FREE CBCS Billing and Coding Basics Questions and Answers
In which scenario would the Coordination of Benefits (COB) provision be applied?
COB is relevant when an insured person has multiple health insurance policies. It coordinates the payment of claims among these policies to ensure that the total reimbursement does not exceed the medical expenses incurred.
What is a key eligibility requirement for TRICARE coverage?
Eligibility for TRICARE coverage is primarily based on military service status. Active duty members, retirees, and their dependents are eligible for TRICARE benefits. It does not require federal employment or Medicaid enrollment.
Which federal program uses the Prospective Payment System (PPS) to reimburse hospitals?
Medicare uses the Prospective Payment System (PPS) to determine hospital reimbursements. Understanding this system is vital for billing professionals who work with Medicare claims.
What is the CMS-1500 claim form primarily used for?
The CMS-1500 claim form is primarily used by healthcare providers to bill Medicare and Medicaid, as well as many private insurance companies, for outpatient and professional services.
What information is typically recorded in an audit trail?
An audit trail typically records dates and times of record access, user IDs of individuals who accessed the records, and the actions performed (such as viewing, modifying, or deleting records). This detailed information helps maintain data integrity and accountability.