2023 test
Which of the following does a patient sign to allow payment of claims directly to the
Assignment of benefits statement
Many third-party payers require that a patient pay a set amount of cligible charges per year before the patient's heaith care plan will begin to pay benefits. This which of the following terms?
Deductible
Which of the following terms describes the amount the patient must pay for a service when they have an insurance plan benefit that pays 70% of the allowed amount and the patient is responsible for 30% of the allowed amount?
Deductible
A patient's employer has not submitted a premium payment for the company's commercial insurance plan. Which of the following is the elaim status the provider will receive for any claims sent to the third-party
Denied
Which of the following processes is used to verify patient benefits and insurance coverage for an outpatient procedure?
Precentification
provider orders a comprehensive metabolic panel for a 70-year-old patient who has Medicare as their primar the patient they may be responsible for payment? •
Claim form
A billing and coding specialist is posting payments to accounts based on a remittance advice and discovers and discovers a denial of payment, which of the following codes indicates why reimbursement was denied
Claims adjustment reason code
Which of the following is an electronic form that is used to post reimbursements?
Electronic remittance advice (ERA)
Which of the following government agencies is responsible for combating fraud and abuse in health insurance and heath care delivery
Office of Inspector General (O1G)
A billing and coding specialist is submitting a batch of claims to the clearinghouse and receives a report stating that three claims actions should the specialist take? were rejected. Which of the following Bill the patient for the services that
Review the scrubber report.
Category 2 CPT codes
Supplemental Codes for Performance Measures
billing and coding specialist should identify that which of the following statements is correct regarding the filing limit for Medicaid?
The filing limit is 1 year from the date of service.
that are submitted without an NPI number will delay payment to the provider due to which of the following?
The number is needed to identify the provider.
Which of the following information is required to include on an Advance Beneficiary Notice (ABN) form?
The reason Medicare may not pay
A billing and coding specialist is preparing a claim using procedure code 43286. Based on this code, which of the following types of service is being provided?
View
Which of the following is the filing limit for claim submission for an outpatient service with TRICARE?
Within I year from the date of service
Which of the following identifies improper payments made for CMS claims?
• Office of Inspector General (OIG)