Exam (elaborations)
NHA CBCS Module 4: Billing and Reimbursement Exam Questions & answers
- Course
- Institution
NHA CBCS Module 4: Billing and Reimbursement Exam Questions & answers
[Show more]
Seller
Follow
Victorious23
Reviews received
Content preview
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
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Victorious23. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $12.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
75759 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now