Billing Regulations| CPC Professional Exam Rehearsals| Written Test with Verified Q&A
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Billing Regulations| CPC Professional
Exam Rehearsals| Written Test with
Verified Q&A
Accountable Care Organizations (ACO) is an organization working to better coordinate
patient care
For which reason might Medicare deny payment on a claim?
When the service is not deemed medically necess...
Billing Regulations| CPC Professional
Exam Rehearsals| Written Test with
Verified Q&A
Accountable Care Organizations (ACO) is an organization working to better coordinate
patient care
For which reason might Medicare deny payment on a claim?
When the service is not deemed medically necessary under Medicare guidelines.
What is the purpose of the National Correct Coding Initiative (NCCI) edits in medical billing?
To prevent improper coding and overbilling by identifying inappropriate code combinations.
How does the Medicare 72-hour rule affect hospital billing?
Any outpatient services within 72 hours of admission must be billed as part of the inpatient
claim.
Under HIPAA, what is required of covered entities when dealing with patient information?
They must ensure the privacy and security of Protected Health Information (PHI).
What is the function of the Explanation of Benefits (EOB) in the billing process?
It provides a summary of what the insurance covered, including any patient responsibility.
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, When might a claim be submitted to secondary insurance?
When the primary insurance has completed payment or denial, any remaining balance can be
sent to secondary insurance.
What is the purpose of a patient’s Advance Beneficiary Notice (ABN)?
To notify the patient in advance if Medicare may not cover a service, allowing them to decide
if they still wish to proceed.
What is the difference between fraud and abuse in medical billing?
Fraud is intentional deception to gain payment, while abuse involves actions that
unintentionally misrepresent facts for reimbursement.
How often must HIPAA training be conducted for employees who handle patient information?
Annually, to ensure compliance with privacy and security regulations.
What does the “Medically Unlikely Edits” (MUE) program do?
It limits the number of times certain procedures and services can be reported on the same day.
What is the “Birthday Rule” in determining primary insurance for a dependent child?
The parent with the earliest birthday in the year has the primary insurance.
How are “incident-to” services billed in a physician’s office?
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