CHAA CHAA Denial Management and Claims Processing 1

Question 1

What is a claim denial in the context of healthcare revenue cycle?

Accepted Answer

When a payer refuses to reimburse a submitted claim fully or partially

Answer

When a patient refuses treatment

Answer

When a provider cancels an appointment

Answer

When a patient's copay is waived

Question 2

Which type of denial can be corrected and resubmitted by the provider?

Accepted Answer

Soft denial (or correctable denial)

Answer

Hard denial

Answer

Final denial

Answer

Contractual denial

Question 3

What is a 'hard denial' in claims management?

Accepted Answer

A denial that is final and cannot be overturned without a formal appeal

Answer

A denial that can be resolved with additional documentation

Answer

A denial due to a missing authorization number

Answer

A denial caused by incorrect patient demographics

Question 4

Which denial root cause originates in the patient access department due to missing or incorrect information at registration?

Accepted Answer

Front-end denial

Answer

Clinical denial

Answer

Back-end denial

Answer

Contractual adjustment

Question 5

What does 'timely filing' mean in the context of claim submission?

Accepted Answer

Submitting claims to the payer within the contractually specified deadline after service

Answer

Submitting claims in alphabetical order

Answer

Filing annual tax returns for the hospital

Answer

Completing pre-authorization before service

Question 6

A claim is denied due to 'duplicate billing.' What does this mean?

Accepted Answer

The patient was billed twice for the same service within the same billing cycle

Answer

The claim contained incorrect diagnosis codes

Answer

The provider was not in-network

Answer

The service was not medically necessary