GetMarked_Quiz_Import – Coastal Medical Training Institute LLC

Which of the following resources is used to understand Medicare coverage circumstances such as indications and coding guidance?

NCD articles

NCCI edits

Mutually exclusive edits (MUE)

Alternative payment model (APM)

A billing and coding specialist is reviewing a remittance advice that has a remark code that indicates a claim is pended for review of medical records. Which of the following actions should the specialist take?

Send the requested medical records to the third-party payer.

Resubmit the claim to the third-party payer as a corrected claim.

Notify the third-party payer to review the claim for payment.

Advise the patient they will be responsible for the charges not covered.

Which scenario eliminates the need for prior authorization?

The patient had already been admitted to the hospital.

The patient required an emergency procedure.

The patient received an elective procedure.

The patient is a Medicare beneficiary.

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