CHAPTER 2

**Revenue Per Visit (RPV) Calculated

= Total amount collected ./. total # pt visits

WHIC OF THE SERVICES BELOW WOULD MEET MEDICAL NECESSITY?

A LIPID PANEL (80060) FOR A PATIENT WITH HIGH CHOLESTEROL

ABN

ADVANCE BENIFICIARY NOTICE

WHICH OF THE FOLLOWING ARE REASONS A CLAIM MAY BE DENIED?

AN INCORRECT PLACE OF SERVICE; AN INCORRECT NPI ; TRUNCATED DIAGNOSIS CODES

THERE ARE MANY ELEMENTS TO SUCCESSFUL APPEALS PROCESS. IDENTIFY WHICH OF THE BELOW CHOICES IS AN ELEMENT OF THE PROCESS.

ANALYZE THE REASON FOR THE DENIAL.

YOU WORK FOR A PEDIATRIC OFFICE AND THE PARENTS OF A PATIENT INFORM YOU THEY CAN NO LONGER AFFORD HEALTH INSURANCE. THEY DO NOT QUALIFY FOR MEDICAID AS THEIR INCOME IS TOO HIGH. WHAT WOULD YOU RECOMMEND?

APPLY FOR CHIP COVERAGE

A MEDICARE PATIENT IS SEEN IN THE URGENT CARE CLINIC FOLLOWING A MINOR AUTOMOBILE ACCIDENT. THE PATIENT HAS MEDICARE PART A,B AND C AS WELL AS NO-FAULT THROUGH AUTO INSURANCE. WHO IS THE PRIMARY INSURANCE IN THIS CASE?

AUTOMOBILE NO- FAULT

WHEN REVIEWING DENIALS,YOUR BILLER NOTICES THAT ONE OF THE PRIVATE PAYERS IS NOT PAYING FOR VENIPUNCTURE WHEN PERFORMED DURING AN OFFICE VISIT. WHAT SHOULD BE DONE?

CHECK THE PAYER CONTRACT TO SEE IF THE DENIAL IS APPROPRIATE.

OF THE SERVICES LISTED BELOW , WHICH ARE CPT EVALUATION AND MANAGEMENT SERVICES?

CHEST X-RAY , OFFICE CONSULTATION, NEW PATIENT PREVENTIVE MEDICINE EXAM

A CLAIM FORM THAT IS COMPLETE AND ACCURATE AND INCLUDES ALL PROVIDER INFORMATION, MEMBER INFORMATION AND OTHER ADDITIONAL INFORMATION NEEDED TO PROCESS FOR PAYMENT IS CALLED:

CLEAN

WHICH OF THE FOLLOWING IS NPT A BEST PRACTICE PROCESS TO ENSURE ADEQUATE CASH FLOW TO HELP KEEP PRACTICE RUNNING?

CONDUCT A THOROUGH ANALYSIS OF RECEIVEABLES WEEKLY.

PROCEDURE CODES ARE REPORTED BY THE PROVIDER USING WHICH CODE SET?

CPT

PAYMENT FOR FEE FOR SERVICE OUTPATIENT PHYSICIAN SERVICES IS BASE ON

CPT AND HCPCS LEVEL II

PAYMENTS FOR PHYSICIAN SERVICES IS BASED ON THE ----- CODE . SELECT ALL THAT APPLY.

CPT HCPCS LEVEL II

THE FRONT DESK PLAYS AN IMPORTANT ROLE IN: SELECT ALL THAT APPLY.

CUSTOMER SERVICE, OPTIMIZING PHYSICIAN TIME, CLAIM QUALITY ASSURANCE

WHICH OF THE FOLLOWING IS AN EXAMPLE OF PRIVATE HEALTH PLAN

MCO

WHAT ARE EXAMPLES OF PRIVATE HEALTH INSURANCE

MCO , PPO , HMO, CDHC, HAS

ELECTRONIC HEALTH RECORDS GUIDE A PROVIDER TO SELECT E/M CODES BASED ON THE NUMBER OF ELEMENTS DOCUMENTED. WHAT DOES THIS LEAVE OUT THAT CAUSES A POTENTIAL COMPLIANCE RISK?

MEDICAL NECESSITY

WHICH OPTION IS NOT A REASON TO APPEND A MODIFIER TO A CPT OR HPCS LEVEL II CODE?

MEDICAL NECESSITY

WHICH HEALTH PLANS BELOW ARE CONSIDERED PUBLIC HEALTH PLANS?

MEDICARE , MEDICAID , PREFERED PROVIDER ORGANIZATION(PPO)

MBI

MEDICARE BENEFICIARY IDENTIFIER

HOSPITALS BILL FOR INPATIENT SERVICES (CHARGES FOR THE ROOM, TIME IN THE OR, MEALS, SUPPLIES AND NURSING SERVICES) BASED ONA

MS-DRG

AN ABN FOR IS USED TO :

NOTIFICATION TO PATIENTS THAT MEDICARE MAY NOT COVER A CERTAIN PROCEDURE OR SERVICE.

AN ABN FORM IS USED TO:

NOTIFICATION TO PATIENTS THAT MEDICARE MAY NOT COVER A CERTAIN PROCEDURE OR SERVICE.

MEDICARE OFFERS PLANS FOR PART A, PART B, PART C AND PART D. WHICH OF THESE COVERS INPATIENT HOSPITAL CARE?

PART A

WHICH OPTION BELOW IS NOT REPORTED BY EVALUATION AND MANAGEMENT CODES?

PHYSICAL THERAPY EVALUATIONS

WHICH OF THE FOLLOWING SERVICES IS COVERED BY MEDICARE PART B

PHYSICIAN SURGICAL FEES

WHICH OF THE FOLLOWING SERVICES IS COVERED BY MEDICARE PART B?

PHYSICIAN SURGICAL FEES

POSTING PAYMENT AND COLLECTION POLICIES IN A PROMINENT PLACE IN YOUR OFFICE HAS WHAT BENEFIT?

PREPARES THE PATIENT TO MAKE PROPER PAYMENTS AT THE TIME OF SERVIE

WHICH OF THE FOLLOWING ARE COMMON BILLING ERRORS?

SERVICE IS NOT MEDICALLY NECESSARY; NO PROVIDER NAME, ADDRESS AND ZIP CODE OF WHERE SERVICE WAS PROVIDED.

WHAT IS THE DEFINITION OF HEALTHCARE PROVIDER CONTRACTING?

THE PROCESS OF REQUESTING PARTICIPATION IN A HEALTH INSURANCE NETWORK BY A HEALTHCARE PROVIDER.

THE PLACE OF SERVICE(POS) CODE ON A CLAIM FORM IS IMPORTANT TO DETERMINE CORRECT REIMBURSEMENT. WHICH STATEMENT IS CORRECT

THE PROFESSIONAL COMPONENT FOR SERVICES PROVIDED IN A FACILITY (FOR EXAMPLE , HOSPITAL OR ASC) ARE LESS THAN WHEN PROVIDED IN THE PHYSICIAN'S OFFICE BECAUSE THE PHYSICIAN DOES NOT HAVE ANY PRACTICE EXPENSE ( RENT, STAFF, SUPPLIES)AT THE FACILITY.

WHICH OPTION IS A COMMON REASON FOR DENIALS

THE SERVICE IS NOT MEDICAL NECESSARY

WHEN REVIEWING PAYER CONTRACTS, HOW IS THE RPV(REVENUE PER VISIT) CALCULATED?

TOTAL AMOUNT COLLECTE DIVIDED BY THE TOTAL NUMBER OF PATIENT VISITS.

A COMMON BILLING ERROR IS INVALID OR TRUNCATED ICD-10-CM CODES. HOW CAN YOU PREVENT THIS?

UPDATE THE PRACTICE MANAGEMENT SYSTEM WHEN NEW , DELETED AND REVISED CODES ARE RELEASED.

WHAT IS THE BEST WAY TO PREVENT DENIALS FOR INVALID CODES?

UPDATE THE PRACTICE MANAGEMENT SYSTEM WHEN NEW DELETED AND REVISED CODES ARE RELEASED

WHICH VOLUME CODE OF THE ICD-9 IS USED TO IDENTIFY DIAGNOSES? SELECT ALL THAT APPLY

VOLUME 1 / VOLUME 2

WHEN SHOULD CREDENTIALING OF A PROVIDER BE PERFORMED?

WHEN IT IS DETERMINED THE PHYSICIAN WILL BE HIRED

WHICH OF THE FOLLOWING IS NOT REQUIRED TO PROCESS THE ONLINE APPLICATION ON THE CMS WEBSITE FOR A NPI (NATIONAL PROVIDER INDENTIFICATION)

DEA NUMBER

WHAT CODE SET REPRESENTS HEALTHCARE EQUIPMENT, DRUGS AND SUPPLIES?

HCPCS LEVEL II

WHAT IS A CHRONOLOGIAL DESCRIPTION OF THE DEVELOPEMENT OF THE PATIENT'S COMPLAINTS?

HISTORY OF PRESENT ILLNESS

PROCEDURE CODES ARE REPORTED BY THE FACILITY USING WHICH CODE SET ?

ICD-10-PCS

WHIS OF THE FOLLOWING OPTIONS IS MOST LIKELY TO NEGATIVELY IMPACT COLLECTIONS?

INCREASE IN NUMBER OF PATIENTS WITH HIGH DEDUCTIBLE INSURANCE PLAN