NHI Medical Office Procedures & Billing 5

Question 1

A physician sees a patient for a follow-up on hypertension and also addresses a new complaint of knee pain during the same visit. To bill both problems, the biller should use:

Accepted Answer

A single claim with multiple diagnosis codes linked to appropriate procedure codes

Answer

Multiple conditions addressed in the same visit are reported on a single claim with all relevant diagnosis codes linked to the appropriate procedure codes.

Question 2

The 'allowed amount' on an insurance payment represents:

Accepted Answer

The maximum amount the payer will reimburse for a given service

Answer

The allowed amount (also called the approved or contracted amount) is the maximum the payer will pay for a specific service under the provider's contract.

Question 3

A medical office that uses 'wave scheduling' typically:

Accepted Answer

Schedules multiple patients at the top of each hour, then none for the second half

Answer

Wave scheduling books several patients at the same start time each hour, allowing the provider to see them in order of arrival and accommodate variations in visit length.

Question 4

When a patient has both Medicare and Medicaid, Medicare is considered the:

Accepted Answer

Primary payer

Answer

Medicare is always the primary payer for patients who have both Medicare and Medicaid; Medicaid pays secondary as the payer of last resort.

Question 5

Which of the following best describes 'upcoding' in medical billing?

Accepted Answer

Intentionally billing a higher-level code than the service rendered to increase payment

Answer

Upcoding is a fraudulent billing practice where a provider intentionally bills for a more expensive service than what was actually performed.

(NHI) National Healthcareer Institute Certification Practice Test

(NHI) National Healthcareer Institute Certification Practice Test

NHI Medical Office Procedures & Billing 5