for personal use only BILLING PREPARATION

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for personal use only PREPARATION EXAM- BILLING


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Created Jul 31, 2010
by keader

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1	NAME 5 ADMINISTRATIVE AND FINANCIAL HEALTHCARE TRANSACTION STANDARDS ?????????????????????????	837I – FACILITY CLAIMS; 837P- PHYSICAIN CLAIMS; 835- REMITTANCE; 278- REFERRAL CERTIFICATION...
2	NAME 5 EXAMPLES OF FRAUD AND ABUSE.?????????????????????????	– BILLING FOR SERVICES NOT RENDERED- WAIVING THE PATIENT’S DEDUCTIBLES AND COINSURANCES-...
3	DEFINE A COMPREHENSIVE CODENO	A COMPREHENSIVE CODE ENCOMPASSES THE ENTIRE SERVICE PERFORMED.
4	DEFINE A COMPONENT CODE.NO	A COMPONENT CODE IS PART OF A COMPREHENSIVE CODE THAT CANNOT BE BILLED AT THE SAME TIME AS...
5	MEDICARE PART A COVERS CERTAIN TYPES OF MEDICALLY NECESSARY CARE LIST 4 EXAMPLES.?????????????????????????	INPATIENT HOSPITAL CARE- HOSPICE CARE- HOME HEALTH CARE- CARE IN A SNF FOLLOWING A 3...
6	LIST THE MEDICARE ADVANTAGE PLANS.???????????????????????	MEDICARE MANAGED CARE PLANS- MEDICARE FEE FOR SERVICE PLANS- MEDICARE PPO’S- MEDICARE...
7	DEFINE CPT MODIFIER.?????????????????????????	A CODE ATTACHED TO A CPT CODE TO INDICATE THAT THE ORIGINAL PROCEDURE HAS MODIFYING CIRCUMSTANCES...
8	WHEN SHOULD A MODIFIER BE USED- GIVE 4 EXAMPLES?????????????????????????	WHEN ONLY PART OF THE PROCEDURE WAS DONE- WHEN THE PROCEDURE HAS BOTH TECHNICAL AND PROFESSIONAL...
9	. DEFINE MDS.	MINIMUM DATA SET- A MINIMUM SET OF INFORMATION ABOUT A PATIENT ADMITTED INTO A LONG TERM...
10	DEFINE APC.AR SECTION	A PROSPECTIVE PAYMENT SYSTEM UNDER MEDICARE FOR OUTPATIENT SERVICES. PART B ONLY...
11	DME STANDS FOR , IS DEFINED AS AND GIVE 5 EXAMPLES OF DME.?????????????????????????	DURABLE MEDICAL EQUIPMENT. IT IS DEFINED AS EQUIPMENT THAT CAN WITHSTAND REPEATED USE...
12	DEFINE CAPITATED.?????????????????????????	CAPITATED IS DEFINED AS A PAYOR IS ALLOTED A FLAT FEE USUALLY PAID PER MONTH PER PATIENT FOR...
13	DEFINE PER DIEM.?????????????????????????	PER DIEM IS DEFINED AS A FACILITY IS REIMBURSED A FLAT FEE OR SPECIFIED AMOUNT USUALLY PER...
14	DEFINE DRG?????????????????????????	DRG IS DEFINED AS A PAYOR IS REIMBUSED BASED ON DIAGNOSIS RELATED GROUP VALUE. THE VALUE...
15	DEFINE MEDICARE OUTPATIENT CODE EDITOR.?????????????????????????	EDITOR THAT EDITS OUTPATIENT HOSPITAL CLAIMS, DETECTS INCORRECT BILLING DATA AND DETERMINES...
16	WHAT IS A BALANCE SHEET AND WHAT DOES IT DO??????????????????????????AR SECTION	A BALANCE SHEET LISTS ASSETS, EQUITY AND LIABLITIES. IT SHOWS IF AN ORGANIZATION IS IN...
17	WHAT IS A INCOME SHEET AND WHAT DOES IT DO?????????????????????????AR SECTION	AN INCOME SHEETS LISTS REVENUES AND EXPENSES FOR A SPECIFIC DATE. IT EVALUTES ABILITY...
18	WHAT DOES MEDICARE PART B COVER.	MEDICARE PART B COVERS: PHYSICIAN FEES AND CONSULTATION AND SECOND OPINIONS, PHYSICAL...
19	DEFINE CASE MANAGEMENT.	CASE MANAGEMENT IS A COLLABORATIVE APPROACH TO COORDINATING AND PROVIDING HEALTHCARE SERVICES.
20	WHAT ARE 5 WAYS CASE MANAGEMENT EFFECTS PATIENT BILLING.	PREAUTHORIZES THE STAY WITH THE INSURANCE COMPANY; COORDINATES THE NEXT LEVEL OF CARE...
21	WHO IS EXEMPT FROM THE MEDICARE DRG WINDOW.	PSYCHIATRIC HOSPITALS, LONGTERM HOSPITALS, HOSPITALS IN HAWAII AND ALASKA, CANCER HOSPITALS.
22	NAME 4 BENEFITS OF ELECTRONIC BILLING.	FASTER PAYMENTS; REDUCES CLERICAL ERRORS; LESS PAPER; AND PROVIDES BILLING REPORTS.
23	A MEDICARE PATIENT IS UNEMPLOYED HIS SPOUSE IS WORKING AND HAS GROUP INSURANCE. WHAT...	HOW MANY EMPLOYEES DOES THE EMPLOYER HAVE. THE REASON THE PATIENT IS ENTITLED TO MEDICARE.
24	WHAT ARE 5 RESPONSIBILITES OF THE BILLING SUPERVISOR??????????????????????????	-SUPERVISING BILLING STAFF, INCLUDING HIRING, TRAINING AND EVALUATING-MONITOR PAYER BULLETINS...
25	. WHEN CHOOSING AN ELECTRONIC CLAIMS PROCESSOR NAME 5 CAPABILITIES OR ASSESSMENTS A MANAGER...	THE MANAGER SHOULD CONSIDER THE FOLLOWING: - does the system have a reports menu- does the...
26	DEFINE THE PRIVACY RULE. AND LIST 4 ASPECTS OF HIPAA THAT HAS IMPACT ON BILLING AND DESCRIBE...	THE PRIVACY RULE IS DEFINED AS: use and disclosure of individual health information...
27	DEFINE PRECERTIFICATION. LIST WHAT IMPACTS IT HAS ON BILLING WHEN NOT AUTHORIZED PROPERLY. ...	PRECERTIFICATION IS DEFINED AS: the prior authorization by an insurance company...
28	WHAT DOES ABN STAND FOR? WHAT ARE 4 THINGS LISTED ON AN ABN? LIST 4 REASONS WHY...	ABN- stands for advanced beneficiary notices. FOUR THINGS LISTED ON AN ABN ARE: ...
29	LIST 7 COMPONENTS OF OIG COMPLIANCE AND LIST 6 KEY CONSIDERATIONS WHEN DEVELOPING COMPLIANCE...	7 COMPONENTS ARE: written policy and procedures- a designated compliance officer- effective...
30	LIST 5 REASONS THE NATIONAL CORRECT CODING INITIATIVE WAS ESTABLISHED BY MEDICARE FOR...	THE NCCI WAS ESTABLISHED TO: - establish identifiers for fraud and abuse- to set uniform...
31	DEFINE THE 72 HOUR RULE. LIST THE EFFECT IT HAS ON BILLING. AND LIST 3 STEPS FOR...	. THE 72 HOUR RULE IS DEFINED AS: a medicare regulation requiring any outpatient non-physician...
32	WHEN ARE MEDICARE PART A INPATIENT ANCILLARY SERVICES BILLABLE UNDER MEDICARE PART B. ...	PART A CHARGES ARE BILLABLE UNDER PART B WHEN:- the beneficiary is not eligible for part...
33	DEFINE LATE CHARGES. LIST 3 REASONS LATE CHARGES OCCUR AND LIST STEPS THAT CAN BE TAKEN...	LATE CHARGES ARE: charges posted after the bill is finalized. LATE CHARGES OCCUR...
34	DEFINE A HOSPITAL CHARGEMASTER AND WHY IS IT IMPORTANT TO REVIEW THE CHARGEMASTER. LIST...	A CHARGE MASTER IS : a computer file that contains all the charges that a hospital...
35	CALCULATE THE PRORATION OF CHARGES: WHAT IS INSURANCE RESPONSIBILITY AND PATIENT RESPONSIBILITY.TOTAL...	15000 TOTAL BILL SUBTRACT- $350.00 non-covered and subtract $500.00 deductible: the covered...
36	A MAJOR BILLING BACK LOG HAS OCCURRED IN YOUR HOSPITAL. LIST 10 SHORT AND 10 LONG TERM...	SHORT TERM- screen all bills for accuracy- sort bills by reimbursement and bill them in descending...
37	DETERMINE FROM THE FOLLOWING INFORMATION THE EXPECTED PAYMENT FROM MEDICARE FOR AN INPATIENT...	12. TOTAL CHARGES ARE 11810.00YOU CAN BILL MEDICARE PART B FOR 920 ...
38	A MANAGED CARE CONTRACT PAYS AN ER CASE RATE OF $350.00 TO INCLUDE SUPPLIES BUT EXCLUDES...	$350 CASE RATE $200 + $1000...
39	UNDER WHAT CIRCUMSTANCE WILL MEDICARE PAY INPATIENT ONLY O/P CLAIM	IF THE PATIENT DIED BEFORE ADMISSION
40	EXPLAIN THE MEDICARE TRANSFER DRG AND THE IMPACT IT HAS ON REIMBURSEMENT AND BILLING	MEDICARE MAINTAINS A LIST OF DRG'S WHERE DRG PAYMENTS IS REDUCED WHEN THE PATIENT IS DISCHARGED...
41	DEFINE 3 STEPS IN A COMPREHENSIVE FOLLOW UP PROCESS AND LIST 4 REASONS WHY IT IS IMPORTANT...	A COMPREHENSIVE FOLLOW UP PROCESS IS IMPORTANT IN ORDER TO:-MAINTAIN CASH FLOW-REDUCE AR-REDUCE...
42	CONTRACTUAL WRITE OFF'S ARE TOO HIGH- WHAT ARE CAUSES AND LIST AT LEAST ONE ACTION TO ADDRESS...	-CONTRACTUAL OVERSTATED BY COMPUTER- ACTION- RECHECK REMIT FROM PAYOR TO MAKE SURE CONTRACTUALS...