General Billing - Assesment II
Questions and Answers
- 1.
If the insurance is Medicaid or Medicaid HMO, the billing physician cannot be a PA(Physician Assistant) or NP(Nurse Practitioner). For your case the supervising provider is a Physician Assistant, What will you Do?
- 2.
If the insurance is other than Medicaid or Medicaid HMO, the supervising provider is a Physician Assistant, What will you Do?
- 3.
Member has Medicare Part C coverage through United healthcare PPO plan, Medicare Part B active and also has state Medicaid. List the order of primary, secondary and tertiary payers respectively.
- 4.
Modifier 76 is for
- 5.
Modifier 77 is for
- 6.
The member was admitted in an Emergency Room and he was registered as inpatient. After 3 days of treatment he declared to be dead. He had medicare as active insurance. What would you do with the physician charges of these 3 days?
- A.
Bill the balance to the member
- B.
Submit the claim to Medicare Part B
- C.
Write off the claim as PT Deceased
- D.
Void out the claim from the system
Correct Answer
B. Submit the claim to Medicare Part BExplanation
Since the member had Medicare as active insurance, the appropriate action would be to submit the claim to Medicare Part B. Medicare Part B covers outpatient services, including physician charges, even if the member was initially admitted as an inpatient. Therefore, the physician charges for the 3 days of treatment should be submitted to Medicare Part B for reimbursement.Rate this question:
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- 7.
The claim denied by healthfirst as patient ineligible on DOS. Healthfirst website shows policy is inactive on DOS. But, Epaces shows Healthfirst Medicaid HMO on DOS. What will be your next action?
- A.
Move to Patient calling for COB update
- B.
Submit the Appeal to healthfirst
- C.
Submit Discrepancy request through healthfirst portal
- D.
Bill the patient for the balance
Correct Answer
C. Submit Discrepancy request through healthfirst portalExplanation
The next action would be to submit a discrepancy request through the Healthfirst portal. This is because there is a discrepancy between the claim denial by Healthfirst stating that the patient is ineligible on the date of service (DOS), and the information shown on Epaces, which indicates that the patient has Healthfirst Medicaid HMO coverage on the DOS. By submitting a discrepancy request, it allows for clarification and resolution of the conflicting information, potentially leading to a reconsideration of the claim denial.Rate this question:
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- 8.
If CPT 88300,26 gets denied as not covered as it is not available in Medicaid fee schedule,
- A.
Can be adjusted
- B.
Submit an appeal
- C.
Send for reprocess
- D.
Bill the patient for the balance
Correct Answer
A. Can be adjustedExplanation
If CPT 88300,26 gets denied as not covered because it is not available in the Medicaid fee schedule, it can be adjusted. This means that the healthcare provider can make changes to the billing or coding information in order to rectify the denial. Adjustments may involve correcting any errors or inaccuracies in the claim, resubmitting the claim with updated information, or providing additional documentation to support the medical necessity of the procedure. By making the necessary adjustments, the provider can potentially resolve the denial and receive payment for the service.Rate this question:
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- 9.
Which one of the below referenced CPT code CANNOT be adjusted per COM, if it was denied as non covered
- A.
96127
- B.
93000
- C.
93042
- D.
99153
Correct Answer
C. 93042Explanation
CPT code 93042 cannot be adjusted per COM if it was denied as non covered.Rate this question:
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- 10.
The claim denied by medicaid as WE DO NOT OFFER COVERAGE FOR THIS TYPE OF BENEFITS. Per Medicaid portal, member only has Emergency benefits on DOS. On verifying Medical records, physician performed regular office visit. What will be next possible action?
- A.
Write off the claim as non covered
- B.
Bill the balance to the member as he has no coverage for this type of benefits
- C.
Appeal the claim
- D.
Update ER indicator and resubmit the claim
Correct Answer
D. Update ER indicator and resubmit the claimExplanation
Based on the information provided, the correct next possible action would be to update the ER (Emergency Room) indicator and resubmit the claim. This is because the member only has coverage for emergency benefits on the date of service, but the physician performed a regular office visit. By updating the ER indicator to reflect the correct type of service, the claim can be resubmitted for consideration and potential reimbursement.Rate this question:
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- 11.
If the claim is pending for the provider Attestation ( MD Attestation), What is the next possible action?
- A.
Submit the claim anyhow
- B.
Wait untill to the MD attestation
- C.
Write off the claim as non Billable
- D.
Void the claim
Correct Answer
B. Wait untill to the MD attestationExplanation
The next possible action when a claim is pending for MD attestation is to wait until the MD attestation is completed. This means that the claim is currently being reviewed and verified by the medical provider, and it is necessary to wait for their confirmation or approval before taking any further action.Rate this question:
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- 12.
The claim denied as duplicate for CPT 93010. When verifying in billing summary, another claim was reported for same DOS & provider(Syed Asma). On verifying through EPIC, there are 3 records (EKG report) for DOS, 1 for another provider and 2 for this provider(Syed Asma). Next action on this claim.
- A.
Write off the charge as duplicate
- B.
Appeal the claim with medical record
- C.
Send back the claim for reprocess
- D.
Resubmit the claim with appropriate modifier
Correct Answer
D. Resubmit the claim with appropriate modifierExplanation
The correct answer is to resubmit the claim with appropriate modifier. This is because there are 3 records for the same DOS (Date of Service), 1 for another provider and 2 for the provider named Syed Asma. By resubmitting the claim with an appropriate modifier, it indicates that there are multiple services provided on the same DOS by the same provider. This will help to ensure that the claim is processed correctly and that the provider is appropriately reimbursed for the services rendered.Rate this question:
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- 13.
Medicare secondary Qualifier is
- A.
Medicare Identification number
- B.
Used for the Qualified medicare Beneficiary
- C.
Indicator to notify why medicare is secondary
- D.
Medicare ICN
Correct Answer
C. Indicator to notify why medicare is secondaryExplanation
The Medicare secondary qualifier is an indicator that is used to notify why Medicare is secondary. This means that Medicare is not the primary insurance coverage for the individual, and there is another insurance policy that is primary. The qualifier helps to determine the order in which insurance claims are processed and paid.Rate this question:
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- 14.
Say Yes or no for the below referenced Match. IF Worker's compensation is Primary then Medicaid is Secondary
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement "IF Worker's compensation is Primary then Medicaid is Secondary" is false. In the context of insurance, primary and secondary refer to the order in which insurance providers cover medical expenses. If worker's compensation is primary, it means that it is the first insurance provider responsible for covering the costs. Medicaid, on the other hand, is a government-funded program that provides healthcare coverage to low-income individuals. It is not considered secondary to worker's compensation. Therefore, the correct answer is false.Rate this question:
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- 15.
Which one of the below Listed code is an E&M code
- A.
93327
- B.
93970
- C.
99233
- D.
93299
Correct Answer
C. 99233Explanation
The correct answer is 99233. E&M stands for Evaluation and Management, which refers to the codes used for medical services that involve the evaluation and management of a patient's condition. Code 99233 is an E&M code, while the other codes listed (93327, 93970, 93299) are not E&M codes.Rate this question:
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- 16.
Modifier GC is only acceptable with
- A.
Medicare & Medicare HMO's
- B.
Medicaid
- C.
Auto insurance
- D.
All Commercial Payers
Correct Answer
A. Medicare & Medicare HMO'sExplanation
The correct answer is Medicare & Medicare HMO's. This means that the modifier GC can only be used when billing for services provided to patients with Medicare or Medicare HMO insurance. Modifier GC is not acceptable for Medicaid, auto insurance, or any commercial payers.Rate this question:
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- 17.
GC modifier is Billable only with E&M codes
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The statement "GC modifier is billable only with E&M codes" is true. The GC modifier is used to indicate that a service or procedure is related to a diagnosis or condition that is not covered by Medicare. It is typically used with evaluation and management (E&M) codes to indicate that the service provided is not related to a Medicare-covered diagnosis. The GC modifier helps to ensure accurate billing and reimbursement for non-covered services.Rate this question:
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- 18.
Established Patient visit code for 99205 is________
Correct Answer
99215Explanation
The correct answer is 99215. The established patient visit code for 99205 is 99215. This code is used for a comprehensive examination and evaluation of an established patient, where the physician spends a significant amount of time face-to-face with the patient. It involves a detailed history, comprehensive examination, and medical decision-making of high complexity. This code is appropriate for patients with complex medical conditions or multiple chronic illnesses.Rate this question:
- 19.
Annual Examination visit codes (99381 - 99387) & (99391 - 99397) are payable once in Every
- A.
1 month
- B.
12 months
- C.
6 months
- D.
3 months
Correct Answer
B. 12 monthsExplanation
Annual examination visit codes (99381 - 99387) & (99391 - 99397) are payable once every 12 months. This means that these codes can only be billed and reimbursed once within a 12-month period. After the initial visit, any subsequent visits with the same codes within the same 12-month period will not be reimbursed. This is to ensure that patients receive an annual check-up and prevent excessive billing for frequent visits.Rate this question:
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- 20.
When a claim is billed for an Immunization Vaccine performed for a child, Both administration code and Vaccine Injection code should be reported as per payer Guidelines.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
When a claim is billed for an immunization vaccine performed for a child, both the administration code and the vaccine injection code should be reported as per payer guidelines. This means that the healthcare provider should accurately report both codes on the claim form in order to ensure proper reimbursement. By doing so, the payer can easily identify the specific vaccine administered and the associated administration fee, allowing for accurate billing and payment. Therefore, the statement "True" is correct.Rate this question:
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- 21.
If the patient is Homeless and has medicaid as the Only insurance, What will you do for the member's medical Bill
- A.
Write off the claim as Homeless
- B.
Ask the member to update address
- C.
Submit the claim to medicaid by updating Brookdale office address as member's address
- D.
Void out the claim
Correct Answer
C. Submit the claim to medicaid by updating Brookdale office address as member's addressExplanation
In this scenario, the patient is homeless and has Medicaid as their only insurance. Since the patient does not have a permanent address, submitting the claim to Medicaid with the Brookdale office address as the member's address is the appropriate course of action. This ensures that the claim is processed correctly and the patient's medical bill is covered by Medicaid.Rate this question:
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- 22.
For Work Comp Case, The medical bill is denied as Member exhausted medical Benefits,
- A.
Submit the claim to medical payer
- B.
Bill the balance to the member
- C.
Write off the balance
- D.
Appeal the claim with medical record
Correct Answer
B. Bill the balance to the memberExplanation
The correct answer is "Bill the balance to the member". This means that since the medical bill has been denied due to the member exhausting their medical benefits, the remaining balance of the bill should be sent to the member for payment.Rate this question:
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- 23.
Is the Date of Service and Date of Injury are same?
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement is false because the date of service and the date of injury are not always the same. The date of service refers to the date on which a service or treatment is provided, while the date of injury is the specific date when an injury or incident occurred. These two dates can be different, especially if there is a delay between the injury and seeking medical treatment.Rate this question:
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- 24.
Mr.John got injured in his Left Wrist when he was playing Baseball. His Medicare denying the claim as "This injury/illness is the liability of the no-fault carrier". What is your Next action?
- A.
Ask John to update No fault Information
- B.
Write off the balance as medicare Non covered
- C.
Appeal the claim with medical records
- D.
Bill the balance to John
Correct Answer
C. Appeal the claim with medical recordsExplanation
The correct answer is to appeal the claim with medical records. This means that you should gather all the necessary medical records related to Mr. John's injury and submit them as evidence to support the claim. By doing so, you are requesting a review of the denial and providing additional information that may help overturn the decision made by Medicare.Rate this question:
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- 25.
The claim initially denied by medicaid-NY as invalid gender. Patient's Gender Need to be updated with State Medicaid, but member have not updated anything. Later the claim was submitted to Senior Whole Health - MLTC plan, Which denies the claim . What will be your Next action
- A.
Write off the claim
- B.
Submit the Appeal the Senior Whole health
- C.
Bill the balance to the member
- D.
Resubmit the claim to medicaid
Correct Answer
C. Bill the balance to the memberExplanation
Since the claim was denied by both Medicaid-NY and Senior Whole Health, the next action would be to bill the balance to the member. This means that the member will be responsible for paying the remaining amount of the claim.Rate this question:
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Current Version
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Mar 21, 2023Quiz Edited by
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Mar 17, 2020Quiz Created by
Merina
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