Certification Exam ALL ANSWERS & SOLUTION 2023 EDITION GUARANTEED GRADE A+

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 If a married couple Is covered under both spouses' health insurance and the husband wishes to schedule an appointment for an annual exam,he should call his primary care provider and schedule an appointment using both his insurance benefits and his wife's Insurance benefits. An appropriate way to open the discussion when explaining practice fees to a patient? Do you have any questions about the cost or today's visit? I will be glad to answer them.. 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 When is a referral from a provider required? if patient goes to a network hospital for services The patient needs to have a tubal ligation performed. Which of the following is needed in order for the third party payer to cover the procedure? pre-certification Which of the following is the correct procedure for keeping a Workers Compensation patient financial and health records when the same physician is also seeing the patient as a private patient? Separate financial and health records must be used what should an insurance and coding specialist do when checking for completion of a new patient's registration form? check that demographics are complete, make sure that the patient's name matches the insurance card, and make sure that the registration form is signed and dated. Which of the following information is necessary to post payments from the RA/EOB? CONTINUED...