NHA - Certified Billing and Coding Specialist (CBCS) Study Guide

A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by obtaining what? - Precertification A claim can be denied or rejected for which of the following reasons? - Block 24D contains the diagnosis code A coroner's autopsy is comprised of what examinations? - Gross Examination A patient's health plan is referred to as the "payer of last resort." What is the name of that health plan? - Medicaid Abstracting - The extraction of specific data from a medical record, often for use in an external database, such as a cancer registry. Abuse - Practices that directly or indirectly result in unnecessary costs to the Medicare program. Account Number - Number that identifies specific episode of care, date of service, or patient. Accounts Receivable Department - Department that keeps track of what third-party payers the provider is waiting to hear from and what patients are due to make a payment. Advance Beneficiary Notice of Noncoverage - Form provided if a provider believes that a service may be declined because Medicare might consider it unnecessary. Aging Report - Measures the outstanding balances in each account. Allowable Charge - The amount an insurer will accept as full payment, minus applicable cost sharing. Ambulatory surgery centers, home health care, and hospice organizations use which form to submit claims? - UB-04 Claim Form APC Grouper - Helps coders determine the appropriate ambulatory payment classification (APC) for an outpatient encounter.