Question

ULIUn information The first step in filing a claim with a third-party is a. verify all charges and fees. b. proof read the claim information. c. complete the precertification process. d. obtain accurate billing information from the patient. 30. Patients belonging to a MCO usually are required to get a referral from their_ before seeing a specialist a. HMO b. EPO с. РСР d. CMS Which of the following methods can be used to determine a patient's eligibility for insurance a. Calling the provider services number on the back of the health insurance ID b. Using the provider web portal sponsored by the patient's health insurance company c. Both A and B d. None of the above 32. Which of the following steps is needed to obtain precertification? a. Call provider services phone number on the back of the patient's health insurance ID card. b. Provide the insurance company with procedures/services requested and the diagnoses. c. Document the outcome of the call in the patient's health record. d. All of the above 33. Patient care approached from a holistic approach defines a. Health Maintenance Organizations. b. Patient-Centered Medical Home. c. precertification. d. medical necessity. 34. Abuse is knowingly and willfully executing or attempting to execute a scheme to defraud any healthcare benefit program. Fraud is an unintended action that results in an overpayment to the healthcare provider. a. Both statements are true. b. Both statements are false. c. The first statement is true and the second statement is false. d. The first statement is false and the second statement is true. 35. If the ICD-10-CM codes and the CPT/HCPCS codes do not match the claim will not show a. eligibility b. precertification

Answer 1

29) The correct option is c) complete the precertification process is the first step in filling up a claim for third party because it provides the details about what all services is taken by the patient based on which claim will be provided .

30) The correct option is a) HMO . Health maintenance organisation . Pateints belonging to a MCO usually are required to get a referral from their HMO before seeing specialist.

31) The correct option is c) Bothe A) and B)

32) The correct option is b) provide the insurance company with procedure / services requested and the diagnosis . This is the important step needed before precertification .