The Claims Process - Set 2

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NCCT Reviewer

give a more accurate description

When coding some procedures and services it is necessary to add a 2 digit modifier in order to _________?

a) indicate usual charges
b) prevent miscoding
c) give a more accurate description
d) meet federal guidelines

monitor coding accurancy

Random audits of medical records by insurance carriers are used to ___________?

a) catch errors by insurance companies
b) monitor coding accurancy
c) assess physician dictation timeliness
d) revise CPT codes

malignant lesions are reimbursed at a higher rate

It is best to delay the submission of certain claims until pathology reports are received because ___________?

a) the physician's office bills for the pathologist
b) you can never code symptoms on a claim
c) insurance companies require this
d) malignant lesions are reimbursed at a higher rate

clean claim

A correctly completed claim submitted within the policy time limit is termed a ________?

a) paper claim
b) paid claim
c) legal claim
d) clean claim

coding updates

A EOB document may include all of the following EXCEPT ________?

a) dedcutible
b) patient name
c) allowed amounts
d) coding updates

closed

Claims paid with no errors are considered ________?

a) closed
b) pending
c) filed
d) suspended

batch

A group of electronic claims submitted from one facility is termed a _______?

a) bunch
b) batch
c) cluster
d) bundle

fewer steps

From beginning to end, an electronic claim versus a paper claim requires ___________?

a) fewer steps
b) more steps
c) signature stamps
d) documents be sent

clearinghouse

A third party entity that recieves, separates, and transmits claims to the appropriate payer is called a(n) ___________?

a) carrier
b) insurance specialist
c) clearinghouse
d) national network

medically necessary

Medicaid policy allows for coverage and payment of all services that are __________?

a) billed by a physician
b) medically necessary
c) viewed as appropriate by the physician
d) less than $100

smart card

A plastic card containing information regarding a patient's insurance, history and elgibility is called ________?

a) disk
b) record
c) debit card
d) smar card

When a omission or error comes to his or her attention

When may a physician modify, change, or add an addendum to a medical record ____________?

a) Only after a claim is submitted
b) Only before a claim is submitted
c) Never
d) When an omission or error comes to his or her attention

daily

Large medical practices generally submit electronic claims _________?

a) daily
b) hourly
c) weekly
d) monthly

never printed on paper

A digital fax claim is a claim that arrives at the insurance carrier via fax machine but is _______?

a) printed on paper
b) never printed on paper
c) duplicated and verified
d) monitored by phone

fax must be turned on

In order to receive tha carrier's fax back verification, the physician's office ___________?

a) runs a test phase
b) follows a schedule
c) fax must be turned on
d) staff must be present

Handwritten information

Which of the following is NOT recommended on faxed claims ________?

a) Dark, distinct print
b) Font size of 10-14 points
c) Handwritten information
d) CMS-1500 forms

in writing

Submissions to the insurance commissioner should be handled __________?

a) electronically
b) by telephone
c) in writing
d) by the patient

carrier must pay the physician within 2 or 3 weeks

If an insurance carrier sends payment directly to the patient even though the physician has been assigned the benefits, the ____________?

a) carrier must pay the physician within 2 or 3 weeks
b) payment is not recoverable
c) patient will pay the physician
d) physician will revoke the assignment of benefits form

clean claims

The following are types of problem claims EXCEPT __________?

a) partial payment
b) clean claims
c) delinquent claims
d) suspended claims

correct dates of serice

The following are common reasons for denial of claims EXCEPT ________?

a) deleted codes
b) when gender does not match services
c) correct dates of serice
d) transposed numbers

write a letter of appeal

If a claim is denied for lack of medical necessity and the physician feels the service was medically necessary, the physician should __________?

a) contact the commissioner
b) write a letter of appeal
c) resubmit the claim
d) write off the amount of the claim

tracer

An inquiry made to locate the status of an insurance claim is called a _________?

a) follow-up
b) tracer
c) review
d) tracker

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