AAPC Denial Management & Appeals 3

Question 1

What is the primary goal of tracking a practice's denial rate as a key performance indicator (KPI)?

Accepted Answer

To measure the percentage of claims denied and identify trends to reduce future denials

Answer

Monitoring the denial rate helps practices identify patterns in denials, address root causes, and implement process improvements to reduce revenue loss.

Question 2

Which of the following actions best prevents 'authorization not obtained' denials?

Accepted Answer

Verifying and obtaining prior authorization before services are rendered

Answer

Proactively verifying prior authorization requirements and obtaining approval before rendering services is the most effective prevention for authorization-related denials.

Question 3

A claim is denied because the rendering provider's NPI is not on file with the payer. What should the biller do?

Accepted Answer

Contact the payer to credential/enroll the provider and then resubmit the claim

Answer

When a provider's NPI is not recognized by the payer, the biller should work with the payer to complete credentialing or enrollment, then resubmit the claim once the provider is on file.

Question 4

What is the significance of tracking the 'days in AR' (accounts receivable) metric in denial management?

Accepted Answer

It measures the average number of days it takes to collect payment after a claim is submitted

Answer

Days in AR measures the average time between claim submission and payment receipt, and a high number often signals denial or follow-up issues that are delaying revenue collection.

Question 5

When a payer's remittance advice shows an OA-23 adjustment reason code, what does this mean?

Accepted Answer

The amount is not covered by Medicare; this is a Medicare Secondary Payer situation

Answer

OA-23 indicates that the payment was adjusted because Medicare is the secondary payer, meaning another insurance is primary and Medicare's payment reflects that coordination.

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

AAPC Denial Management & Appeals 3