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

A rejection occurs before adjudication when a claim has technical errors such as incorrect ID numbers and must be corrected and resubmitted.

Question 2

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

Accepted Answer

Resource-Based Relative Value Scale

Answer

The Resource-Based Relative Value Scale (RBRVS) is used by Medicare to set payment rates for physician and outpatient therapy services.

Question 3

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

Accepted Answer

Upcoding

Answer

Upcoding is the fraudulent practice of billing for a more expensive service than was rendered, inflating reimbursement.

Question 4

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

Accepted Answer

Pre-verification

Answer

Pre-verification (eligibility verification) confirms coverage, co-pays, and deductibles before the patient arrives for care.

Question 5

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

Accepted Answer

The charge exceeds the fee schedule amount

Answer

CO-45 is a CARC (Claim Adjustment Reason Code) indicating the charge exceeds the contracted fee schedule or maximum allowable amount.

(CEHRS) Certified Electronic Health Records Specialist Practice Test