MEDICAL BILLING CH 13 || A+ CERTIFIED.
When the Cigna appeals process has been exhausted, what happens if the provider still disagrees
with the decision? correct answers the claim goes into arbitration
CPT codes 11400 and 12031 were reported on a claim. The insurance carrier denied 12031 as
bundled with 11400. According to CPT guidelines for excision for benign lesions what action
should the biller take? correct answers appeal the claim
Which regulations require a health insurer offering group or individual coverage to implement an
effective appeals process for appeals of coverage determinations and claims? correct answers
Patient Protection and Affordable Care Act
What is the process of determining which of two or more insurance policies will have the
primary responsibility of processing a claim? correct answers Coordination of benefits
Under what Federal Act must insurance companies implement effective to appeals processes?
correct answers The Patient Protection and Affordable Care Act
A denial is received in the office indicating that a service that was billed is denied due to
bundling issues. The medical record is obtained and, upon review, it is documented that the
second procedure is a staged procedure that was planned at the time of the initial procedure.
When the claim is reviewed, no modifier was attached to the codes on the claim. What should be
done to resolve the claim? correct answers Add modifier 58 to the procedure and follow the
payer's guidelines for appeaks
According to Cigna, what is the best way to resolve claim processing errors? correct answers
contact cigna healthcare
According to Cigna's appeals process, how many levels of internal appeals are offered? correct
answers one
Which of the following modifiers will appropriately bypass the NCCI bundling edits?
I. Modifier 25
II. Modifier 52
III. Modifier 62
IV. Modifier 58 correct answers I,IV
Claim rejections are due to what? correct answers claims that do not contain necessary
information for adjudication
Which of the following can be appealed regarding a claim? correct answers coordination of
benefts
What should be done when a denial is received that states there is a global surgery package
bundling issue? correct answers Check RBRVS, CPT, and the payer's policies
When the Cigna appeals process has been exhausted, what happens if the provider still disagrees
with the decision? correct answers the claim goes into arbitration
CPT codes 11400 and 12031 were reported on a claim. The insurance carrier denied 12031 as
bundled with 11400. According to CPT guidelines for excision for benign lesions what action
should the biller take? correct answers appeal the claim
Which regulations require a health insurer offering group or individual coverage to implement an
effective appeals process for appeals of coverage determinations and claims? correct answers
Patient Protection and Affordable Care Act
What is the process of determining which of two or more insurance policies will have the
primary responsibility of processing a claim? correct answers Coordination of benefits
Under what Federal Act must insurance companies implement effective to appeals processes?
correct answers The Patient Protection and Affordable Care Act
A denial is received in the office indicating that a service that was billed is denied due to
bundling issues. The medical record is obtained and, upon review, it is documented that the
second procedure is a staged procedure that was planned at the time of the initial procedure.
When the claim is reviewed, no modifier was attached to the codes on the claim. What should be
done to resolve the claim? correct answers Add modifier 58 to the procedure and follow the
payer's guidelines for appeaks
According to Cigna, what is the best way to resolve claim processing errors? correct answers
contact cigna healthcare
According to Cigna's appeals process, how many levels of internal appeals are offered? correct
answers one
Which of the following modifiers will appropriately bypass the NCCI bundling edits?
I. Modifier 25
II. Modifier 52
III. Modifier 62
IV. Modifier 58 correct answers I,IV
Claim rejections are due to what? correct answers claims that do not contain necessary
information for adjudication
Which of the following can be appealed regarding a claim? correct answers coordination of
benefts
What should be done when a denial is received that states there is a global surgery package
bundling issue? correct answers Check RBRVS, CPT, and the payer's policies
