Blog

CPT® codes 64418 and 19380 were reported together for the injection of the supra capsular nerve with anesthetic agent (64418) with revision of a reconstructed breast (19380). The injection was denied as a bundled service. Colum1/Column2 Edits Column 1 Column 2 Effective Date Deletion Date Modifier PTP Edit Rationale 19380 64418 20090401 * 0 Standards of medical / surgical practice What is the next step for the biller? A.Resubmit corrected claim adding modifier -59 to 64418. B.Resubmit corrected claim adding modifier -51 to 64418. C.Move the charge for the bundled procedure to patient responsibility D.Write-off the charge for 64418 because it is a bundled procedure

What is “qui tam”?   A.A provision in the False Claims Act which allows a private citizen to file a lawsuit in the name of the US government. B.A provision of the False Claims Act which allows the US government to file a lawsuit on behalf of a private citizen. C.A provision of HIPAA that allows a patient the right to view their medical records. D.A provision of HIPAA that allows the US government to seize medical records at will.

What providers submit the UB-04 claim? Community Mental Health Centers (CMHCs) Emergency Department Hospice Organizations Institution based ambulance companies Outpatient rehabilitation facilities Ambulatory surgery centers   III-VI IV, VI I, III, IV, VI I-V

The following types of charges would be reported on the CMS-1500 claim form EXCEPT which?   A.Ambulatory Surgery Center (ASC) B.Observation services reported by a physician C.Inpatient services provided by a physician D.Room and board

The drug Trisenox is administered by which route?   A.Intramuscular B.Intravenous C.Inhalation D.Subcutaneous

Which of the following information is NOT required when requesting a prior authorization? A.The ordering physician B.The amount of time needed to complete the procedure C.Anticipated dates of surgery D.ICD-10-CM code(s)

Who is covered by CHAMPVA?   Veterans with service-connected disabilities and their families Active duty military and their families. Retired military and their families Active duty military over the age of 65

Transmission of claims via DSL, internet, magnetic tape, disk, or CD would be considered which of the following?   A.Attached claims submission B.Interactive claims submission C.Pushed claims submission D.Electronic claims submission

John is tasked to perform an audit on Dr. Corbel’s practice. What are the key elements John needs for the audit process on 20 records to support what Dr. Corbel is charging?   A.Patient account record, encounter form, and CMS-1500 claim form B.Patient registration form, encounter form, and CMS-1500 claim form C.Medical record, encounter form, and CMS-1500 claim form D.Medical record, day sheet, and ledger

What should happen to an account that has been determined (by the practice’s policy) to be delinquent?   A.Be written off as a bad debt. B.Be closed and no further visits scheduled for the patient. C.Be turned over to a collection agency. D.Continue to be worked by the practice’s billing office staff as time allows.