FREE MEDICAL AND STUDY GAMES ABOUT NCCT

PDF Download

FREE MEDICAL AND STUDY GAMES ABOUT NCCT

PRACTICE EXAM QUESTIONS

Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -41 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation Question 1: The provider is paid the same rate per patient whether or not they provide services and no matter which services were provided. This payment is known as

Answer:

Capitation Question 2: A third party payer made an error while adjudicating a claim. Which of the following should the insurance and coding specialist do?

Answer:

Resubmit the claim with an attachment explaining the error

Question 3: When is a referral from a provider required?

Answer:

When contained in the individual policy Question 4: When there is a professional courtesy awarded to a patient's account the insurance and coding specialist should post the amount under the?

Answer:

adjustment column

Question 5: The most effective method to manage patient statements and other financial invoices as well as avoid payment delays is to

Answer:

Collect fees at the time of service

Question 6: Developing an insurance claim begins

Answer:

when the patient calls to schedule an appointment Question 7: When filing an electronic claim, the insurance and coding specialist processes which of the following forms?

Answer:

CMS-1500

Question 8: The Fair Debt Collection Practices Act restricts debt collectors from engaging in conduct that includes

Answer:

Calling before 8:00am or after 9:00pm unless permission is given Question 9: If a married couple is covered under both spouses' health insurance and the husband wishes to schedule an appointment for an annual exam, he should call his primary car provider and

Answer:

Schedule an appointment using both his insurance benefits and his wife's insurance benefits Question 10: A patient has called to schedule an appointment for an office visit to see the doctor tomorrow for an earache. It is discovered during the scheduling process that the insurance policy on file has been cancelled. What do you do?

Answer:

Advise the patient to bring current insurance information to the appointment Question 11: A patient was seen in the office . Charges were recorded and submitted to the patient's insurance, and an EOB was received by the office with a payment of $70.89. These transactions should be recorded in the ?

Answer:

Patient ledger

Question 12: When following up on a denied claim, an insurance and coding specialist should have which of the following info available when speaking with the insurance company?

Answer:

Date of service, Physician's NPI, patient's insurance ID number Question 13: Collecting statistics on the frequency of copay collection at time of service is a step in the process of

Answer:

managing A/R Question 14: The patient is sent a statement for an office visit. The total amount of the bill is $100.00 and this amount must be paid before the insurance company will pay on the claim? Its called?

Answer:

Deductible Question 15: A Medicare patient has an 80/20 plan, The charged amount was $300.00. The amount allowed was $100.00. Which of the following is the patient's coinsurance?

Answer:

$20 Question 16: When the patient has signed the assignment of benefits form, the payment for services should be sent to the provider unless the provider is

Answer:

Out of network Question 17: Which of the following processes makes a final determination for payment in an appeal board?

Answer:

Arbitration Question 18: Which of the following financial reports produces a quarterly review of any dollar amount a patient still owes after all insurance carriers claim payments have been received?

Answer:

Aging

Question 19: The patient opted to have a tubal ligation performed. Which of the following is needed in order for the third party payer to cover the procedure?

Answer:

Pre-certification

Question 20: Which of the following are violations of the Stark Law?

Answer:

Accepting gifts in place of payments from patients, referring patients to facilities where the provider has a financial interest Question 21: When using an EHR system to enter CPT codes on a CMS-1500 claim form for electronic submission, which of the following should be entered on the claim form first?

Answer:

The most resource-intensive procedure or service Question 22: HIPPA allows a health care provider to communicate with a patient's family, friends, or other persons who are involved in the patient's care regarding their mental health status providing

Answer:

the patient does not object Question 23: Which of the following fees posted to the patient's account is an example of "usual, customary, and reasonable?"

Answer:

Allowed amount Question 24: Which of the following is the correct procedure for keeping a Workers' Compensation patient's financial and health records when the same physician is also seeing the patient as a private patient?

Answer:

Separate financial and health records must be used Question 25: In order to have claims paid as quickly as possible, the insurance specialist must be familiar with which of the following?

Answer:

Payers claim processing procedures