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 ...
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.
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.
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