CBCS Billing and Claims Submission 3

Question 1

What modifier is used to indicate that a procedure was performed on both sides of the body (bilateral)?

Accepted Answer

-50

Answer

-51

Answer

-59

Answer

-76

Question 2

What does the 837P electronic transaction format represent?

Accepted Answer

Electronic claim transaction for professional (physician) services submitted to payers

Answer

Electronic remittance advice from payer to provider

Answer

Electronic eligibility verification inquiry

Answer

Electronic prior authorization request

Question 3

What is a clearinghouse in medical billing?

Accepted Answer

An intermediary company that receives electronic claims from providers, checks them for errors, reformats them to payer specifications, and transmits them to payers

Answer

A federal agency that reviews and approves Medicare claims

Answer

A secure facility where paper claims are processed

Answer

A software tool that checks claims against NCCI edits before submission

Question 4

When a claim is rejected vs. denied, what is the key difference?

Accepted Answer

Rejected claims were never processed due to errors (missing data, invalid codes); denied claims were processed but not paid for a coverage or policy reason

Answer

Rejected claims have been processed by the payer and denied for a clinical reason; denied claims were never entered into the payer's system

Answer

Rejected claims can be resubmitted; denied claims cannot be appealed

Answer

There is no difference — rejection and denial are interchangeable terms

Question 5

What is an electronic data interchange (EDI) in healthcare billing?

Accepted Answer

The computer-to-computer exchange of standard business documents (claims, eligibility, remittance) between trading partners in a standard format

Answer

A database of payer fee schedules accessible by providers

Answer

An encryption method for protecting PHI during transmission

Answer

A real-time insurance verification tool for patient check-in

Question 6

What is the purpose of using Modifier -25 on a claim?

Accepted Answer

To indicate that a significant and separately identifiable E/M service was performed on the same day as a procedure

Answer

To indicate a procedure was performed on multiple wounds at the same operative session

Answer

To indicate that a service was performed by a different provider than usually performs the service

Answer

To indicate a procedure was discontinued before completion