfacilities yto yassign yprocedures)
- yCPT ymanual y(outpatient yprofessional yservice yand yprocedure ycodes yin yan A ypatient yhas yan yemergency yappendectomy ywhile yon yvacation. yThe yclaim yis yrejected ydue yto ythe ypatient yobtaining yservices yout yof ynetwork. yWhich yof ythe yfollowing yinformation yshould ybe yincluded yin ythe yclaim yappeal?
- yThe yprovider's ynetwork ystatus
- yThe ynames yof ythe ytravelers ywho ywhere ywith ythe ypatient yduring ythe yemergency
- yThe ypatient ywas yout yof ytown yduring ythe yemergency
- yThe yreason ywhy ythe ypatient ywas yout yof ytown y- ycorrect yanswers y-The ypatient ywas yout yof ytown yduring ythe yemergency After yreading ya yprovider's ynotes yabout ya ynew ypatient, ya yCBCS ydecides yto ycode yfor ya ylonger ylength yof ytime ythan ythe yactual yoffice yvisit. yWhich yof ythe yfollowing ydescribes ythat yaction?
- yUnbundling
- yAbuse
- yFraud
- yError y- ycorrect yanswers y-fraud Two yproviders yfrom ythe ysame ypractice yvisit ya ypatient yin ythe yER yusing ythe ysame yCPT ycode. yThe yclaim ymay ybe ydenied ydue yto ywhich yof ythe yfollowing yreasons?
- yContinuity yof ycare
- yIncident yto yservice y(non yphysician ypractitioner ybills yin yplace yof ythe yphysician)
- yCritical ycare
- yDuplication yof yservices y- ycorrect yanswers y-duplication yof yservice Which yof ythe yfollowing ystatements yis ytrue ywhen ydetermining ypatient yfinancial yresponsibility yby yreviewing ythe yremittance yadvice?
- yAny yservice ynot ypaid yby ya ythird yparty ypayer
- yAny ycoinsurance, ycopayment, ydeductions
- yThe ydifference ybetween ythe ybilled yamount yand ythe yallowed yamount y
- yclaims ynot ybilled yto ya ythird yparty ypayer ywithin ythe ycorrect ytime yperiod y- ycorrect yanswers y-Any ycoinsurance, ycopayment, ydeductions Which yof ythe yfollowing yis ya yrequirement yof ysome ythird yparty ypayers ybefore ya yprocedure yis yperformed?
- yPredetermination yform
- yPre yAuthorization yform
- yAdvanced ybeneficiary ynotice
- yClaims ysubmission y- ycorrect yanswers y-Claims yadjudication
- yClaim yprocessing y(second)
- yClaims ypayment y( yfourth)
- yClaims ysubmission y(first) A ypatient ypresents yto ythe yprovider ywith ychest ypain yand yshortness yof ybreath. yAfter yan yunexpected yECG yresult, ythe yprovider ycalls ya ycardiologist yand ysummarizes ythe ypatient's ysymptoms. yWhat yportion yof yHIPAA yallows ythe yprovider yto yspeak yto ythe ycardiologist yprior yto yobtaining ythe ypatient's yconsent?
- yTitle yI y
- yThe yprivacy yrule
- yTitle yII
- yFERPA y- ycorrect yanswers y-Title yII
- yTitle yI y(regulates yinsurance yreform)
- yThe yprivacy yrule
- yFERPA y( yfamily yeducation yright yand yprivacy yact y= yprotects ythe yprivacy yof ystudent yrecords, ynot ypart yof yHIPAA) When ya yphysician ydocuments ya ypatient's yresponse yto ysymptoms yand yvarious ybody ysystems. yThe yresults yare ydocumented yas ywhich yof ythe yfollowing?
- yPast ymedical yhistory
- yFamily yhistory
- yReview yof ysystems
- yComprehensive yexamination y- ycorrect yanswers y-Review yof ysystems Which yof ythe yfollowing ystatements yis ytrue yregarding ythe yrelease yof ypatient yrecords?
- yVerbal yrequests yfor yrecords yfrom ylife yinsurance ycompanies yare yappropriate
- yIdentification yis ynot yrequired ywhen yrequesting yaccess yto ypatient yrecords
- yProviders ycannot yshare ya ypatient' ymedical yinformation ywith yother yhealth ycare yprofessionals yif ythe ypatient's ymentally yunstable
- yPatient yaccess yto ypsychotherapy ynotes ymay ybe yrestricted y- ycorrect yanswers y-Patient yaccess yto ypsychotherapy ynotes ymay ybe yrestricted A yclaim yis ydenied ybecause ythe yservice ywas ynot ycovered yby ythe yinsurance. yUpon yconfirmation yof yno yerrors yon ythe yclaim, ywhich yof ythe yfollowing ydescribes ythe yprocess ythat ywill yfollow ythe ydenial?
- yThe yclaim ywill ybe ysubmitted ywith ya ynew yCPT ycode
- yThe yclaim ywill ynot ybe yresubmitted yand ythe ypatient ywill ybe ysent ya ybill
- yThe yclaim ywill ybe yresubmitted ywith ya ymodifier yon ythe yCPT ycode
- yThe yclaim ywill ynot ybe yresubmitted, ybut ythe yclaim ywill ybe yappealed. y- ycorrect yanswers y-The yclaim ywill ynot ybe yresubmitted yand ythe ypatient ywill ybe ysent ya ybill When yan yelectronic yclaim yis yrejected ydue yto yincomplete yinformation, ywhich yof ythe yfollowing yaction yshould ythe yCBCS ytake?
- yProcess ythe yclaim yas yan yadjustment
- yComplete ythe yinformation yand yretransmit yaccording yto ythe ythird yparty ystandards
- yReprocess ythe yrejected yclaim ywithin y 30 ydays
- ySend ythe yclaim yback ywith ythe ynext ybatch yof yclaims y- ycorrect yanswers y- Complete ythe yinformation yand yretransmit yaccording yto ythe ythird yparty ystandards Which yof ythe yfollowing ydocuments yis yrequired yto ydisclose yan yadult ypatient's yinformation
- yA ysigned yreleased yfor ythe ypatient's yfamily ymember
- yThe ypatient's ydriver's ylicense
- yA ysigned yrelease yfrom ythe ypatient
- yThe ypatient's ysocial ysecurity ycard y- ycorrect yanswers y-A ysigned yrelease yfrom ythe ypatient In y 1995 yand y 1997 y, ywhich yof ythe yfollowing yintroduced ydocumentation yguidelines yto yMedicare ycarriers yto yensure ythat yservice ypaid yfor yhave ybeen yprovided yand ywere ymedically ynecessary?
- yHIPAA
- yOIG y
- yCMS
- yAMA y- ycorrect yanswers y-CMS
- yOIG y- yfraud yand yabuse
- yAMA y- yphysician ypatient yrelationship For ywhich yof ythe yfollowing ytime yperiods yshould ythe yCBCS ytrack yunpaid yclaims ybefore ytaking yfollow yup yaction? 10 ydays 30 ydays 60 ydays 90 ydays y- ycorrect yanswers y-30 ydays A ybeneficiary yof ya yMedicare/Medicaid ycrossover yclaim ysubmitted yby ya yparticipating yprovider yis yresponsible yfor ywhich yof ythe yfollowing ypercentage? 40% 20% 10% 0% y- ycorrect yanswers y-0% A yCBCS yshould yadd ymodifier y-50 yto ycodes ywhen yreporting ywhich yof ythe yfollowing?
- yA ybilateral yprocedure
- yA yunilateral yprocedure y
- yMultiple yprocedure y
- yReduces yservices y- ycorrect yanswers y-A ybilateral yprocedure
- yThe yprovider ycan ycollect yfull ypayment yfrom ythe ypatient y- ycorrect yanswers y- The yprovider yreceives ypayment ydirectly yfrom ypayer Which yof ythe yfollowing yforms ymust ythe ypatient yor yrepresentative ysign yto yallow ythe yrelease yof yPHI?
- yAn yauthorization
- yAn yaffidavit
- yA ycopy yof ythe yHIPAA ysecurity yrule
- yA ycopy yof ythe yHIPAA yprivacy yrule y- ycorrect yanswers y-an yauthorization Which yof ythe yfollowing yis ythe yprimary yinformation yused yto ydetermine ythe ypriority yof ycollection yletters yto ypatients?
- yThe yage yof ythe yaccount
- yThe ytype yof ythe yaccount
- yThe ytype yof ythe yinsurance
- yThe ylast ypayment yreceived y- ycorrect yanswers y-the yage yof ythe yaccount Which yof ythe yfollowing yclaims ywould yappear yon yan yaging yreport?
- yA yclaim ypaid yin yfull ywithin ythe ypast y 90 ydays
- yA yclaim ythat yis ydelinquent yfor y 60 ydays
- yA yclaim yprocessed yand ypaid ywithin ypast y 60 ydays
- yA yclaim ythat ybilled yand yreimbursed ythe ypatient ywithin ythe ypast y 30 ydays y- ycorrect yanswers y-A yclaim ythat yis ydelinquent yfor y 60 ydays A yCBCS yshould yenter ythe yprior yauthorization ynumber yon ythe yCMS-1500 yclaim yform yin ywhich yof ythe yfollowing yblocks?
- y21A y(diagnosis ycode)
- y 24 yD y(procedures yand yservices)
- y 23 y(prior yauthorization)
- y24E y(federal ytax yid) y- ycorrect yanswers y-23 y(prior yauthorization)
- y21A y(diagnosis ycode)
- y 24 yD y(procedures yand yservices)
- y24E y(federal ytax yid) Which yof ythe yfollowing yblocks yrequire ythe ypatient's yauthorization yto yrelease ymedical yinformation yto yprocess ya yclaim?
- y 12
- y 13 y(patient yauthorization yfor yassignment yof ybenefits yrequired yfor ythird yparty ypayer
- y 27 y(accepting yassignment yof ybenefits)
- y 31 y(treating yphysician's yname) y- ycorrect yanswers y-
- y 13 y(patient yauthorization yfor yassignment yof ybenefits yrequired yfor ythird yparty ypayer
- y 27 y(accepting yassignment yof ybenefits)
- y 31 y(treating yphysician's yname)
Which yof ythe yfollowing yclaims yis ysubmitted yand ythen yoptically yscanned yby ythe yinsurance yand yconverted yto yan yelectronic yform?
- yPaper yclaim
- yPending yclaim
- yClean yclaim
- yRejected yclaim y- ycorrect yanswers y-paper yclaim Which yof ythe yfollowing yactions yby ya yCBCS ywould ybe yconsidered yfraud?
- ySubmitting ya yclaim yfor yservices ythat yare ynot ymedically ynecessary
- yViolating yparticipating yprovider yagreements ywith ythird yparty ypayer
- yBilling yfor yservices ynot yprovided
- yBilling ynon-covered yservices yas ycovered yservices y- ycorrect yanswers y-billing yfor yservices ynot yprovided Which yof ythe yfollowing yprivacy ymeasures yensures yPHI?
- yConfirming ytest yresults ywith ythe ypatient yover ythe yphone yat ythe yreception
- yAsking ypatients ythe yreason yfor ytheir yvisit yat ycheck yin
- yUsing ydata yencryption ysoftware yon yoffice yworkstation
- yCalling ya ypatient yinto ythe yclinical yarea yusing yfirst yand ylast yname. y- ycorrect yanswers y-Using ydata yencryption ysoftware yon yoffice yworkstation A yform ythat ycontains ycharges, yDOS, yCPT ycodes, yICD ycodes, yfees yand ycopayment yinformation yis ycalled ywhich yof ythe yfollowing?
- yEncounter yform
- yItemized ybill
- yChargemaster
- yRemittance yadvice y- ycorrect yanswers y-encounter yform Which yof ythe yfollowing ymedical yterms yrefers yto ythe ysac ythat yencloses ythe yheart? -Endocardium -Epicardium -Myocardium -pericardium y- ycorrect yanswers y-pericardium When ycompleting yCMS-1500 ypaper yclaim yform, ywhich yof ythe yfollowing yis yan yacceptable yaction yfor ythe yCBCS yto ytake?
- yUse yappropriate ytitle yfor yall ypatients
- yFold ythe yform yin yhalf yfor ymailing
- yUse yArial ysize y 10 yfont
- yAttach ydocuments ywith ystaples yin ythe yleft yhand ycorner y- ycorrect yanswers y- use yArial ysize y 10 yfont Which yof ythe yfollowing ydescribes ya ydelinquent yclaim?
- yThe yclaim ywas ysubmitted ybeyond ythe ytimely yfiling ylimit
- yThe yclaim yhad ymore ythan yone yprocedure ysubmitted
