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A patient with ABC insurance is seen on May 1st, and the claim is submitted on July 15 of the same year. Has the claim met the timely filing deadline? a. Yes. All payers have the same timely filing deadline of one year from date of service. b. No. All payers have a 30-day timely filing deadlin...
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Add to cartA patient with ABC insurance is seen on May 1st, and the claim is submitted on July 15 of the same year. Has the claim met the timely filing deadline? a. Yes. All payers have the same timely filing deadline of one year from date of service. b. No. All payers have a 30-day timely filing deadlin...
Eight standard transactions were adopted for Electronic Data Interchange (EDI) under HIPAA. Which of the following is NOT included as a standard transaction? - Answer- d. Physician unique identifier number A physician received office space at a reduced rate for referring patients to the hospital...
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Add to cartEight standard transactions were adopted for Electronic Data Interchange (EDI) under HIPAA. Which of the following is NOT included as a standard transaction? - Answer- d. Physician unique identifier number A physician received office space at a reduced rate for referring patients to the hospital...
TPO - Answer- Treatment, Payment & Operations CMPs - Answer- Civil Monetary Penalties EDI - Answer- Electronic Data Interchange HHS - Answer- Health and Human Services TILA - Answer- Truth in Lending Act ROI - Answer- Release of Information OCR - Answer- Office of Civil Rights C...
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Add to cartTPO - Answer- Treatment, Payment & Operations CMPs - Answer- Civil Monetary Penalties EDI - Answer- Electronic Data Interchange HHS - Answer- Health and Human Services TILA - Answer- Truth in Lending Act ROI - Answer- Release of Information OCR - Answer- Office of Civil Rights C...
Abuse - Answer- An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly Anti-Kickback - Answer- Knowingly and willfully offering or accepting rewards or remuneration for services that are billable to a federal healthcare plan Beneficiary - Ans...
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Add to cartAbuse - Answer- An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly Anti-Kickback - Answer- Knowingly and willfully offering or accepting rewards or remuneration for services that are billable to a federal healthcare plan Beneficiary - Ans...
A physician received office space at a reduced rate for referring patients to the hospital's outpatient physical therapy center. What Law does this violate? 1. Anti-kickback Statute 2. Stark Law 3. False Claims Act 4. Truth in Lending Act - Answer- Anti-Kickback Statute Rationale: The anti...
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Add to cartA physician received office space at a reduced rate for referring patients to the hospital's outpatient physical therapy center. What Law does this violate? 1. Anti-kickback Statute 2. Stark Law 3. False Claims Act 4. Truth in Lending Act - Answer- Anti-Kickback Statute Rationale: The anti...
Medicare's payment amount for services are determined by which of the following formulas? a. Sustainable growth rate (SGR) X Geographic Practice Cost Index (GPCI) = Medicare payment b. Total RVU X Conversion factor = Medicare payment c. Total Practice Expense (PE) X Conversion factor = Medicar...
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Add to cartMedicare's payment amount for services are determined by which of the following formulas? a. Sustainable growth rate (SGR) X Geographic Practice Cost Index (GPCI) = Medicare payment b. Total RVU X Conversion factor = Medicare payment c. Total Practice Expense (PE) X Conversion factor = Medicar...
A ______ indicates the location or type of service provided for an inpatient and is reported with _______. a. Revenue code; four-digit code b. Revenue code; three-digit code c. CPT code; five-digit code d. MSDRG code; three-digit code - Answer- a. Revenue code; four-digit code Which of the ...
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Add to cartA ______ indicates the location or type of service provided for an inpatient and is reported with _______. a. Revenue code; four-digit code b. Revenue code; three-digit code c. CPT code; five-digit code d. MSDRG code; three-digit code - Answer- a. Revenue code; four-digit code Which of the ...
On 05/02/19, a claim for a fine needle aspiration biopsy with ultrasound guidance was reported with CPT code 10022, ICD-10-CM code D49.2 for DOS 05/01/2019. Why would the claim be denied? a. Not medically necessary b. Invalid CPT code for DOS c. Invalid ICD-10-CM code for DOS d. Timely filing ...
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Add to cartOn 05/02/19, a claim for a fine needle aspiration biopsy with ultrasound guidance was reported with CPT code 10022, ICD-10-CM code D49.2 for DOS 05/01/2019. Why would the claim be denied? a. Not medically necessary b. Invalid CPT code for DOS c. Invalid ICD-10-CM code for DOS d. Timely filing ...
The term for the set payment that the member pays to the healthcare provider on the day of service is the: a. office visit fee. b. co-insurance. c. copay. d. co-signer. - Answer- c. copay. Blue Cross/Blue Shield identifies the individual or employee who pays for healthcare insurance coverag...
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Add to cartThe term for the set payment that the member pays to the healthcare provider on the day of service is the: a. office visit fee. b. co-insurance. c. copay. d. co-signer. - Answer- c. copay. Blue Cross/Blue Shield identifies the individual or employee who pays for healthcare insurance coverag...
Which statement is TRUE regarding the Prompt Payment Act? a. Patients are required to pay patient balances within 30 days. b. Patient balances are dismissed if a statement is not sent to the patient within 30 days. c. Federal agencies are not required to respond to all clean claims within 30 da...
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Add to cartWhich statement is TRUE regarding the Prompt Payment Act? a. Patients are required to pay patient balances within 30 days. b. Patient balances are dismissed if a statement is not sent to the patient within 30 days. c. Federal agencies are not required to respond to all clean claims within 30 da...
Which of the following does NOT qualify a patient for coverage under Medicare? a. End Stage Renal Disease (ESRD) b. Age 65 or older c. Under age 65 with disabilities d. Low income individual - Answer- d. Low income individual The insurance claim process begins with: a. Patient informatio...
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Add to cartWhich of the following does NOT qualify a patient for coverage under Medicare? a. End Stage Renal Disease (ESRD) b. Age 65 or older c. Under age 65 with disabilities d. Low income individual - Answer- d. Low income individual The insurance claim process begins with: a. Patient informatio...
Joe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. ...
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Add to cartJoe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. ...
Health plan, clearinghouses, and any entity transmitting health information is considered by the Privacy Rule to be a: - Answer- covered entity Which of the following is not a covered entity in the Privacy Rule - Answer- healthcare consulting firm A request for medical records is received for ...
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Add to cartHealth plan, clearinghouses, and any entity transmitting health information is considered by the Privacy Rule to be a: - Answer- covered entity Which of the following is not a covered entity in the Privacy Rule - Answer- healthcare consulting firm A request for medical records is received for ...
Joe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. ...
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Add to cartJoe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. ...
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What process would NOT be performed at the check-out process? a. Follow-up appointments b. Collection of copays or deductibles c. Patient registration process d. Review of charge ticket or encounter form - Answer- Patient registration process Which of the following processes could result in l...
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Add to cartWhat process would NOT be performed at the check-out process? a. Follow-up appointments b. Collection of copays or deductibles c. Patient registration process d. Review of charge ticket or encounter form - Answer- Patient registration process Which of the following processes could result in l...
Stablization Act - 1942 - Answer- 1. Wages and price controls were placed on employers 2. Congress limited the wages that could be offered, but allowed the adoption of employee insurance plans Internal Revenue Code - 1954 - Answer- Stated employer contributions to employee health plans were ex...
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Add to cartStablization Act - 1942 - Answer- 1. Wages and price controls were placed on employers 2. Congress limited the wages that could be offered, but allowed the adoption of employee insurance plans Internal Revenue Code - 1954 - Answer- Stated employer contributions to employee health plans were ex...
A patient presents to be seen in the office. He does not pay at the time the services are rendered as the provider is his primary care provider, or gatekeeper. The large group practice has 800 covered members under this plan as is paid on a monthly basis with a set amount that is based on the number...
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Add to cartA patient presents to be seen in the office. He does not pay at the time the services are rendered as the provider is his primary care provider, or gatekeeper. The large group practice has 800 covered members under this plan as is paid on a monthly basis with a set amount that is based on the number...
FCA - Answer- False Claims Act (FCA): {"knowing" and "knowingly"}-Federal statue setting civil and criminal penalties to protect the government from being overcharged or sold substandard goods or services: -falsely billing the government -over-representing the amount of a delivered product ....
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Add to cartFCA - Answer- False Claims Act (FCA): {"knowing" and "knowingly"}-Federal statue setting civil and criminal penalties to protect the government from being overcharged or sold substandard goods or services: -falsely billing the government -over-representing the amount of a delivered product ....
The office policy for claims follow-up is to prioritize the insurance balance accounts past 90 days by highest outstanding balance. Based on the A/R report provided, which payer type and aging category would be one of the top priorities on which to focus collection efforts? - Answer- workers' compe...
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Add to cartThe office policy for claims follow-up is to prioritize the insurance balance accounts past 90 days by highest outstanding balance. Based on the A/R report provided, which payer type and aging category would be one of the top priorities on which to focus collection efforts? - Answer- workers' compe...
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What does the acronym PHI stand for? a. Patient Healthcare Information b. Patient History of Illness c. Protected Health Information d. Protected Healthcare Index - Answer- c. Protected Health Information A new radiology company opens in town. The manager calls your practice and offers to p...
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Add to cartWhat does the acronym PHI stand for? a. Patient Healthcare Information b. Patient History of Illness c. Protected Health Information d. Protected Healthcare Index - Answer- c. Protected Health Information A new radiology company opens in town. The manager calls your practice and offers to p...
Eight standard transactions were adopted for Electronic Data Interchange (EDI) under HIPAA. Which of the following is NOT included as a standard transaction? a. Payment and remittance advice b. Eligibility in a health plan c. Coordination of benefits d. Physician unique identifier number - Ans...
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Add to cartEight standard transactions were adopted for Electronic Data Interchange (EDI) under HIPAA. Which of the following is NOT included as a standard transaction? a. Payment and remittance advice b. Eligibility in a health plan c. Coordination of benefits d. Physician unique identifier number - Ans...
A practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice used x-rays of one patient to justify services on multiple other patients' claims. The office manager brought the civil suit. What type of case is this? - Answer- Qui Tam In which of the following circumstances m...
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Add to cartA practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice used x-rays of one patient to justify services on multiple other patients' claims. The office manager brought the civil suit. What type of case is this? - Answer- Qui Tam In which of the following circumstances m...
What is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? - Answer- A deductible is the amount a policyholder pays for health care services before the health insurance begins to pa...
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Add to cartWhat is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? - Answer- A deductible is the amount a policyholder pays for health care services before the health insurance begins to pa...
HRA - Answer- Health Reimbursement Account What part of Medicare pays for prescriptions - Answer- Part D What type of plan allows an insurer to administer straight indemnity insurance, an HMO, or a PPO insurance plans to its members? - Answer- Triple Option Plan HIPAA - Answer- Health Insur...
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Add to cartHRA - Answer- Health Reimbursement Account What part of Medicare pays for prescriptions - Answer- Part D What type of plan allows an insurer to administer straight indemnity insurance, an HMO, or a PPO insurance plans to its members? - Answer- Triple Option Plan HIPAA - Answer- Health Insur...
WHO IS COVERED BY CHAMPVA? A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR FAMILIES B) ACTIVE DUTY MILITARY AND THEIR FAMILIES C) RETIRED MILITARY AND THEIR FAMILIES D) ACTIVE DUTY MILITARY OVER THE AGE OF 65 - Answer- A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR FA...
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Add to cartWHO IS COVERED BY CHAMPVA? A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR FAMILIES B) ACTIVE DUTY MILITARY AND THEIR FAMILIES C) RETIRED MILITARY AND THEIR FAMILIES D) ACTIVE DUTY MILITARY OVER THE AGE OF 65 - Answer- A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR FA...
What is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? A. Copayment B. Deductible C. Secondary Payment D. Coinsurance - Answer- B. Deductible Which type of insuranc...
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Add to cartWhat is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? A. Copayment B. Deductible C. Secondary Payment D. Coinsurance - Answer- B. Deductible Which type of insuranc...
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