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20 Cards in this Set
- Front
- Back
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Which of the following describes the reason for a claim rejection of Medicare NCCI edits?
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Improper code combinations
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Which of the following actions should be taken if an insurance company denies a service as not medically necessary?
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Appeal the decision with a provider's report
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A coroners autopsy is comprised of which of the following examinations?
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Gross examination
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Which of the following conditions is associated with microcephaly?
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Downs Syndrome
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Which of the following terms describes the process used to challenge a payers decision to deny reduce or down code a claim?
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Appeal
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When completing a CMS-1500 paper claim form
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Use 10 point PICA font
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In the CPT manual, an esophagectomy can be found in which of the following subsections?
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Excision
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A nurse is reviewing a patients lab results prior to discharge and discovers an elevated glucose level. Which of the following healthcare providers should be alerted before the nurse can proceed with discharge planning?
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The attending physician
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Which of the following sections of the CPT manual lists the appropriate code for WBC with differential, automated?
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Pathology and Laboratory
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To assign a diagnosis to the highest level of specifically a billing and coding specialist should
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Check for a fourth or fifth digit
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A patient suffers a second degree burn of the left axilla and a third degree burn on the left wrist. Twelve percent was burned with three percent of the burns designated as third degree. Which of the following demonstrates the proper coding sequence?
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Third degree burn of the wrist , second degree burn of the axilla, burn involving 10 to 19% of the body surface with less than 10% of the being third degree burns
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Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays 30%?
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Coinsurance
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Representatives from which of the following accrediting agencies can visit office laboratories to review manuals and interview staff?
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CLIA
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A patient undergoes hemodialysis. The code for the procedure found in which of the following sections of the CPT manual?
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Medicine
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V codes are used as the first listed diagnosis to indicate
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Family history
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Which of the following scenarios describes a HIPPA violation?
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Reporting test results to a family member via phone
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Medigap coverage is offered to Medicare beneficiary by which of the following?
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private third party payer
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A patient has a new onset of diabetes mellitus. Which of the following medical specialist should the primary care provider refer the patient to further treat the disease?
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Endocrinologist
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A billing and coding specialist observes a coworker drinking during work hours. Which of the following actions should be taken?
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Inform the supervisor of the observation
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Which of the following is a covered entity affected by HIPPA security rules?
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healthcare clearinghouses
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