AHIMA Revenue Cycle Management 2

Question 1

Which claim form is required for professional/physician billing to Medicare?

Accepted Answer

CMS-1500

Answer

The CMS-1500 is the standard claim form used by non-institutional providers, including physicians, for professional billing to Medicare.

Question 2

What is the primary purpose of a Remittance Advice (RA)?

Accepted Answer

To explain payments and adjustments made by the payer

Answer

A Remittance Advice details how a payer processed and paid (or denied) a claim, including adjustment reason codes and payment amounts.

Question 3

A denial with CARC code CO-4 typically indicates:

Accepted Answer

The procedure code is inconsistent with the modifier used

Answer

CO-4 means the procedure code is inconsistent with the modifier used, or a required modifier is absent.

Question 4

What is the Medicare timely filing limit for initial claim submission?

Accepted Answer

12 months (1 year) from date of service

Answer

Medicare requires claims to be filed within one calendar year (12 months) from the date of service.

Question 5

In denial management, what does it mean to 'work' a denial?

Accepted Answer

Investigating the denial reason and taking corrective action to resolve it

Answer

Working a denial involves analyzing the reason code, gathering supporting documentation, and submitting a corrected claim or formal appeal.

(AHIMA) American Health Information Management Association Practice Test