When is it appropriate to file a patient

Question 1

1. HCPCS is a multilevel coding system that contains _________ levels.1

   2

   3

   4

2 points

Question 2

1. CPT-4 is published annually byAMA

   CMS

   WHO

   Medicare

2 points

Question 3

1. CPT index terms that are printed in boldface are calleddescriptors

   essential modifiers

   main terms

   subterms

2 points

Question 4

1. An example of a supplemental insurance plan isCHAMPUS

   Medicaid

   Medigap

   TRICARE

2 points

Question 5

1. The Medicare physician fee schedule amount for code 99213 is $100. Calculate the nonPAR allowed charge.$20

   $80

   $95

   $102.25

2 points

Question 6

1. The purpose of the creation of HCPCS codes was to furnish health care providers with a :mandate to use electronic claims submission

   method for obtaining higher reimbursement from Medicare.

   standardized language for reporting professional services, procedures, supplies, and equipment.

   standardized way of reporting inpatient and outpatient diagnoses.

2 points

Question 7

1. Medicare participating providers commonly report actual fees to Medicare but adjust fees after payment is received. The difference between the fee reported and the payment received is afee adjustment

   limiting charge

   neutral charge

   write-off

2 points

Question 8

1. Nonparticipating (nonPAR) providers are restricted to billing at or below thefee-for-service

   limiting charge

   physician fee schedule

   relative value scale

2 points

Question 9

1. Modifiers are used with HCPCS codes tochange the original description of the service, procedure, or supply item.

   decrease payment from Medicare.

   increase payment from Medicare.

   provide additional information regarding the product or service identified.

2 points

Question 10

1. When is it appropriate to file a patient’s secondary insurance claim?after a copy of the explanation of benefits is received by the practice

   after the explanation of benefits is received by the patient

   after the remittance advice is received by the medical practice

   at the same time the primary insurance claim is filed, if the primary and secondary payers are different

2 points

 

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