General Billing - Assesment II

25 Questions | By Jayakumar | Updated: Mar 21, 2022 | Attempts: 43

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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
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
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
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
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
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
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
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
14.

Say Yes or no for the below referenced Match. IF Worker's compensation is Primary then Medicaid is Secondary
- A.
  
  True
- B.
  
  False
15.

Which one of the below Listed code is an E&M code
- A.
  
  93327
- B.
  
  93970
- C.
  
  99233
- D.
  
  93299
16.

Modifier GC is only acceptable with
- A.
  
  Medicare & Medicare HMO's
- B.
  
  Medicaid
- C.
  
  Auto insurance
- D.
  
  All Commercial Payers
17.

GC modifier is Billable only with E&M codes
- A.
  
  True
- B.
  
  False
18.

Established Patient visit code for 99205 is[Blank]
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
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
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
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
23.

Is the Date of Service and Date of Injury are same?
- A.
  
  True
- B.
  
  False
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
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