CHAA CHAA Denial Management and Claims Processing 3

Question 1

What is the role of patient access staff in preventing authorization-related denials?

Accepted Answer

To obtain required prior authorizations from payers before scheduled services are rendered

Answer

To code diagnoses after service

Answer

To process claims after discharge

Answer

To negotiate payer contracts

Question 2

Which claim form is most commonly used to bill professional (physician) services to Medicare and most other payers?

Accepted Answer

CMS-1500

Answer

UB-04

Answer

ADA Dental Claim Form

Answer

HCFA-1450

Question 3

Which claim form is used to bill inpatient hospital and institutional outpatient services?

Accepted Answer

UB-04 (CMS-1450)

Answer

CMS-1500

Answer

ADA Claim Form

Answer

837P

Question 4

What is the National Provider Identifier (NPI) and why is it required on claims?

Accepted Answer

A unique 10-digit identification number assigned to healthcare providers, required on all HIPAA-covered claim transactions

Answer

A state-issued medical license number

Answer

A Medicare beneficiary identification number

Answer

A hospital accreditation code

Question 5

What action should patient access staff take when a payer requests additional documentation to process a claim?

Accepted Answer

Promptly gather and submit the requested documentation within the payer's specified timeframe

Answer

Ignore the request and wait for the claim to auto-adjudicate

Answer

Immediately write off the claim balance

Answer

Rebill the claim with different procedure codes

Question 6

What does the term 'medical necessity denial' mean?

Accepted Answer

A denial issued when the payer determines the service was not medically necessary based on clinical criteria

Answer

A denial because the patient did not have insurance

Answer

A denial due to incorrect patient demographics

Answer

A denial because the claim was filed after the timely filing deadline