edOpp: Claim Control

Froggy Jumps

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NHA CEHRS Coding knowledge check.

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RNPRPEPBESTIE

United States

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edOpp: Claim Control


Froggy Jumps edOpp: Claim ControlOnline version NHA CEHRS Coding knowledge check. by RNPRPEPBESTIE 1 A provider removes a skin lesion during an office visit. The medical assistant must code the service performed. Which code set should be used? a CPT b HCPCS c ICD-10-CM 2 A nurse records blood pressure, pulse, and temperature in a structured table within the EHR. Where is this information documented? a Discharge summary b Narrative progress note c Flowsheet 3 A claim is denied because the diagnosis does not justify the procedure billed. What requirement was not met? a Medical necessity linkage b Eligibility verification c Fee schedule accuracy 4 Two CPT codes are billed together, but only one is reimbursed because the other is bundled. Which standard explains this outcome? a National Correct Coding Initiative (NCCI) b HIPAA c Electronic Data Interchange (EDI) 5 Insurance coverage is verified instantly when the patient checks in. What type of eligibility verification is this? a Retrospective b Real-time c Secondary 6 A patient is injured on the job and requires imaging. Payment depends on employer coverage and a provider order. Which reimbursement system applies? a Workers’ compensation b Medicare c Medicaid 7 Claims are sent electronically using standardized formats between the EHR and the payer. What process allows this exchange? a Clearinghouse scrubbing b Data encryption c Electronic Data Interchange (EDI) 8 An insurer requires approval before a scheduled MRI can be performed and billed. What must be obtained and documented? a Prior authorization b Referral c Remittance advice 9 A patient asks for an estimate of out-of-pocket costs before a procedure. What is primarily used to calculate this estimate? a Guarantor information b Fee schedule c Explanation of Benefits (EOB) 10 A payment receipt total does not match the patient account balance in the EHR. What process should be completed next? a Balance reconciliation b Claim resubmission c Charge reconciliation 11 After insurance processes a claim, a document explains payments, adjustments, and denials. What document is this? a Explanation of Benefits (EOB) b Superbill c Encounter form 12 During an EHR system outage, claims cannot be transmitted electronically. What should staff follow until systems are restored? a Downtime procedures b Batch posting rules c Clearinghouse workflows 13 A parent signs an agreement to pay charges not covered by insurance. How is this person identified in the EHR? a Guarantor b Policyholder c Subscriber 14 An error is identified in a signed EHR note. The correction is dated, timed, and traceable. What does this protect? a Legal integrity of the record b Audit trail c Coding accuracy 15 A tissue sample is collected during surgery and sent to pathology for analysis. What term refers to the sample itself? a Culture b Specimen c Biopsy

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edOpp: Claim Control

Froggy Jumps

About this activity

Created by

Download the paper version to play

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edOpp: Claim ControlOnline version

by RNPRPEPBESTIE

A provider removes a skin lesion during an office visit. The medical assistant must code the service performed. Which code set should be used?

A nurse records blood pressure, pulse, and temperature in a structured table within the EHR. Where is this information documented?

A claim is denied because the diagnosis does not justify the procedure billed. What requirement was not met?

Two CPT codes are billed together, but only one is reimbursed because the other is bundled. Which standard explains this outcome?

Insurance coverage is verified instantly when the patient checks in. What type of eligibility verification is this?

A patient is injured on the job and requires imaging. Payment depends on employer coverage and a provider order. Which reimbursement system applies?

Claims are sent electronically using standardized formats between the EHR and the payer. What process allows this exchange?

An insurer requires approval before a scheduled MRI can be performed and billed. What must be obtained and documented?

A patient asks for an estimate of out-of-pocket costs before a procedure. What is primarily used to calculate this estimate?

A payment receipt total does not match the patient account balance in the EHR. What process should be completed next?

After insurance processes a claim, a document explains payments, adjustments, and denials. What document is this?

During an EHR system outage, claims cannot be transmitted electronically. What should staff follow until systems are restored?

A parent signs an agreement to pay charges not covered by insurance. How is this person identified in the EHR?

An error is identified in a signed EHR note. The correction is dated, timed, and traceable. What does this protect?

A tissue sample is collected during surgery and sent to pathology for analysis. What term refers to the sample itself?