NHA Domain 2 Review

Front

A minor patient, whose parents are married, is covered under both parent’s group insurance plans and also has Medicaid benefits. Parent A has a birthdate of June 6 1988 and Parent B has a birthdate of October 23, 1987. Which of the following third party payers should be billed as the primary? Options: Parent A's Insurance, Parent B's insurance, Medicaid, Either parent A’s or parent B’s insurance

Back

Parent A's Insurance

Answer explanation

According to the birthday rule, which states the parent whose birthday comes first in the calendar year is the primary, parent A's insurance would be billed as the primary.

Front

A billing and coding specialist is reviewing the patient’s record. The specialist should recognize that which of the following should be signed by the patient if there is a concern that Medicare might not pay for the service? Options: Informed consent form, Advanced Beneficiary Notice (ABN), Patient referral authorization form, Notice of Privacy Practices (NPP)

Back

Advanced Beneficiary Notice (ABN)

Answer explanation

The ABN form informs the patient of services that might not be covered under Medicare.

Front

A billing and coding specialist is preparing a claim for a 69-year-old patient who was involved in a motor-vehicle crash. The specialist should submit the primary claim to which of the following third-party providers? Options: Medicare, Medicaid, Private Insurance, Auto Insurance

Back

Auto Insurance

Answer explanation

Auto insurance is primary coverage for medical expenses due to a motor-vehicle crash

Front

A billing and coding specialist is reviewing insurance eligibility for a 49-year-old patient who has end stage renal disease and multiple third party payers. The specialist should recognize that which of the following payers is the primary? Medicare, Medicaid, TRICARE, Worker's Compensation

Back

Medicare

Answer explanation

A patient who is under the age of 65 years old and has a qualifying disability or end-stage renal disease is eligible for primary coverage through Medicare even though they have not met the usual starting age of 65

Front

A billing and coding specialist is calculating a patient’s financial responsibility for a procedure. The charge for the procedure is 1400 and the provider is in the patient’s insurance provider network. The allowable amount for the procedure is 500 with no deductible required. If the insurance plan pays at 80/20, what is the patient’s total coinsurance amount?

Back

$100

Answer explanation

For a patient who has an 80/20 insurance plan, the patient will pay a coinsurance of 20% of the allowable amount. This is calculated as follows: $500 x 20% (0.20) = $100. Therefore, the patient's coinsurance is $100 for an 80/20 plan

Front

A billing and coding specialist is reviewing a patient’s insurance coverage and notices that the patient is covered by two group insurance plans: one through their own employer and one through their partner’s employer. The specialist should recognize that which of the following is true regarding the client’s primary insurance coverage?

Back

Primary coverage is provided through the patient’s plan

Answer explanation

The patient's own plan is primary while the patient's partner's plan is secondary.

Front

A billing and coding specialist is preparing the registration for a patient who is covered under their spouses insurance. Which item is required to complete the registration? Options: Patient demographics, Credit card, Spouses Social Security Number, Work History

Back

Patient demographics

Answer explanation

Patient demographics are required and obtained during the registration process.

Front

A patient fell and was injured while picking up a catering order during their break for an all-employee staff meeting. Which third-party payer is responsible for this encounter? Options: Auto Insurance, Worker's Compensation, Homeowner's Insurance, Group Health Plan

Back

Worker's Compensation

Answer explanation

Workers' compensation covers an employee who is injured or becomes ill on the job,

Front

A billing and coding specialist is submitting a claim for a patient who experienced an injury from a fall during their lunch break away from the building. Which is the correct primary payer for the claim? Options: The patient’s group health insurance plan, Disability insurance, Out of pocket patient payment, Worker’s compensation

Back

The patient’s group health insurance plan

Answer explanation

The patient's group health insurance would be the primary payer for a claim for an illness or injury of a patient.

Front

A billing and coding specialist is preparing a claim for a 16 year old patient. Which of the following should be contacted to verify the child’s demographics? The child's school, Policyholder, Third party payer, Patient

Back

Policyholder

Answer explanation

A policyholder is a person who has entered into a contract with an insurance plan and would be the appropriate contact for a patient who is a minor.