Table of Contents
- 1 Which statement is an accurate interpretation of the phrase assignment of benefits if signed by the patient on the CMS 1500 claim quizlet?
- 2 Which occurs when a physician in the community refers a patient to the hospital for observation bypassing the clinic or emergency department?
- 3 What prohibits a payer from notifying the provider about payment or rejection?
- 4 What is meant by the phrase assignment of benefits?
- 5 Which occurs when a physician in the community refers a patient?
- 6 How do healthcare providers determine whether a patient’s status is inpatient?
- 7 When completing a CMS 1500 paper claim form which of the following is an acceptable action for the billing and coding specialist to take?
- 8 When a health insurance plans preauthorization requirements are not met by providers?
- 9 What happens if you write a letter of circumstance?
- 10 When to use a special circumstance appeal letter?
Which statement is an accurate interpretation of the phrase assignment of benefits if signed by the patient on the CMS 1500 claim quizlet?
An accurate interpretation of the phrase “assignment of benefits” on the CMS 1500 form with a signature of the patient means? THE PAYER IS INSTRUCTED TO REIMBURSE THE PROVIDER DIRECTLY.
Which occurs when a physician in the community refers a patient to the hospital for observation bypassing the clinic or emergency department?
direct admission
A “direct admission” occurs when a physician in the community refers a patient to the hospital for observation, bypassing the clinic or emergency department (ED). Effective for services furnished on or after January 1, 2003, hospitals may bill for patients directly admitted for observation services.
When completing the CMS 1500 enter a between the CPT or Hcpcs Level II code modifiers?
On a CMS-1500 do not enter a hyphen between the CPT or HCPCS code and modifier. On a CMS-1500 enter hyphens or spaces in the social security number. On a CMS-1500 do not enter a person’s title or other designations unless printed on the patient’s insurance ID card.
What prohibits a payer from notifying the provider about payment or rejection?
chapter 11
| Question | Answer |
|---|---|
| Federal privacy act of 1974 | prohibits a payer from notifying the provider about payment or rejection of unassigned claims or payments sent directly to the patient/policyholder |
| medical management | deals with chronic conditions affecting patient care |
What is meant by the phrase assignment of benefits?
Assignment of Benefits (AOB) is an agreement that transfers the insurance claims rights or benefits of the policy to a third-party. An AOB gives the third-party authority to file a claim, make repair decisions, and collect insurance payments without the involvement of the homeowner.
What is meant by the phrase assignment of benefits quizlet?
Assignment of benefits means the patient and/or insured authorizes the payer to reimburse the provider directly.
Which occurs when a physician in the community refers a patient?
Hospitals may bill for patients who are “direct admissions” to observation. A “direct admission” occurs when a physician in the community refers a patient to the hospital for observation, bypassing the clinic or emergency department (ED).
How do healthcare providers determine whether a patient’s status is inpatient?
inpatient care is determined by whether a doctor writes an order to admit a patient formally into their hospital. If the doctor writes the order and the patient gets admitted, then the medical service will be considered inpatient.
Which CMS 1500 block requires entry of either the social security number?
Field 1A of the CMS 1500 form requires a patient’s social security number.
When completing a CMS 1500 paper claim form which of the following is an acceptable action for the billing and coding specialist to take?
NHA practice test 1
| Question | Answer |
|---|---|
| A true statement regarding the release of patient records | Patient access to psychotherapy notes may be restricted |
| When completing a CMS-1500 claim paper form the following is an acceptable action for the billing and coding specialist to take | Use Arial size 10 font |
Health Insurance Chapter 1
| Question | Answer |
|---|---|
| If the health plan preauthorization requirements are not met by providers,.. | Payment of the Claim is denied |
| Which coding system is used to report diagnosis and conditions on claims? | ICD |
| The CPT coding system is published by the… | AMA |
| National codes are associated with… | HCPCS |
How to write a letter in special circumstances?
Take your time while writing the letter if you need it. If it helps, look up a special circumstances essay example to guide you: don’t follow it directly, but use it as a reference as you cover the situation.
What happens if you write a letter of circumstance?
Once the school receives the letter, it will look further into the situation. If the school determines that your family’s situation qualifies as a special circumstance, it will make arrangements so that you can go to school, regardless of the financial crisis.
When to use a special circumstance appeal letter?
A Special Circumstance Appeal may also be used to share ongoing circumstances not included on the FAFSA. For example, a family member with a chronic illness and high unreimbursed medical expenses would be a part of your financial situation that the FAFSA would not capture.
Which is an example of a special circumstance?
For example, a family member with a chronic illness and high unreimbursed medical expenses would be a part of your financial situation that the FAFSA would not capture. You should know that not all of these examples are considered “special circumstances” by all schools.