NHA Billing and Coding Flashcards

Questions and Answers

Which of the following healthcare providers should be alerted before the nurse can proceed with discharge planning?

A social worker

The attending physician (correct)

A physical therapist

A nurse practitioner

Blocks 14 through 33 on the CMS-1500 Claims form contain information about which of the following?

Insurance policy details

The patient's condition and the provider's information (correct)

Billing address

Patient demographics

Which of the following describes the level of the examination if a provider performs an examination of a patient's throat during an office visit?

Detailed examination

Comprehensive examination

Expanded problem focused examination

Problem focused examination (correct)

The symbol 'O' in the Current Procedural Terminology reference is used to indicate which of the following?

Reinstated or recycled code Signup and view all the answers

Which of the following is the portion of the account balance the patient must pay after services are rendered and the annual deductible is met?

Coinsurance Signup and view all the answers

By what should the billing and coding specialist divide the evaluation and management code?

Place of service Signup and view all the answers

The standard medical abbreviation 'ECG' refers to a test used to assess which of the following body systems?

Cardiovascular system Signup and view all the answers

In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances?

Add-on codes Signup and view all the answers

As of April 1st, 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 Signup and view all the answers

When submitting a clean claim with a diagnosis of kidney stones, which of the following procedure names is correct?

Nephrolithiasis Signup and view all the answers

Which of the following is one of the purposes of an internal auditing program in a physician's office?

Verifying that the medical records and the billing record match Signup and view all the answers

What is a reason this claim was rejected based on incorrect claim information entered?

The DOB is entered incorrectly Signup and view all the answers

Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures?

Operative report Signup and view all the answers

Which of the following actions should be taken first when reviewing delinquent claims?

Verify the age of the account Signup and view all the answers

Which of the following components of an explanation of benefits expedites the process of a phone appeal?

Claim control number Signup and view all the answers

A claim can be denied or rejected for which of the following reasons?

Incorrect coding entered Signup and view all the answers

To be compliant with HIPAA, which of the following positions should be assigned in each office?

Privacy officer Signup and view all the answers

All email correspondence to a third-party payer containing patients' protected health information (PHI) should be?

Encrypted Signup and view all the answers

A billing and coding specialist should understand that the financial record source generated by a provider's office is called a?

Patient ledger account Signup and view all the answers

Which of the following includes procedures and best practices for correct coding?

Coding compliance plan Signup and view all the answers

HIPAA transaction standards apply to which of the following entities?

Health care clearinghouses Signup and view all the answers

Which of the following actions should be taken if an insurance company denies a service as not medically necessary?

Appeal the decision with a provider's report Signup and view all the answers

A patient with a past due balance requests that his records be sent to another provider. Which of the following actions should be taken?

Accommodate the request and send the records Signup and view all the answers

A participating BlueCross/BlueShield (BC/BS) provider receives an explanation of benefits for a patient account. How much should the patient expect to pay?

$48 Signup and view all the answers

The physician bills $500 to a patient. After submitting the claim to the insurance company, the claim is sent back with no payment. The patient still owes $500. What is this amount called?

Deductible Signup and view all the answers

Study Notes

Definitions and Key Concepts

The attending physician should be informed about any elevated lab results before discharge planning can proceed.
CMS-1500 Claim form, blocks 14 through 33, details the patient's condition and provider's information essential for billing.
A problem-focused examination refers to a targeted assessment, such as checking a patient's throat during a visit.
The Current Procedural Terminology (CPT) symbol "O" signifies reinstated or recycled codes within the coding system.
Coinsurance is the percentage of the account balance a patient is responsible for after fulfilling their annual deductible.
Evaluation and management codes are divided by the place of service to determine billing categories.
"ECG" is an acronym for electrocardiogram, which assesses the cardiovascular system.
Add-on codes in the anesthesia section refer to specific qualifying circumstances that accompany primary procedures.
April 1, 2014, marked the date when the maximum number of diagnoses reported on a CMS-1500 claim form was capped at 12.
For kidney stones (nephrolithiasis), the proper procedure name must be accurately submitted on claims for exact billing.
Internal auditing programs at a physician's office serve the critical purpose of ensuring the medical records align with billing documentation.
Incorrectly entered date of birth (DOB) can lead to claim rejections, as seen in cases where patients’ birth dates are misformatted.
Operative reports are necessary supportive documentation for correctly reporting CPT and ICD codes related to surgical procedures.
When addressing delinquent claims, verifying the age of the account should be the first step taken.
The claim control number on an explanation of benefits helps expedite the process of a phone appeal regarding denied claims.
A claim may be denied or rejected if the diagnosis code is incorrectly noted in block 24D.
A designated privacy officer is essential for HIPAA compliance in healthcare offices, ensuring patient information is handled correctly.
All emails containing protected health information (PHI) should be encrypted for security when sent to third-party payers.
A patient ledger account is the financial record maintained by a provider’s office, documenting all patient transactions.
A coding compliance plan encompasses procedures and best practices essential for accurate coding and billing practices in healthcare.
Health care clearinghouses must comply with HIPAA transaction standards, which govern how healthcare transactions are managed.
If a service is denied for not being medically necessary, appealing the decision with a provider's report is a recommended course of action.
When a patient requests that their records be sent to another provider, accommodating the request and sending records is necessary if they have a past due balance.
In a billing scenario with BlueCross/BlueShield where a provider charges $100, allowed $40 for the deductible, and the balance is paid at 80%, the patient is responsible for $48.
Patients may owe the total billed amount ($500) if an insurance claim is returned with no payment and the deductible is not met.

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Description

This quiz focuses on essential terms and definitions related to billing and coding in healthcare, particularly relevant for the CBCS exam. It includes key concepts that healthcare professionals must know to handle claims effectively and ensure proper communication among providers.