When submitting claims - Study guides, Class notes & Summaries

True or False: The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). - Answer- True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) - Answer- 1.Protect our programs 2.Protect your patients 3.Protect the Provider At which level of the Medicare Part A or Part B appeals process is the app...

When the disclosure of an insured's nonpublic information is involved, what is the insurer obligated to do? Give notice, explain, and allow opting out Under the Telemarketing Sales Rule, telemarketing calls may NOT be received after 9:00 PM A health plan offered by private insurance companies is Medicare Supplement Chris has a single major medical contract which covers all medical expenses. His plan is considered to be comprehensive In accident and health insurance, 60 days must pass afte...

Alcohol and Drug Abuse codes - H0001-H2037 Categories of temporary codes: C codes - identify items that may qualify for transitional pass through payments under OPPS Categories of temporary codes: G codes - identify professional health care procedures and services that do not have codes identified in CPT Categories of temporary codes: H codes - reported to state Medicaid agencies as mandated by state law to identify mental health services. Categories of temporary codes: K codes - reported...

NHA Billing and Coding practice test (CBCS) 100% Correct The attending physician - Correct Answer ️️ -A nurse is reviewing a patients lab results prior to discharge and discovers an elevated glucose level. Which of the following health care providers should be altered before the nurse can proceed with discharge planning? The patients condition and the providers information - Correct Answer ️️ -On the CMS- 1500 Claims for, blocks 14 through 33 contain information about which of the...

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 ...

When multiple restrictions are selected in a single column, correct answer: there is an OR relationship between those choices. If two payers are selected, charges will be pulled into the claim run if they are assigned to either payer. When restrictions are listed across the columns, there is an AND condition between those restrictions. correct answer: If a payer restriction is listed and a location restriction is listed, charges will be pulled into the claim run if the charge is assi...

CBCS Exam 2023/2024 with Question and 100% Correct Answers. Medical Billing & Coding as a Career - Correct answer-*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? - Correct answer-Standards of conduct based on moral principle. They a...

NR511 Final Exam Questions with 100% Correct Answers | Latest Update 2024 | Rated A+ Define diagnostic reasoning - -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 probab...

What are the primary job duties of a medical biller? correct answersReview and submit patient visit claims to the patient's insurance payer for appropriate reimbursement. Provider-based billing refers to correct answersCharges for a provider's services Professionalism is not important to a medical biller correct answersFalse What is the advantage of obtaining a billing and coding certification? correct answersDisplays billing knowledge to an employer and show the ability to network wi...

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 A physician is contracted with an insuran...