Primary payer - Study guides, Class notes & Summaries

Joe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd. C. Mary, because her birth year is before Joe's birth year. D. Joe, because his birth month and day are before...

NHA,CBCS Exam (Latest 2024/ 2025 Update) | Questions and Verified Answers| 100% Correct| Grade A Q: Which of the following would most likely result in a denial on a Medicare claim? Answer: An experimental chemotherapy medication for a patient who has stage III renal cancer Q: Which of the following pieces of guarantor information is required when establishing a patient's financial record? Answer: Phone number Q: A provider surgically punctures through the space betw...

NC Medicare Supplement & Long Term Care Insurance Licensing Latest Update Graded A+ Medicare Health insurance for those over age 65, people under 65 with certain disabilities & those with ESRD (end stage renal disease - permanent kidney failure requiring dialysis or kidney transplant) CMS Centers for Medicare and Medicaid Services administers the Medicare program. Social Security Administration handles most of the enrollment & plays a role in claims appeal process. MAC Medicare A...

Single-payer health care system Correct Ans Tax $ pay for health insurance provided to all residents through gov Providers may be public, private, or a combination Insurers may be not-for-profit or for-profit; tightly regulated two-tier health care system Correct Ans Mandated minimum/catastrophic coverage- required or provided for all Patients may voluntarily purchase additional coverage/ services insurance mandate Correct Ans Gov mandates that all residents purchase insurance from p...

RHIA Domain 4 Exam Questions with Correct Answers Which government-sponsored program provides coverage for active-duty service members of the armed forces (ADSM)? - Answer-TRICARE Dr. McGee is a primary care physician. Several of Dr. McGee's patients are insured by Super Payer. Super Payer reimburses Dr. McGee for each service she provides during a clinic visit. Which reimbursement methodology does Super Payer use to reimburse Dr. McGee? - Answer-Fee schedule Dayna is analyst at Communit...

Medicare Health insurance for those over age 65, people under 65 with certain disabilities & those with ESRD (end stage renal disease - permanent kidney failure requiring dialysis or kidney transplant) CMS Centers for Medicare and Medicaid Services administers the Medicare program. Social Security Administration handles most of the enrollment & plays a role in claims appeal process. MAC Medicare Administrative Contractor - company contracted to administer Part A & Part B claims....

Which of the following sections of the medical record is used to determine the correct evaluation and management code used for billing and coding? - history and physical A billing and coding specialist is reviewing a CMS-1500 claim form. The "assignment of benefits" box has been checked "yes." The checked box indicates which of the following? - The provider receives payment directly from the payer Which of the following do physicians use to electronically submit a claim? - Clearinghouse W...

A practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice used x-rays of one patient to justify services on multiple other patients' claims. The office manager brought the civil suit. What type of case is this? Answer Qui Tam In which of the following circumstances may PHI not be disclosed without the patient's authorization or permission? Answer An office receives a call from the patient's husband asking for information about his wife's recent office visit. A...

________ is when the provider has limited access to payer and patient data elements on their patients only. - Extranet An extranet is a private computer network allowing controlled access to the payer's system. The provider has limited access to payer and patient data elements on their patients only. 1992 US federal government implemented a standardized physician payment schedule utilizing resourcebased relative value scale - RBRVS A batch of claims is submitted to the clearinghouse for pr...

Medicare Part B correct answers Financed by the Supplementary Medical Insurance (SMI) Trust Fund, which is funded through general tax revenue and premiums paid by benefit recipients. Assignment correct answers If a doctor has accepted a Medicare assignment, the doctor will bill the patient directly. The patient then fills out a Medicare claim form and attaches the itemized bills from the doctor. These providers are known as Non-participating providers or suppliers. Non-participating providers...