Reimbursement & Claims Processing Flashcards
6 cards from real CPC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Reimbursement & Claims Processing flashcards as text
Which claim form is used by physicians and outpatient facilities to bill Medicare Part B?
Answer: CMS-1500
The CMS-1500 claim form is the standard paper claim form used by physicians and non-institutional providers to bill Medicare Part B and most commercial insurers.
What does the term 'coordination of benefits' (COB) mean in health insurance?
Answer: A process to determine which payer pays first when a patient has multiple insurance plans
Coordination of benefits (COB) determines the order in which multiple health insurance plans pay claims so that total payments do not exceed 100% of the claim.
What is a 'clean claim' in medical billing?
Answer: A claim submitted without errors that can be processed and paid without additional information
A clean claim is one that contains all required information and can be processed for payment without additional follow-up or information from the provider.
Which Medicare term describes the amount Medicare has approved for a covered service?
Answer: Medicare Fee Schedule amount
The Medicare Fee Schedule amount (approved amount) is the maximum amount Medicare will pay for a covered service based on the Medicare Physician Fee Schedule.
What is the timely filing deadline for Medicare Part B claims?
Answer: One year (12 months) from the date of service
Medicare Part B claims must be filed within one calendar year (12 months) from the date of service to be considered timely.
A patient's insurance pays 80% of allowed charges after the deductible is met. The remaining 20% is called the:
Answer: Coinsurance
Coinsurance is the percentage of the allowed amount the patient pays after meeting the deductible, typically expressed as a percentage like 20%.