When submitting claims - Study guides, Class notes & Summaries

The coverage territory of the Business Auto form provides for "worldwide liability coverage" for private passenger autos that the insured: a) Hires, leases, rents or borrows without a driver while outside the United States, its territories and possessions. b) Purchases while outside the United States, its territories and possessions. c) Sells while outside the United States, its territories and possessions. d) Occupies while outside the United States, its territories and possession...

What are Medical Ethics? - Answer-Standards of conduct based on moral principle. they are generally accepted as a guide for behavior towards pt's, dr's, coworkers, the gov, and ins co's What does acting within ethical behavior boundaries mean? - Answer-Carrying out one's responsibilities with integrity, dignity, respect, honesty, competence, fairness, and trust Compliance regulations - Answer-Most billing-related cases are based on HIPAA and False Claims Act Health Insurance Portabi...

Correctly order the E&M office visit codes based on complexity from least to most complex. - ️️New pt: 1. Minimal/RN visit: 99201 2. Problem focused: 99202 3. Expanded problem focused: 99203 4. Detailed: 99204 5. Comprehensive: 99205 Established pt: 1. Minimal/RN visit: 99211 2. Problem focused: 99212 3. Expanded problem focused: 99213 4. Detailed: 99214 5. Comprehensive: 99215 Describe the differences between medical billing and medical coding. - ️️Medical billing: process...

While driving, Ben was struck by another driver, Roxanne. Ben then filed a claim with Roxanne's insurer. In essence, what was Ben doing when he filed this claim? Alerting Roxanne's insurer of his intent to take the case to court Submitting a formal request to settle the damages with Roxanne's insurer Ordering Roxanne's insurer to pay for his damages within 15 days Admitting he was actually "at fault" - Answer Submitting a formal request to settle the damages with Roxanne's insure...

HIPAA Questions and Answers with Certified Solutions State or local laws can never override HIPAA. False Protected health information (PHI) requires an association between an individual and a diagnosis. True Some covered entities are exempted under HIPAA from submitting claims electronically using the standard transaction format. True The acronym EDI stands for Electronic data interchange. Which group of providers would be considered covered entities? a. Rehabilitation center, same-day sur...

CBCS Exam Study Guide Exam Questions And Answers Medical Billing & Coding as a Career - ANS *Claims assistant professional or claims manager, *Coding Specialist, * Collection Manager, *Electronic Claims Processor, *Insurance Billing Specialist, * Insurance Coordinator, *Insurance Counselor, *Medical Biller, *Medical & Financial Records Manager, * Billing & Coding Specialist What are Medical Ethics? - ANS Standards of conduct based on moral principle. They are generally accepted as a ...

NR511 Final Exam Questions with Correct Answers Define diagnostic reasoning - Answer--A type of critical thinking -Includes systematic way of thinking that evaluates each new piece of data to support some hypothesis and reduce others -Evaluates if all the avenues have been explored and that the conclusion is based on evidence -To solve problems, promote health, screen for dz/illness: all require sensitivity to complex stories, contextual factors, sense of probability/uncertainty Discus...

PSI Life, Accident, Health Practice Exam Questions & Answers-Which is an ACCURATE statement regarding benefits of Medicare supplement and Medicare select plans? 1 The insurer is able to cancel, or deny renewal of an existing policy, based solely on the health of the insured. 2 There is no restriction for benefits after the coverage has been in effect for six months when involving a preexisting condition. 3 The coverage for a loss from an illness or disease is treated differently than for...

When submitting claims, which of the following is the outcome if Block 13 is left blank? -The third-party payer reimburses the patient, and the patient is responsible for reimbursing the provider Which of the following do physicians use to electronically submit claims? -clearinghouse When billing a secondary insurance company, which block should the billing and coding specialist fill out on the CMS-1500 claim form? -Block 9a

What are some ways to avoid missing/invalid code denials on submitted claims? I. QA coding staff II. Code the same way all the time III. Offer education to coding staff IV. Use current year coding books I, II, III I, IV I, III, IV I, III 1 of 27 Term Which regulations require a health insurer offering group or individual coverage to implementan effective appeals process for appeals of coverage determinations and claims? Health Insurance Portability and Accountability Act False Claim...