NHI Administrative Duties and Records 5 — Questions and Answers
Question 1: In the context of medical billing, what is a 'clean claim'?
- A claim submitted within 24 hours of the patient visit
- A claim free of errors that can be processed without additional information (Correct answer)
- A claim that has been audited and found to be fraud-free
- A claim submitted on paper rather than electronically
Correct answer: A claim free of errors that can be processed without additional information
A clean claim contains all required information and is free of errors, allowing the insurer to process and adjudicate it without requesting additional data.
Question 2: Which scheduling technique allows two patients to be booked at the same appointment time, with one seen by the physician and one completing intake paperwork?
- Cluster scheduling
- Stream scheduling
- Double booking (Correct answer)
- Wave scheduling
Correct answer: Double booking
Double booking places two patients in the same time slot, relying on intake procedures and staggered readiness to keep the provider productive.
Question 3: When verifying a patient's insurance eligibility, which information is most critical to confirm?
- The patient's pharmacy preference
- Coverage effective dates, deductible status, and co-pay amounts (Correct answer)
- The patient's previous surgical history
- The name of the patient's employer
Correct answer: Coverage effective dates, deductible status, and co-pay amounts
Confirming coverage dates, deductible status, and co-pay amounts ensures accurate billing and informs the patient of their financial responsibility before the visit.
Question 4: What is the correct action when a patient verbally requests changes to their demographic information at check-in?
- Update the record immediately without any verification
- Have the patient complete and sign a demographic update form (Correct answer)
- Relay the changes to the billing department only
- Wait until the next visit to update the information
Correct answer: Have the patient complete and sign a demographic update form
Patients should complete and sign a demographic update form so changes are documented and the updated information can be verified before entering it into the system.
Question 5: Which ICD code set is used in the United States for documenting diagnoses in medical records and claims?
- CPT (Current Procedural Terminology)
- HCPCS Level II
- ICD-10-CM (Correct answer)
- DSM-5
Correct answer: ICD-10-CM
ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is the US standard for coding diagnoses on claims and health records.
Question 6: A patient presents a Medicare card and a secondary insurance card. In what order should the claims be filed?
- Secondary insurance first, then Medicare
- Medicare first, then submit the secondary claim with the Medicare Explanation of Benefits (Correct answer)
- File both simultaneously to expedite payment
- Only file Medicare; secondary insurance will automatically be notified
Correct answer: Medicare first, then submit the secondary claim with the Medicare Explanation of Benefits
Medicare is filed as the primary payer first; once the Explanation of Benefits (EOB) is received, the secondary claim is filed with that EOB attached.
Question 7: What is the best practice for handling a telephone message that requires physician follow-up?
- Relay the message verbally at the end of the day
- Write the message on a sticky note and place it on the physician's desk
- Document the message in the patient's chart or EHR and route it to the physician for action (Correct answer)
- Ask the patient to call back when the physician is less busy
Correct answer: Document the message in the patient's chart or EHR and route it to the physician for action
Documenting telephone messages in the patient's chart or EHR and routing them to the physician ensures the communication is tracked, actionable, and part of the medical record.
NHI Administrative Duties and Records 5
In the context of medical billing, what is a 'clean claim'?