HCA 135 Final Exam Flashcards
A medical practice may choose to ____________ a rejected or partially paid claim.
either appeal or submit
A payer may _________ a procedure which was not medically necessary at the level reported.
downcode
True or False: An aging report groups unpaid claims/bills according to the length of time that they remain due.
True
An insurance aging report lists:
unpaid claims
Assignment of benefits authorizes:
the physician to file claims for a patient and receive direct payments from the payer
CPT Level I modifiers are made up of how many digits?
2
Claims that can be processed for adjudication by payers are called?
clean claims
Collections from patients are classified as consumer collections and are regulated by state and ______ laws.
federal
Durable medical equipment (DME), such as wheelchairs, is reported using:
HCPCS codes
HCPCS Level II codes begin with:
an alphabetic character
HCPCS Level II codes have:
5 characters
How many CPT codes are required to report an immunization?
2
How many steps are there in the Medicare appeal process?
5 steps
How would a payer respond to a claim that does not contain at least one diagnosis code?
the payer will deny the claim
If a claim is submitted with outdated procedure codes, payers will:
payers may deny a claim when outdated procedure codes are used
If a patient has coverage under two insurance plans, the primary plan is the one that:
that has been in effect for the patient the longest
If a payer determines that a code level assigned by a practice is too high for a reported service, the usual action is
downcode the reported procedure code
If a retired patient has a Medicare plan and also has coverage under a working spouse’s plan, the primary plan is:
the spouse’s plan
In CPT, a bullet (a solid circle) next to a code indicates:
a new code
In CPT, a plus sign (+) next to a code indicates:
add on code
In cycle billing, how often does the practice mail all patient statements?
at intervals during the month
In what format can claim attachments be sent?
electronic and paper format
Main term in the Alphabetic Index is:
the word that identifies a disease and appears in boldface
Only the codes that ___________ should be reported.
are the ones supported by documentation
The last step in the coding process is:
Determine the need for modifiers
This process is used to locate a patient who owes an account balance to the practice:
skip tracing
UCR is the abbreviation for:
usual, customary, and reasonable
What are the consequences of inaccurate coding and incorrect billing?
denied claims and reduced payments, fines, prison sentences
What does a provider complete during/after a patient’s visit to summarize their billing information?
encounter form
What is NOT covered by workers’ compensation insurance?
injuries of self-employed individuals
What is another term for prior authorization?
certification
What is sent as additional data to support a claim?
attachments
What is the most common method of claim transmission?
clearinghouse use
What process is used to generate the amount a patient owes?
real-time adjudication
What provision explains how insurance policies will pay if more than one policy applies?
coordination of benefits
What type of coding uses a procedure code that provides a higher reimbursement rate than the correct code?
upcoding
True or False: Disability compensation provides reimbursement for lost income for a disability, preventing the pt from working
True
what will happen to a claim if the most specific code available is not used?
claim will be rejected
Which modifier is used to show multiple modifiers?
99
True or False: FDCPA and TCPA are responsible for regulating the hours during which collection calls may be made?
True
Who may file the first report of injury?
employer or physician
True or False: increased use of information technology as mandated by CMS and HIPAA makes sending paper less common.
True
_____________ refers to a coding problem in which the age of the patient and the selected code do not match:
incorrect coding
