The symbol "O" in the Current Procedural Terminology reference is used to indicate what? - ANSWER Reinstated or recycled code
In the anesthesia section of the CPT manual, what are considered qualifying circumstances? - ANSWER Add-on codes
As of April 1, 2014 what is the maximum number of diag...
NHA - Certified Billing and Coding
Specialist (CBCS) Study Guide
The symbol "O" in the Current Procedural Terminology reference is used to indicate what? -
ANSWER Reinstated or recycled code
In the anesthesia section of the CPT manual, what are considered qualifying circumstances? -
ANSWER Add-on codes
As of April 1, 2014 what is the maximum number of diagnoses that can be reported on the CMS-
1500 claim form before a further claim is required? - ANSWER 12
What is considered proper supportive documentation for reporting CPT and ICD codes for
surgical procedures? - ANSWER Operative report
What action should be taken first when reviewing a delinquent claim? - ANSWER Verify the
age of the account
A claim can be denied or rejected for which of the following reasons? - ANSWER Block 24D
contains the diagnosis code
A coroner's autopsy is comprised of what examinations? - ANSWER Gross Examination
Medigap coverage is offered to Medicare beneficiaries by whom? - ANSWER Private third-party
payers
What part of Medicare covers prescriptions? - ANSWER Part C
What plane divides the body into left and right? - ANSWER Sagittal
Where can unlisted codes be found in the CPT manual? - ANSWER Guidelines prior to each
section
Ambulatory surgery centers, home health care, and hospice organizations use which form to
submit claims? - ANSWER UB-04 Claim Form
What color format is acceptable on the CMS-1500 claim form? - ANSWER Red
Who is responsible to pay the deductible? - ANSWER Patient
A patient's health plan is referred to as the "payer of last resort." What is the name of that health
plan? - ANSWER Medicaid
Informed Consent - ANSWER Providers explain medical or diagnostic procedures, surgical
interventions, and the benefits and risks involved, giving patients an opportunity to ask questions
before medical intervention is provided.
, NHA - Certified Billing and Coding
Specialist (CBCS) Study Guide
Implied Consent - ANSWER A patient presents for treatment, such as extending an arm to allow
a venipuncture to be performed.
Clearinghouse - ANSWER Agency that converts claims into standardized electronic format,
looks for errors, and formats them according to HIPAA and insurance standards.
Individually Identifiable - ANSWER Documents that identify the person or provide enough
information so that the person can be identified.
De-identified Information - ANSWER Information that does not identify an individual because
unique and personal characteristics have been removed.
Consent - ANSWER A patient's permission evidenced by signature.
Authorizations - ANSWER Permission granted by the patient or the patient's representative to
release information for reasons other than treatment, payment, or health care operations.
Reimbursement - ANSWER Payment for services rendered from a third-party payer.
Auditing - ANSWER Review of claims for accuracy and completeness.
Fraud - ANSWER Making false statements of representations of material facts to obtain some
benefit or payment for which no entitlement would otherwise exist.
Upcoding - ANSWER Assigning a diagnosis or procedure code at a higher level than the
documentation supports, such as coding bronchitis as pneumonia.
Unbundling - ANSWER Using multiple codes that describe different components of a treatment
instead of using a single code that describes all steps of the procedure.
Abuse - ANSWER Practices that directly or indirectly result in unnecessary costs to the
Medicare program.
Business Associate (BA) - ANSWER Individuals, groups, or organizations who are not members
of a covered entity's workforce that perform functions or activities on behalf of or for a covered
entity.
What is the main job of the Office of the Inspector General (OIG)? - ANSWER The OIG
protects Medicare and other HHS programs from fraud and abuse by conducting audits,
investigations , and inspections.
Medicare - ANSWER Federally funded health insurance provided to people age 65 or older, and
people 65 and younger with certain disabilities.
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