Preauthorization - Study guides, Class notes & Summaries

CBCS Final Practice Test (NHA) Exam Questions And Answers Which of the following is a key protection standard of the HIPAA privacy rule that requires entities and business associates to limit the use or release of protected health information phi)? minimum necessary A billing and coding specialist is preparing a claim that includes code A9698. Which of the following actions should the specialist take to ensure the claim will be paid the first time it is submitted? append the appro...

NHA CBCS Module 3: Coding And Coding Guidelines Exam Questions And Answers abstracting - ANS Reviewing medical record documentation to discover clinical concepts that support assigning codes to the highest level of specificity. clinical documentation - ANS Information recorded in the medical record pertaining to the health status of a patient as determined by a health care provider. CPT - ANS Current Procedural Terminology. Codes for services and procedures. electronic heal...

Patient demographics refers to: Address, phone number, emergency contact, employer information, copy of patient's identification. Rationale: The staff registering the patient will obtain the patient's demographics (address, phone number, emergency contact, employer information, copy of the patient's identification). The following is TRUE about the chargemaster: It must be updated when coding changes occur. Rationale: A department review should be performed at least annually ...

Pre-Service activities - ANSWER-1. Requested service is screened for med necessity, health coverage/benefits verified, preauthorization obtained and estimate to patient oop costs generated within guidelines of NSA and state regulations. 2. Patient notified of financial responsibility including copayment and health plan deductibles, eligibility of financial assistance assessed. 3. Patient is scheduled 4. Encounter record is generated and patient and guarantor info is obtained and updates as ...

Medical billing and coding latest version graded A+ Medical Insurance Financial plan (the payer) that covers the cost of hospital and medical care Policyholder Person who buys an insurance plan; the insured, subscriber, or guarantor Health Plan Individual or group plan that provides or pays for the cost of medical care Benefits What a health plan pays for services covered in an insurance policy; listed in the schedule of benefits. Medical Necessity Reasonable services of prov...

CPB Certified Professional Biller Certification Exam Questions & Answers 2023/2024 Abuse - ANSWER-Actions inconsistent with accepted, sound medical business or fiscal practice Accept Assignment - ANSWER-Provider accepts as payment in full whatever is paid on the cliam by the payer (except for any copayment and or coinsurance amounts.) Accounts Receivable - ANSWER-The amount owed to a business for services or goods provided. Accounts Receivable Aging Report - ANSWER-Shows the status...

NHA CBCS study guide Questions and Answers (2024 / 2025) (Verified Answers) 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 ...

Calculate the amount of money a patient would owe for a noncovered service costing $900 if their indemnity policy has a coinsurance rate of 80-20, and they have already met their deductible correct answers $900 Calculate the monthly capitation payment a provider should receive from a health plan if they have 80 contracted patients and a capitated payment of $40 per month correct answers The monthly capitation payment would total $3,200 (80 x $40 = $3,200). A capitated payment amount is cal...

NHA Medical Coding and Billing Exam Questions with Verified Solutions Billing and coding specialists should first divide the E & M Code by Place of Service Compliant with HIPPA the following position should be assigned in each office Privacy Officer Coding on the UB-04 Form, must sequence the diagnosis code. Which is the first listed diagnosis? Principal Diagnosis Obstruction of the urethra is Urethratresia Ambulatory surgery centers, home health center, and hospice use what fo...

Payment for client services by an insurance company usually requires which of the following? A: Medication B: Inpatient Care C: Prior Treatment D: Preauthorization - D A properly completed consent form for release of information is valid for a MAXIMUM of... A: Six Months B: One year after discharge C: The length of time during which treatment services provided D: The time reasonable necessary to serve the purpose of which it was given - A Cirrhosis of the liver is characterized by A: ...