Duke HB Feb-16 monthly test

1.

1 point

POS 34 used for?

Urgent care

Ambulatory surgical center

Skilled nursing facility

None of the above

2.

1 point

What is condition code D7 used for?

Change in DX or CPT codes

Change in revenue codes

Changes in charges

Change to make MCR the secondary payer

3.

1 point

What is the use of taxonomy codes?

To identify the provider group

For requesting the Authorization for specific doctor

To change the provider credentials

None of the above

4.

1 point

Modifier 57 used for?

Follow-up care only

Anesthesia by Surgeon

Decision for Surgery

None of the above

5.

1 point

DOB change requests should go to.

PRMO

HIM

Registration

Internal Biller

6.

1 point

On claims billed with UD Modifier on drug codes for Medicaid, Medicaid would deny these claims as CO45/CO16. In this case we will bill write off the charges as non-payable.

True

False

7.

1 point

What is the activity code used when forwarding the secondary Medicaid claims for coding review

204

444

451

365

8.

1 point

All the coding changes done from duke as well as internal coding team and suggesting us to refile the Claim, Need to refile without using the previous claim data

True

False

9.

1 point

If there is any take-back or offset involved in the accounts, what will be the next action?

Move to PRMO

Move to supervisor for review

Place in spreadsheet

Adjust the charges

10.

1 point

The GW modifier is used when a physician is providing a service that is not related to the diagnosis for which a patient has been enrolled into hospice

True

False

11.

1 point

Combining accounts cannot be performed on?

In-patient to In-patient

In-patient to Out-patient

Out-Patient to Out-patient

Out-patient to In-patient

12.

1 point

Secondary Medicaid denied as no auth (N175) and service is related to labor and delivery need to

Append U2 modifier and refile

Tickle for 90 days

Move to PRMO assistance

Adjusted as no authorization

13.

1 point

Aetna MCR denied the claim and User calls payer : As per rep claim denied for COB and letter sent to patient from payer side recently to update the COB information, Also rep suggest to allow 15 days for FU for the patient to respond. What will be the next action?

Bill Patient

Move it to Registration department

Send letter to patient to update the COB information

Tickle the account for 15 days FU

14.

1 point

If partial payment is recouped stating Member Out-Of-Pocket maximum has been met and payment is based on provider’s agreement. Need to adjust the charges as Contractual

True

False

15.

1 point

Revenue code 0513 used as

Cardiology Visit

Psychiatric Clinic Visit

Stress Test

General Classification Visit