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