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
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
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
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
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
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 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.
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
ABN
ADVANCE BENIFICIARY NOTICE
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
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
WHICH OF THE FOLLOWING IS AN EXAMPLE OF PRIVATE HEALTH PLAN
MCO
WHAT ARE EXAMPLES OF PRIVATE HEALTH INSURANCE
MCO , PPO , HMO, CDHC, HAS
WHICH OPTION IS NOT A REASON TO APPEND A MODIFIER TO A CPT OR HPCS LEVEL II CODE?
MEDICAL NECESSITY
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.
WHICH OF THE FOLLOWING IS NOT REQUIRED TO PROCESS THE ONLINE APPLICATION ON THE CMS WEBSITE FOR A NPI (NATIONAL PROVIDER INDENTIFICATION)
DEA NUMBER