Which of the following is considered the final determination of the issues involving the settlement of an
insurance claim? correct answerAdjudication - is the process of putting an insurance claim through a
series of edits for final determination.
Chapter 4
A form that contains charges, DOS, CPT codes, fees, and copayment information is called which of the
following? correct answerEncounter form is a form that contains charges, DOS, CPT code, ICD codes,
fees, and copayment information.
page 67
A patient comes to the hospital for an inpatient procedure. Which of the following hospital staff
members is responsible for the initial patient interview, obtaining demographic and insurance
information, and documenting the chief complaint? correct answerAdmitting these duties clerk has
Chapter 3
Which of the following privacy measures ensures protected health information (PHI)? correct
answerUsing data encryption software on office workstations - encryption software ensures that
electronically transmitted health information cannot be read by third parties. This privacy measure
guarantees PHI.
Chapter 1
Which of the following planes divide the body into left and right? correct answerSagittal plane divides
the body into right and left sections
Which of the following provisions ensures that an insured's benefits from all insurance companies do
not exceed 100% of allowable medical expenses? correct answerCoordination of benefits ensures that
the insured benefits from all insured companies do not exceed 100% of allowable medical expenses.
page 16
, Which of the following actions should be taken first when reviewing a delinquent claim? correct
answerVerify the age of the account is the first action.
page 45
Which of the following is the advantage of electronic claim submission? correct answerClaims are
expedited - submitting claims electronically is faster than submitting paper claims.
page 15
Which of the following components of an explanation of benefits expedites the process of a phone
appeal? correct answerClaim control number expedites the process of a phone appeal.
Chapter 4
The standard medical abbreviation "ECG" refers to a test used to assess which of the following body
systems? correct answerCardiovascular system- which is a test that checks for problems with the
electrical activity of the heart.
Chapter 5
Which of the following actions by a billing coding specialist (bcs) would be considered fraud? correct
answerBilling for a service not provided is considered fraud and can result in fines for the bcs and the
physician page 6
The "> <" symbol is used to indicate new and revised text other than which of the following? correct
answerProcedures descriptors Chapter 5
On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the following?
correct answerThe patient's condition and the provider's information are found on the CMS-1500 at
blocks 14 - 33 page 21
Which of the following includes procedures and best practices for correct coding? correct answerCoding
Compliance Plan contains rules, procedures, and best practices to ensure accurate coding.
Chapter 5
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