CCS Billing, Reimbursement, & Insurance Policies 2

Question 1

Which Medicare claim form is used to submit outpatient hospital facility claims?

Accepted Answer

UB-04 (CMS-1450)

Answer

CMS-1500

Answer

ADA Dental Claim Form

Answer

TRICARE Standard Form

Question 2

Under the Outpatient Prospective Payment System (OPPS), payment is based on which grouping unit?

Accepted Answer

Ambulatory Payment Classification (APC)

Answer

Diagnosis Related Group (DRG)

Answer

Resource-Based Relative Value Scale (RBRVS)

Answer

Per Diem Rate

Question 3

A claim is denied due to a 'coordination of benefits' issue. What does this mean?

Accepted Answer

The patient has more than one insurance plan and payer order is disputed

Answer

The patient has exceeded their annual deductible

Answer

The provider is not in the payer's network

Answer

The diagnosis code does not support medical necessity

Question 4

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

Accepted Answer

To explain how a claim was processed and what was paid or denied

Answer

To authorize a procedure before it is performed

Answer

To notify a patient of their financial responsibility

Answer

To request additional clinical documentation from the provider

Question 5

Which federal law prohibits offering, paying, soliciting, or receiving anything of value to induce or reward referrals of federal health care program business?

Accepted Answer

Anti-Kickback Statute (AKS)

Answer

HIPAA

Answer

False Claims Act

Answer

Stark Law

Question 6

A patient's claim is returned as 'unprocessable.' What is the most likely reason?

Accepted Answer

Required fields such as subscriber ID or NPI are missing or invalid

Answer

The claim was filed after the timely filing deadline

Answer

The procedure is not covered under the patient's plan

Answer

The patient owes a prior balance