CEHRS Revenue Cycle and Billing 2

Question 1

A claim is returned to the provider because the patient's insurance ID number was entered incorrectly. This is classified as a:

Accepted Answer

Rejection

Answer

Denial

Answer

Write-off

Answer

Adjustment

Question 2

Which Medicare fee schedule is used to reimburse outpatient physical therapy services?

Accepted Answer

Resource-Based Relative Value Scale

Answer

Inpatient Prospective Payment System

Answer

Ambulatory Payment Classification

Answer

Diagnosis-Related Group

Question 3

When a provider bills a higher-complexity service than was actually performed, this is known as:

Accepted Answer

Upcoding

Answer

Unbundling

Answer

Downcoding

Answer

Balance billing

Question 4

The process of verifying a patient's insurance eligibility BEFORE the date of service is called:

Accepted Answer

Pre-verification

Answer

Pre-authorization

Answer

Pre-certification

Answer

Pre-adjudication

Question 5

A Remittance Advice (RA) from a payer showing CO-45 indicates:

Accepted Answer

The charge exceeds the fee schedule amount

Answer

The service requires prior authorization

Answer

The claim was submitted past the timely filing limit

Answer

The patient has a secondary payer

Question 6

Which of the following is the correct order of payer coordination when a patient has both Medicare and Medicaid?

Accepted Answer

Medicare pays first, then Medicaid

Answer

Medicaid pays first, then Medicare

Answer

They split the payment equally

Answer

The patient chooses which pays first

Question 7

An Advance Beneficiary Notice (ABN) must be given to a Medicare patient when:

Accepted Answer

The provider believes Medicare may deny the service as not medically necessary

Answer

The patient has a secondary insurance

Answer

The patient owes a co-payment

Answer

The claim exceeds the annual deductible