Medical Coding and Billing: Exam Questions and Complete Answers

HIPAA Standards and Protected Health Information

What is Protected Health Information? It consists of Individually Identifiable Information. Within the healthcare system, there are Permitted uses and disclosures of PHI, which distinguish between PHI Use vs Disclosure and require a HIPAA Valid Authorization. Incidental Uses and Disclosures can occur, and there are specific examples of incidental uses and disclosures in clinical settings.

To maintain security, Using data encryption software on office workstations is which of the following privacy measures ensures protected health information (PHI). According to HIPAA Standards, the NPI (National Provider Identifier) identifies the rendering provider on the CMS 1500 claim form in Block 24J.

Insurance Policies and Claim Adjudication

The National Coverage Determination (NCD) is which of the following Medicare policies determines if a particular item or service is covered by Medicare. Once a claim is processed, Adjudication is considered the final determination of the issues involving settlement of an insurance claim. Regarding financial management, the Coordination of Benefits is which of the following provisions ensures that an insured's benefits from all insurance companies do not exceed 100% of allowable medical expenses.

For delinquent accounts, you should Verify the age of the account as which of the following actions should be taken first when reviewing a delinquent claim. While Claims are expedited as an advantage of electronic claim submission, The claim requires an attachment indicates a claim should be submitted on paper instead of electronically. Additionally, the Claim control number is which of the following components of an explanation of benefits expedites the process of a phone appeal.

Clinical Documentation and the CMS 1500 Form

Documentation is vital; the Encounter Form is a form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information. When a patient arrives, the Admitting clerk is the hospital staff member responsible for the initial patient interview, obtaining demographic and insurance information and documenting the chief complaint. For accuracy, a Coding Compliance Plan includes procedures and best practices for correct coding. It is important to note that Billing for services not provided is considered fraud.

When completing a CMS 1500 form, it is an acceptable action for the billing and coding specialist to Use Arial size 10 font. Blocks 14 through 33 show the patient's condition and the provider's information. The following data outlines specific block requirements for the CMS 1500 form:

• Block 20: Outside Lab
• Block 21: Diagnosis or nature of illness or injury in CMS 1500
• Block 23: Prior Authorization Number in CMS 1500
• Block 24A: Dates of Services in CMS 1500
• Block 24B: Place of Service in CMS 1500
• Block 24D: Procedures, Services or Supplies in CMS 1500
• Block 24E: Diagnosis Pointer in CMS 1500
• Block 24F: Charges in CMS 1500
• Block 24G: Days or Units in CMS 1500
• Block 24J: Rendering Provider ID # in CMS 1500
• Block 25: Federal Tax I.D. Number / SSN / EIN in CMS 1500
• Block 26: Patient's Account Number in CMS 1500
• Block 27: Accept Assignment in CMS 1500
• Block 31: Signature of the Physician in CMS 1500
• Block 32: Service facility location information in CMS 1500

In terms of medical terminology, the Sagittal plane divides the body from left and right. Familiarity with the Medicare summary notice (MSN) and various claim forms of info needed for a claim account number is essential for professional practice.