27 Oct What does the denial code CO mean

Question 373 pts

What does the denial code CO mean?

Group of answer choices

Contractual Obligation

Other Adjustment

Patient Responsibility

 Payer-initiated adjustments

Flag question: Question 38Question 383 pts

 

 

 

It is rare, but the external independent review may occur at the same time as an internal review when the appeal concerns urgent care.

 

Group of answer choices

 

True

 

 

 

False

 

 

 

 

 

Flag question: Question 39Question 393 pts

 

 

 

Remittance Advice (RA), also known as

 

Group of answer choices

 

ICD-10 Form

 

 

 

CMS1500

 

 

 

Explanation of Benefits

 

 

 

Electronic remittance advice (ERA)

 

 

 

 

 

Flag question: Question 40Question 403 pts

 

 

 

From the insurance company, all the following are included along with the denial of a claim EXCEPT:

 

Group of answer choices

 

A reason the claim was denied

 

 

 

Acknowledgment on the right to request an external review if the internal review was unsuccessful

 

 

 

Acknowledgment of the right to an internal appeal

 

 

 

The patient’s PHI

 

 

 

 

 

Flag question: Question 41Question 413 pts

 

 

 

All the following are true in the appeals process EXCEPT:

 

Group of answer choices

 

If the appeal concerns urgent care, the payer must respond within 24 hours of receiving the request.

 

 

 

If the appeal concern is non-urgent care not yet received the payer has 30 days to respond.

 

 

 

If the appeal concerns urgent care, the payer must respond within 72 hours of receiving the request.

 

 

 

If the appeal concern is for services already received the payer has 60 days to respond.

 

 

 

 

 

Flag question: Question 42Question 423 pts

 

 

 

There is no variation in the Patient Refund process. It has a strict policy that all healthcare providers must follow.

 

Group of answer choices

 

True

 

 

 

False

 

 

 

 

 

Flag question: Question 43Question 433 pts

 

 

 

First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid “Coinsurance 20% of Allowed Amount” Patient Responsibility

James Weaver Cigna 99203-Evaluation & Management, new patient $ 205.00 $ 205.00 $ – $ 20.00 $ ___?____ $ –  

Insurance Paid: $ 

 

 

 

 

 

 

 

Flag question: Question 44Question 443 pts

 

 

 

First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid “Coinsurance 20% of Allowed Amount” Patient Responsibility

Jen Jones Aetna 99215-Evaluation & Management, established patient $ 175.00 $ 150.00 $ 55.00 $ – $ 76.00 $ ___?____

Patient Responsibility is: $

 

 

 

 

 

Flag question: Question 45Question 453 pts

 

 

 

First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid Coinsurance 20% of Allowed Amount is: $ Patient Responsibility

Juan Ramos Medicaid 71010-Chest x-ray, 1 view $ 130.00 $ 100.00 $ – $ 25.00 $ ___?____ $ 40.00

Insurance Paid is: $

 

 

 

 

 

 

 

Flag question: Question 46Question 463 pts

 

 

 

First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid Coinsurance 20% of Allowed Amount Patient Responsibility

Juan Ramos Medicaid 71010-Chest x-ray, 1 view $ 130.00 $ 100.00 $ – $ 25.00 $ ____?____ $ 40.00

Coinsurance 20% of Allowed Amount is: $

 

 

 

 

 

Flag question: Question 47Question 473 pts

 

 

 

First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid “Coinsurance 20% of Allowed Amount” Patient Responsibility

Owen Hermit Medicare 66984-Cartract Extraction, Surgical $ 1,250.00 $ 656.27 $ – $ – $ 525.02 $ 131.25 $ ____?_____

Patient Responsibility is: $

 

 

 

 

 

Flag question: Question 48Question 483 pts

 

 

 

First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid Coinsurance 20% of Allowed Amount Patient Responsibility

Jen Jones Aetna 99215-Evaluation & Management, established patient $ 175.00 $ 150.00 $ 55.00 $ – $ 76.00 $ ____?_____  

Coinsurance 20% of Allowed Amount: $

 

 

 

 

 

 

 

Flag question: Question 49Question 493 pts

 

 

 

First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid Coinsurance 20% of Allowed Amount Patient Responsibility

Pedro Tanner BCBS 99291-Critical Care first 30 Minutes $ 375.00 $ 270.00 $ 100.00 $ – $ 136.00 $ ____?_____ $ 134.00

Coinsurance 20% of Allowed Amount is: $

 

 

 

 

 

Flag question: Question 50Question 503 pts

 

 

 

First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid “Coinsurance 20% of Allowed Amount” Patient Responsbility

James Weaver Cigna 99203-Evaluation & Management, new patient $ 205.00 $ 205.00 $ – $ 20.00 [G] $ – $ ____?____