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NHA CBCS Module 4: Billing and Reimbursement Exam Questions & answers
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NHA CBCS Module 4: Billing and Reimbursement Exam Questions & answers
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NHA CBCS Module 4: Billing andReimbursement Exam Questions & answers
835 - -Electronic transmission of RA/EOB information.
-837P - -The electronic version of a professional claim form.
-aging report - -A report that shows the length of outstanding balances in
the system.
Identifies outstanding patient balances that are considered overdue.
-appeal - -The official process of requesting a review of a claim that was
underpaid or denied. Not used for rejected claims.
-claims editing - -A step in the claims process in which appropriate codes
and rules are verified before the claim is submitted.
-electronic funds transfer (EFT) - -The computer-based transfer of money. In
the context of medical billing, it usually refers to an organization receiving
reimbursement from a third-party payer.
-Local Coverage Determination (LCD) - -Describes coverage determined by
a MAC about a particular service.
-Medicare Administrative Contractor (MAC) - -A third-party payer that has
been contracted to process Medicare Part A and Part B medical claims for
Medicare Fee-For-Service (FFS) beneficiaries.
-National Correct Coding Initiative (NCCI) - -This initiative provides a code
editing system that prevents inappropriate reporting of CPT codes.
-National Coverage Determination (NCD) - -Describes Medicare coverage for
a specific service procedure or device.
-National Uniform Claim Committee (NUCC) - -Provides guidelines for each
block of the CMS-1500 form.
-payer mix - -The showing of a percentage of usage under a specific payer.
-CARC - -Claim Adjustment Reason Code
Controlled by CMS, universal method used to code claims adjudication.
, -deductible - -Set annual amount that must be satisfied before the plan
pays a specific percentage (coinsurance) of medical services that are not
subject to a copay.
-dual coverage - -When a patient has more than one health care policy,
often referred to for patients who have Medicare and Medicaid.
-ERA - -An electronic version of a remittance advice document.
-INN - -In-Network
Means that the provider has a contract with the payer/insurance company
and has agreed to the payment amounts set by the payer.
-OON - -Out-of-Network
Means that the provider does not have a contract with the payer/insurance
company and can bill the patient for the difference of what is not paid by the
payer.
-RA - -Remittance Advice
Document used to explain how a payer processed a claim. This document is
also referred to as an EOB (explanation of benefits).
-SOAP - -Subjective, Objective, Assessment, Plan
A method of documentation used by health care providers to document
progress notes in a patient's chart.
-What are some examples of things that may cause a loss of revenue? - -
Incorrect code assignment, modifier use, and units for drugs supplied by the
provider.
-Which of the following forms would be included in a patient's EMR?
A) List of noncovered medical services
B) The right to a second opinion
C) Supplemental coverage forms
D) Consent to treatment - -D) Consent to treatment
Signed consent forms such as consent to treatment, release of medical
records, and financial obligations are required and must be scanned and
uploaded into the patient's chart.
-Which of the following codes is the correct administration code for Kenalog
injected in an adult patient?
A) 99213
B) 90460
C) 90471
D) 96372 - -D) 96372
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